A 600-page independent review of mental health, ADHD and autism provision has concluded that overdiagnosis cannot be said to be occurring “at scale”, while warning that the balance of risk may be shifting towards misdiagnosis in future.
The final report was published last Friday. It was co-authored by the psychologist Peter Fonagy alongside paediatric neurodisability specialist Gillian Baird and psychiatrist Simon Wessely.
The review was commissioned in late 2025 by the then health secretary, Wes Streeting, at a time when Keir Starmer’s grip on the Labour party was loosening and Reform UK was still in its pomp. Its remit covered England’s lengthening waiting lists for the diagnosis of mental illness and neurodevelopmental conditions, and the shortage of support for people living with one or both.
Reporting at the time tied the work to the government’s wider welfare agenda. One Times article said the review was beginning “as Labour seeks a fresh crackdown on welfare spending” amid diagnoses “which have become the most common reason for a sickness benefit claim”. Streeting had appeared to partly endorse claims of overdiagnosis.
Coverage of the findings diverged sharply. The Guardian reported the review as saying today’s youth face greater harms; the Mail led on a warning that rushing to diagnose ADHD and autism can damage children; and the Telegraph highlighted a warning that an ADHD surge is fuelled by benefits.
Appearing on BBC Radio 4’s Today programme, Fonagy said Streeting had been “completely wrong” to agree with suggestions that mental health disorders are commonly overdiagnosed.
On autism and ADHD the report states: “if present trends continue we are clearly entering a phase in which the balance of risks is changing, from previous merited concerns with under-recognition and underdiagnosis towards an increased risk of misdiagnosis and overdiagnosis”.
It adds that “we cannot conclude that overdiagnosis is occurring at scale”, and notes that data capable of settling the dispute “largely do not exist”.
Fonagy, who is 74, rejects the popular idea of a generation of wilting wimps falsely claiming mental ill-health. In a much-praised introduction he writes that “the cacophony of voices now available to a young person – most of them digital, many of them confident, few of them accountable – has made the ordinary developmental process of understanding oneself far harder than it was for me”. He continues: “Young people today are contending with more powerful forces than I ever faced. They are not fragile. They are outnumbered.”
The review also states that “the evidence does not show that people presenting today are less impaired than those presenting previously”.
Among its recommendations is a proposal that provision for mental illness and so-called neurodivergence should often be led by observations of need rather than formal diagnosis. It calls for “a fundamental shift from a diagnosis-dependent system to a needs-led plus diagnosis system”, a change it says would require “increased capacity, transformation through digitally enabled care, clearer national standards and sustained investment”.
Other proposals include tightening regulation of private diagnostic clinics, which are often partly NHS-funded, and stopping them from advertising their services.
The report also defends the term “neurodiversity”, describing “variation in brain function, cognition and behaviour” as “part of natural human diversity rather than pathology or disorder”.
Its conclusions contrast with the argument set out in The Age of Diagnosis by neurologist and epilepsy specialist Suzanne O’Sullivan, which suggested overdiagnosis of autism might have reached the point of partly driving rising anxiety and depression among the young, linked to a claim that “the stigma of autism has been associated with low self esteem among children”. O’Sullivan has said neurodiversity “has a biologising, pathologising effect”, and has publicly called autism an “illness”.
The review carries first-person testimony from an unnamed parent about their daughter’s care. The parent said that at 12 the girl was put on ADHD medication which lowered her mood and led her to self-harm. A referral to child and adolescent mental health services was turned down, the parent said, and within the following month the family attended A&E after an overdose. CAMHS then accepted her and suggested an autism assessment.
Two years later, after an autism diagnosis, “little changed”, the parent said. School adjustments were withheld until an education, health and care plan was accepted, and social care said the girl did not meet its threshold for support because she did not have a learning disability. She was admitted as an inpatient at 15, the testimony states.
Responding to the report, the government said the health and social care secretary, Yvette Cooper, “has asked NHS leaders to urgently examine how people can access advice, assessments and treatment more easily”.
The review was published on the same day as reports that the prime minister and the chancellor had rebuffed Cooper’s requests for money to fund a pay rise for NHS staff including nurses, porters and midwives.
Writing in the Guardian, columnist John Harris said that without sufficient money the proposed “needs-based” approach was likely to amount to very little. He also argued that the Department for Work and Pensions still has a culture built around crackdowns and pushing people into work, and that councils repeatedly fail to meet their responsibilities for the care and education of neurodivergent people.
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