No ‘snowflakes’: mental health review says today’s youth have it harder and harms are real

Peter Fonagy lauds courage of young people and warns of consequences of rising prevalence of mental illness

Full report | NHS at risk of ‘system failures’ as demand for ADHD and autism care soars, inquiry finds

Explainer | What has the Fonagy review found and what does it recommend?

Eighteen months ago, in an off-the-cuff remark during a discussion on disability benefit cuts, Wes Streeting said mental health conditions were being “overdiagnosed”, riding headlong into another culture war.

Prof Peter Fonagy’s mammoth review of mental health conditions, autism and ADHD in England, commissioned by Streeting nine months ago, has no truck with the snowflake generation caricature: the steep rise in the prevalence of mental health problems such as anxiety and depression is real, he says, and so is the distress and difficulties they can cause.

double quotation markI am in awe of their courage. Young people are contending with more powerful forces than I ever faced

The review says the drivers of this rise are cultural and social. Young people are exposed to Covid disruption, financial and housing insecurity, and competitive school and social stresses that are exacerbated by social media. Support services, from Sure Start to youth clubs, have been swept away. There is less belonging, it says, and more loneliness.

Sceptics may yearn for a mythical time when troubled young people just had to pull their socks up, fit in and learn to deal with life’s inevitable hard knocks. Fonagy makes clear the past is another country and you cannot rewind the clock. “Simple answers are rarely adequate,” he writes.

The review is frustrated by the public debate’s focus on whether there is too much or too little diagnosis. There is a risk of overdiagnosis, Fonagy admits (though he says there is no evidence it is happening at scale), and he is scathing about the growth and reliability of unregulated private providers of diagnostic assessments.

Fonagy’s solution is to reduce the heavy reliance on diagnosis (NHS diagnosis waiting times are 64 weeks). An individual’s needs should be identified and triaged early with the goal of ensuring they swiftly get the support they need.