A review of NHS England's mental health, ADHD, and autism services has found that mental distress has substantially increased across the population and cannot be explained by greater awareness alone. The 607-page report, chaired by Professor Peter Fonagy, warns that the current system is unsustainable.
The report highlights that about one in four 16- to 24-year-olds are now thought to have a common mental disorder, an increase from one in six in 1993. Self-harm, eating disorders, OCD, PTSD, and drug dependence have also risen. Around 4 million children are experiencing "serious distress," a figure that could reach 4.5 million by 2030 if current trends continue.
While the overall proportion of the population with ADHD and autism has remained stable, there has been an exponential rise in diagnoses and assessment waiting lists. The report notes a more than sixfold increase in ADHD diagnoses for children aged six to 11 in five years, and over a 15-fold increase for 12- to 17-year-olds. Professor Simon Wessely, the review's vice-chair, stated that this indicates a tipping point where misdiagnosis and overdiagnosis are becoming a risk.
The health secretary, Yvette Cooper, has announced that all diagnostic assessments for ADHD and autism will become Care Quality Commission-regulated. The Advertising Standards Authority will also be asked to review private-sector advertising of these assessments.
Professor Fonagy advocated for a shift from a diagnostic labelling model to a flexible, needs-led system, where support is provided at the point of need rather than being contingent on a diagnosis. The Department of Health and Social Care has committed to a major overhaul of services to ensure earlier, needs-led support without long waits for clinical diagnosis. The report also recommends prioritising patients with the highest needs on waiting lists, rather than a first-come-first-served approach.