The scale of rising distress

The NHS England mental health services review concludes that mental distress has "increased substantially across the population", and says greater awareness alone does not account for the rise. The shift is sharpest among the young: about one in four 16- to 24-year-olds are now thought to have a common mental disorder such as anxiety or depression, up from one in six in 1993.

• •Self-harm, eating disorders, OCD, PTSD and drug dependence have all increased
• •About 4 million children are in serious distress, a figure that could reach 4.5 million by 2030 if current trends continue
• •Self-harm cases could reach 2.5 million across England's population at current rates

Not everything has worsened. Rates of severe mental illness such as bipolar or schizophrenia have stayed much more stable, while hazardous drinking has declined. The proportion of the population estimated to have ADHD or autism has also remained broadly stable, at 3.8% and 1.2% respectively.

ADHD and autism assessments under strain

Diagnoses and waiting numbers have grown far faster than the underlying rates. ADHD diagnoses among children aged six to 11 rose more than sixfold in five years to 2.7%, and among 12- to 17-year-olds more than 15-fold to 3.9%. More than 560,000 people are now waiting for an ADHD assessment and more than 254,000 for an autism assessment.

The spending consequences are stark: NHS spending on independent-sector ADHD services rose by 252% over three years, and private providers accounted for more than a third of NHS-funded autism assessments in the 2025-26 financial year.

Review vice-chair Prof Simon Wessely said the exponential rises meant a threshold had been crossed.

The report adds a caveat, however: the rising numbers do not, by themselves, establish that overdiagnosis is occurring at scale, though the balance of risks between underdiagnosis, misdiagnosis and overdiagnosis may be changing.

Government response

Health secretary Yvette Cooper said the government would make all diagnostic assessments for ADHD and autism Care Quality Commission-regulated, so that assessments are high quality and the NHS is not overcharged by private providers. She stopped short of committing to a ban on private advertising of ADHD and autism assessments, instead asking the Advertising Standards Authority to review it.

The Department of Health and Social Care has committed to a major overhaul delivering earlier, needs-led support for children, young people and adults, without long waits for clinical diagnosis.

What the review recommends

Prof Fonagy said the NHS must shift from a diagnostic labelling model to a flexible, needs-led system, while stressing that "Diagnosis remains essential and must be protected".

Under the review's model, support should be given at the point of need rather than being contingent on a diagnosis. People would be able to seek help through:

• •schools
• •GPs
• •community mental health services
• •social care
• •employers
• •family hubs

A single service would join mental health and neurodevelopmental support together. The review also recommends scrapping first-come-first-served mental health waiting lists in favour of prioritising those with highest needs, such as people facing self-harm, risk of school exclusion or unemployment, with waiting lists "actively reviewed" to enable that prioritisation.

The authors stressed that no one should be removed from a pathway without appropriate assessment, communication and discussion.