Review dismisses claims of widespread over-diagnosis across mental health, ADHD and autism

Disabled campaigners have given a broadly warm welcome to a high-profile independent review into the prevalence of mental ill-health and distress, ADHD and autism in England, despite attempts by commentators and politicians to misrepresent its findings.

The review for the government, chaired by clinical psychologist Professor Peter Fonagy, found a substantial increase in mental distress among children and young people.

And it also concluded that there was no evidence of widespread overdiagnosis of mental health conditions, ADHD and autism – despite frequent claims by politicians and media commentators – although the review said the risks of this happening appear to be increasing.

It found that disabled people were waiting “far too long” for support, diagnosis and treatment, but also that obtaining a diagnosis had become the main way of securing support that “could and should be available earlier”.

It called for a system that currently often requires people to wait for a diagnosis before they can receive support to move to one that “recognises need earlier and responds sooner, while protecting specialist capacity for those who need it most”.

It also called for measures to monitor and regulate the quality of all ADHD and autism assessments that are carried out by independent providers, a recommendation accepted by the government, with social care and mental health minister Alison McGovern promising that all such assessments would now be regulated by the Care Quality Commission.

The government also promised “broader support and advice at the earliest opportunity”, although this appeared to be focused on those with mental distress, ill-health and trauma rather than autistic people and those with ADHD.

The review’s final report also pointed to some of the factors that have increased levels of mental distress, including poverty, financial insecurity, unemployment and housing pressures, social media, social isolation, and reduced opportunities for rest and recovery as daily life is increasingly spent online.

It found clear links between increased poverty and worsening mental health, and it pointed to research from March 2020 which found the rollout of the universal credit working-age benefits system in England was associated with a significant increase in psychological distress among those affected.

It also warned – in another blow for many politicians and media commentators – that work was not always “beneficial”.

The report said: “Secure, well-designed and supported work can promote recovery, while insecure or unsupported work can worsen mental health.”

And it concluded that support across health, social care, education, employment and welfare “remains fragmented”, which was “distressing for the people caught within it” but also “inefficient”.

The report appears to have received a reasonably warm welcome from mental health and neurodivergent activists and campaigners.

Ruairi White, chief executive of National Survivor User Network, said: “The findings of Fonagy’s review echo much of what we know as people with lived experience of mental ill-health, distress and trauma.

“The report found no widespread overdiagnosis of ADHD and autism, and a substantial increase in mental distress across the population, driven by poverty, social exclusion and climate change.

“We also note that the review found some evidence that public attitudes around mental health, especially what the report terms ‘severe mental illness’, are becoming less accepting.

“We have long been aware that these systemic drivers of mental ill-health can only be overcome by systemic change.

“The debate over overdiagnosis, as the report agrees, is a distraction from the real task at hand: making sure people can access comprehensive, person-centred support regardless of formal diagnosis.

“A needs-led approach could make this possible.

“Without sustained investment and a serious commitment to engaging with people with lived experience’s voices on our own terms, however, it could end up further restricting access to care.

“If the government seriously engages with the report’s principles, this could be a watershed moment in the way we think about and respond to distress.

“We will keep pushing for lived experience expertise to drive that change.”

The grassroots, user-led mental health group Recovery in the Bin (RITB) also broadly welcomed the report.

An RITB spokesperson said: “It was inevitable that a nuanced report such as this was going to be misrepresented by bad actors, despite it being pretty decent generally.”

But they warned that the report’s call for a more needs-led system could be “dangerous” as “early intervention can be helpful but not as a substitute for diagnosis”, because of the range of impairments across mental health, autism, ADHD and learning difficulties that staff in the NHS come across.

And, they pointed out, with personal independence payment, although the assessment is needs-led, “the conditions still have to be named at the start of the form”.

They suggested that a mental health diagnosis is more important than with many other impairments and conditions “because there are no blood tests, scans, X-rays to determine it”.

RITB predicted that the government would now be “cherry picking” from the report because it was “driven by the desire for cuts to services and benefits” and the report had not “given ministers the ammunition they need to argue for cuts”.

The RITB spokesperson added: “The bigger question is, ‘Where will the funding come from for this real and urgent need?’”

Kate Skinner, a neurodivergent campaigner, psychology student and academic research assistant, said the media had spun the report to suggest it concluded there was over-diagnosis when that was not the review’s conclusion.

She also warned that a “needs-led” system could be “transformed into a mechanism for rationing and gatekeeping resources, allowing the government to tell struggling individuals that their needs are not ‘severe enough’ to warrant state help, and resulting in stripping away help (benefits, etc) without having to argue about any messy and complicated medical facts”.

And she said that, despite the recognition of widespread mental distress, the report could still provide a “veneer of clinical and academic authority to political narratives that seek to curb welfare spending”.

She added: “While the review was meant to examine the ‘overdiagnosis debate’, this academic exercise distracts from the immediate material catastrophes of a collapsed social safety net, crumbling SEND provisions in schools, and an absolute dearth of community infrastructure.”