England urged to rethink mental health, ADHD and autism support

The final report, published by the Department of Health and Social Care on October 9, concludes that the current system is unsustainable and recommends moving to what it calls a “needs-led plus diagnosis” model. The review was chaired by Professor Peter Fonagy, with Professor Sir Simon Wessely and Professor Gillian Baird serving as vice-chairs. The government launched it in December 2025, and an interim report followed in June 2026.

According to the review, England faces two simultaneous failures: people wait far too long for support, assessment and treatment, and diagnosis has become the main route to help that could be offered earlier. The authors argue that support should be available according to a person’s needs before, during and after assessment rather than being withheld until a diagnosis is confirmed.

The report finds that mental distress has risen substantially, particularly among young people. The share of adults aged 16 to 64 meeting the criteria for a common mental disorder, such as anxiety or depression, climbed from 15.5% in 1993 to 22.6% in 2024. Among 16- to 24-year-olds, the figure rose from about one in six to one in four, with young women now reporting the highest rates of any group. By contrast, rates of severe mental illness such as schizophrenia and bipolar disorder have remained broadly stable. The annual cost of mental ill health in England is estimated at around £300 billion.

For ADHD and autism, the review distinguishes between the number of people who actually have the conditions and the number recorded by health services. The available evidence suggests the underlying prevalence of both has stayed broadly stable or increased only modestly, though the authors note that England lacks up-to-date population data. Recorded cases, however, have surged. Between 2000 and 2025, recorded ADHD among 12- to 17-year-olds rose from 0.26% to 3.88%, while recorded autism among 6- to 11-year-olds increased from 0.24% to 4.58%.

Charts published in the report show that recorded rates of both conditions rose across every age group, with the steepest increases occurring after 2020. Among 18- to 24-year-olds, recorded ADHD climbed from near zero in 2000 to roughly 3% in 2025, overtaking the rate among children aged 6 to 11.

Demand for assessment has grown accordingly. Monthly ADHD referrals more than tripled from about 5,000 in 2019 to roughly 17,000 in 2024, and open ADHD referrals exceeded 560,000 by the end of 2025. More than 254,000 people had an open autism referral as of December 2025, and over 90% of them had been waiting longer than 13 weeks.

The review states that the evidence does not allow it to conclude that overdiagnosis is happening at scale. It warns, however, that the balance of risks is shifting away from underdiagnosis and toward misdiagnosis and overdiagnosis, as recorded diagnoses in some younger age groups now exceed older population estimates. At the same time, the authors stress that people now coming forward are no less impaired than those identified in the past, and that their difficulties are real.

The report also raises concerns about the independent sector, which now carries out more than half of all NHS-funded ADHD assessments and more than a third of autism assessments. Spending on independent-sector ADHD provision has risen by around 252% over three years, with a projected overspend of £164 million in the areas analyzed. The review describes this growth as running without consistent oversight or quality assurance.

Among the wider consequences, the review highlights that around one million people aged 16 to 24 are not in education, employment or training. The share of this group reporting a work-limiting health condition increased from 26% in 2015 to 44% in 2025, with mental health conditions and autism accounting for about 68% of such conditions. The report adds that delays themselves cause harm: the proportion of people whose difficulties worsen while waiting rises from about one in four among those waiting under two weeks to more than seven in 10 among those waiting longer than six months.

The authors attribute rising distress to a combination of factors, including financial and housing insecurity, more evaluative school and work environments, social media, loneliness, reduced youth and community provision, and less time for sleep, play and physical activity. Changes to international diagnostic criteria, which broadened definitions of ADHD and autism, have also contributed to higher recorded rates, though the review says they do not explain the full scale of the increase.

The review sets out 10 priority recommendations. Key proposals include making all ADHD and autism diagnostic assessments a regulated activity under the Care Quality Commission, banning direct-to-public advertising of NHS-funded assessments, and developing a digital and AI-enabled framework to assess and prioritize needs. It also calls for a clinically led review of current ADHD and autism waiting lists, with a pledge that no one should be removed from a list without being connected to appropriate help.

Other recommendations include expanding access to evidence-based treatments, protecting specialist services for people with the most severe needs, conducting regular national prevalence surveys, and launching a public information campaign on neurodevelopmental conditions. The review urges the government to publish a cross-government mental health strategy this year, combining immediate actions over the next 12 to 24 months with a 10-year reform plan.

Earlier, Qazinform News Agency reported that adults with attention-deficit/hyperactivity disorder (ADHD) face a higher risk of developing dementia or mild cognitive impairment later in life, according to a study led by researchers at the University of Pittsburgh.