NHS England mental health services review: what has it found and what does it recommend?

The Fonagy review of NHS England’s mental health, ADHD and autism services was commissioned in 2025 by Wes Streeting, then the health secretary, in response to growing concerns that spiralling waiting lists for assessment, diagnosis and care threatened the NHS’s ability to meet the demand.The 607-page report, published on Friday, says that without a radical overhaul, mental health and neurodiversity services will be overwhelmed. Here are some of its key findings and recommendations.1. Unprecedented and growing levels of distress are realThe report is categoric that mental distress has “increased substantially across the population”, is real and affects everyday functioning, and that the rise “cannot be explained by greater awareness alone”. About one in four 16- to 24-year-olds are now thought to have a common mental disorder such as anxiety and depression, up from one in six in 1993, while self-harm, eating disorders, OCD, PTSD and drug dependence have also increased.About 4 million children are in “serious distress”, and if current trends continue that could reach 4.5 million by 2030, the report says. At current rates self-harm cases could reach 2.5 million across England’s population. But rates of severe mental illness such as bipolar or schizophrenia have remained much more stable, while hazardous drinking has declined.Chart of numbers of cases of mental health need2. The system is failing everyoneWith the cost of mental ill health standing at £300bn a year, “continuing as we are is not sustainable,” the report warns. “Not for the people waiting weeks, months or years, becoming more distressed because help is locked behind waiting for a diagnosis; not for those with the most severe needs who cannot access specialist care; and not for a society paying the human and economic price of failing to support people to participate in family, community, education and working life.”3. Overdiagnosis of ADHD and autism is not yet widespread but is a growing riskWhile the proportion of the population thought to have ADHD and to be autistic has remained broadly stable at an estimated 3.8% and 1.2% respectively, the recent exponential rise in those diagnosed, as well as even larger numbers waiting to be assessed, means we have reached a tipping point where people are at risk of being misdiagnosed with ADHD and autism, said Prof Simon Wessely, the review’s vice-chair.The report finds that the proportion of children aged six to 11 with an ADHD diagnosis has increased more than sixfold in five years, and for 12- to 17-year-olds more than 15-fold, to 2.7% and 3.9% respectively. And with more than 560,000 people waiting for an ADHD assessment and more than 254,000 for an autism assessment, the proportion of people with a diagnosis of ADHD or autism is expected to rise further.ADHD diagnoses chartAutism diagnoses chart“This does not, by itself, establish that overdiagnosis is currently occurring at scale,” the report states. “However, the evidence suggests we are entering a phase in which the balance of risks between underdiagnosis, misdiagnosis and overdiagnosis may be changing, with the risks of misdiagnosis and overdiagnosis becoming increasingly important considerations for policy and service delivery.”4. Private companies should be banned from advertising ADHD and autism assessmentsThe report finds that NHS spending on independent-sector ADHD services rose by 252% over three years and that private providers accounted for more than a third of NHS-funded autism assessments in the 2025-26 financial year. Responding to the report’s call for greater regulation, the health secretary, Yvette Cooper, said the government would “make all diagnostic assessments for ADHD and autism Care Quality Commission-regulated, so people can be confident that assessments are high quality and that the NHS is not being overcharged by independent or private providers”.Chart of self-reported cases of autism, ADHD or other neurodivergenceShe stopped short of committing to banning private-sector advertising of ADHD and autism assessments to the public, instead saying the Advertising Standards Authority would be asked to review it, “to ensure people receive accurate information and are not exploited by companies encouraging them to seek assessments they may not need”.5. The NHS should provide a needs-first serviceProf Peter Fonagy, the review’s chair, said the NHS needed to shift from a diagnostic labelling model to a flexible, needs-led system. “Diagnosis remains essential and must be protected,” he said, but added: “What has to change is that it is no longer the only door through which help can be reached.”Instead, people should be able to seek help through school, GP or community services, mental health services, social care, employers and family hubs. Support should be given at the point of need, not contingent on a diagnosis. And there should be a single service for mental health and neurodevelopmental support to provide more joined-up help.In response, the Department of Health and Social Care committed to a major overhaul of services to ensure “earlier, needs-led support for children, young people and adults, without long waits for clinical diagnosis”.6. Scrap first-come-first-served waiting listsPatients waiting for a diagnosis should be prioritised. Rather than a first-come-first-served system, mental health and neurodiversity services should ensure those with the highest needs – such as self-harm, multiple difficulties or risk of imminent school exclusion or unemployment – get specialist assessment sooner.Waiting lists should be “actively reviewed” to enable that prioritisation. But the authors denied that would leave those with less acute symptoms without any route to diagnosis, stressing: “No one should be removed from a pathway without appropriate assessment, communication and discussion.”