A landmark UK government-commissioned review has warned that ADHD and autism are at risk of overdiagnosis, with the country at a “tipping point” where soon more people will be diagnosed than actually have the conditions. The most comprehensive ever review of mental health in Britain says wrongly labelling children with the conditions can cause it to become their identity and hold them back.
The report, spearheaded by top psychologist Professor Peter Fonagy, blames a system failure which pushes families to seek a diagnosis before they can get support in schools or with employment. It says people have been getting a diagnosis who would have historically had their ADHD or autism missed, but the UK has likely caught up.
Waiting lists and support gaps
This has created a huge waiting list for NHS diagnoses, and the review says children should be given support for symptoms like anxiety, impulse control and lack of concentration sooner. Prof Fonagy said: “Diagnosis remains essential and must be protected - what has to change is that it is no longer the only door through which help can be reached.”
The 607-page document, contributed to by 120 leading experts, found that genuine mental illness has increased in Britain, particularly anxiety and depression and among younger people. Severe mental illness such as schizophrenia and bipolar disorder has not increased. The review will feed into government policies on everything from education to the NHS and the welfare state.
Diagnosis rates vs real prevalence
Health Secretary Yvette Cooper said: “Professor Fonagy’s review has shown the importance of early intervention to address mental health and neurodevelopmental conditions and the huge distress these can cause. It is clear that mental health services need to change to focus more on the early support young people need to stay in education or work or keep their lives on track.”
The probe concluded that there has not been an increase in ADHD and autism prevalence. It estimated that 3.8% of 5-15 year olds have ADHD while NHS data shows 3.88% of 12-17 year olds now have a diagnosis - after increasing 15-fold since 2000. On autism, the review said the best evidence was that 1.2% of young people are autistic, while NHS data shows 4.6% of 6-11 year olds have an autism diagnosis following a 20-fold rise.
The review concluded that “on the basis of evidence available to us we cannot conclude that overdiagnosis is occurring at scale”, but added that present trends suggest overdiagnosis is becoming a greater risk. Polling shows around 20% of school pupils now identify as “neurodivergent” although many are undiagnosed. The NHS is now outsourcing half of ADHD assessments and over a third of autism assessments to private firms, and the review warned that these may be unreliable. The government responded by saying it will ensure all firms providing ADHD and autism tests are regulated by the Care Quality Commission.
Call for radical reform
Presenting their findings at a media briefing in central London, the review’s authors called for “a new model of care and radical reform” so people do not need a medical diagnosis to access support for daily living, education and employment. Vice chair Prof Sir Simon Wessely, of King’s College London, said: “One of the main harms of diagnosis is where it labels you as not being able to do something, which actually, you might be able to. Unfortunately this can sometimes be attributed to personal failures. People have been told that they're making it up, that it’s all in their head etc - which is absolute nonsense. It's system failures we're talking about.”
The report said people wait "weeks, months or years" without support from the NHS, schools or welfare because help is "locked behind waiting for a diagnosis". NHS data shows 560,000 people had an 'open referral' for ADHD at the end of 2025 - more than 17 times the number recorded in 2019. More than 254,000 people had an open autism referral in December last year.
Co-vice chair Prof Gillian Baird OBE, of King's College London, said: “It's remarkably difficult these days to… look, certainly online, without finding something that tells you what symptoms of ADHD and autism are so that if you were given to examining any particular problem you might have, you would be driven towards that. If you have a system which means that you feel you're only going to get support for any difficulties if you've got a diagnosis, then that’s what drives people towards trying to get a diagnosis.”
The review says people seeking ADHD and autism assessments should be "actively reviewed" so people with higher needs get assessed sooner while those with moderate needs should get support while awaiting assessment. Prof Baird told the briefing that currently only 14% of people who get an NHS diagnosis actually get any follow-up care. She added: “In fact diagnosis doesn’t tell you very much about a person's needs and what level of support they require. You need more than a diagnosis.”
Rising mental illness among young people
Prof Fonagy, a psychoanalyst at University College London, said it is harder to be young now due to smartphones, social media and lack of job opportunities. The clinical psychologist said "life has become harder" for young people because it is "more uncertain, more relentlessly observed and appraised, with less belonging and fewer opportunities to take time out, to recuperate and recover".
Mental illness has increased by almost half in three decades, standing at 23% of working age adults last year. Among 16–24-year-olds it has increased from around one in six to one in four, with young women now reporting the highest rates of any group. Self harm and eating disorders have surged. Prof Fonagy said the rise in mental health problems is “real, is affecting everyday functioning, and cannot be explained by greater awareness alone”.
In the foreword, Prof Fonagy described his personal battle with mental health when he was young. He experienced suicidal thoughts as a teenager after moving to London from Hungary without his parents but previously said therapy from a local service "saved his life". Prof Fonagy said: “I know, not only from the research literature but from the inside, that help which arrives in time, is offered with real care, and is matched to what a person needs in that moment, can have effects that feel close to magical.”
Dr Sarah Hughes, chief executive of the charity Mind, said: “The Fonagy Review echoes what we’ve seen across our services for years. Increased need for support is not due to a ‘snowflake generation’ or a case of overdiagnosis. Young people are growing up in a challenging world and it’s no surprise that more are struggling with their mental health. This report is a watershed moment for change.”
The report said the total annual cost of mental ill health in England is estimated at £300 billion, including a £110bn cost to the economy and £60bn cost to the NHS. Dr Nick Broughton, NHS England’s director for mental health, said: "This is a landmark moment for how we better understand the mental health needs across society, in particular the struggles many young people are now facing. The NHS is ready to play its part."
