The NHS in England is heading into a “world of system failures” as it struggles to cope with relentlessly rising demand for mental health, ADHD and autism care, leaving those affected desperate for support, a government-commissioned inquiry has found.
The stark warning was made in a review led by Prof Peter Fonagy into the sharp rise in demand over recent decades for help with mental health and neurodevelopmental conditions.
What to know about NHS at risk of ‘system failures’ as demand
It found there was an increasing risk of overdiagnosis of autism and attention deficit hyperactivity disorder (ADHD) and urged ministers to toughen the regulation of the private clinics to which many people are turning because they cannot get assessed quickly by the NHS.
The experts behind the review also called for access to care to be based primarily on a person’s needs so fewer people would have years-long waits for a formal diagnosis.
The review found that the number of people suffering mental distress has risen significantly across all age groups in England since the 1990s, especially the under-18s.
The number of 16- to 64-year-olds with a common mental disorder increased from 15.5% in 1993 to 22.6% in 2024. However, it jumped more sharply – from about one in six to one in four – among 16- to 24-year-olds over the same period.
The evidence shows that sceptics are wrong to cast doubt on young people’s struggles, the 607-page report found.
“That’s sometimes been attributed to personal failures, people being told they’re making it up, it’s all in their head, which is absolute nonsense,” said Prof Simon Wessely, a leading psychiatrist and vice-chair of the review.
The report’s conclusions may have significant implications for the government’s drive to reduce the number of young people in the UK not in education, employment or training – now almost 1 million – and the size of the welfare bill, with a record 2.8 million people too sick to work; and also for schools as they grapple with the demands arising from the growing number of pupils with special educational needs.
Fonagy, a psychoanalyst and clinical psychologist at University College London, dismissed the notion that young people in particular were “snowflakes” who were less resilient than in previous generations. “The rise in mental health problems is real, is affecting everyday functioning and cannot be explained by greater awareness alone,” his report said.
He lamented that an array of social and economic circumstances had piled unprecedented pressure on young people. “There is increased uncertainty – financial pressures, insecure work, unaffordable housing – but perhaps more important, a lack of hope among young people that their lives will be better than their parents, and that’s the first time since the second world war that surveys have noticed that.”
The explosion in demand for help with mental ill-health and neurodiversity has left people stuck on waiting lists for years at a time and with worsening symptoms, Fonagy said. At the end of last year more than 560,000 people in England were waiting to be assessed for ADHD – 17 times more than were doing so in 2019. Another 254,000 people were waiting for a diagnostic assessment for autism, taking the total number waiting to more than 800,000. Almost all – 90% – had been waiting for at least three months.
The number of six- to 11-year-olds being diagnosed with autism has also soared. It jumped 20-fold to 4.58% between 2000 and 2025 and by even more among those aged 12 to 17 over the same years, from 0.1% to 4.06% – a 40-fold jump. And the proportion of children aged six to 11 with an ADHD diagnosis has increased more than sixfold in five years and more than 15-fold in 12- to 17-year-olds, to 2.7% and 3.9% respectively.
While 4 million children already suffer from “high psychological distress’’, if current trends continue, that could reach 4.5 million by 2030, the report warned. The number of under-18s who self-harm could also rise from 1.9 million to 2.5 million.
The exponential rise in diagnoses of autism and ADHD means the UK has reached a “tipping point” where people are at risk of being misdiagnosed with either condition, Wessely warned.
The authors did not find that overdiagnosis was occurring at scale, but added that the evidence “suggests we are entering a phase in which the balance of risks between underdiagnosis, misdiagnosis and overdiagnosis may be changing, with the risks of misdiagnosis and overdiagnosis becoming increasingly important considerations for policy and service delivery”.
The increasing tendency of young people to self-identify as neurodivergent – as many as a fifth of secondary school pupils do so – means that “the line between the social and the medical is beginning to blur”, they added.
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The 10-month review found “strong concerns about the consistency and quality of ADHD and autism assessments being carried out by independent providers, and the financial incentives associated with assessment activity”.
Ministers should ban direct-to-public advertising of such services and ensure that all clinics offering them are regulated by the Care Quality Commission, it said.
Growing numbers of young people have a combination of mental ill-health and ADHD or autism, or both. “Co-occurrence is the rule rather than the exception,” the report said. For example, 61% of 16- to 24-year-olds with a common mental health condition also had autistic traits, and 57% had ADHD symptoms.
The report said their needs meant the NHS should bring together mental health and neurodevelopmental services and move to a “needs-led” system.
The Royal College of Paediatrics and Child Health backed Fonagy’s call for diagnosis to no longer dictate who received care.
“Too often, a diagnosis is the only route to accessing meaningful help. This means that children and families can be left struggling alone while waiting for assessments, with little or no support available in the meantime,” said Dr Ronny Cheung, its officer for health services.
The NHS moving to a “needs-led” approach would “ensure children and young people can seamlessly and more quickly access a robust, holistic and reliable standard of care”, he added.
Yvette Cooper, the health secretary, will draw on Fonagy’s recommendations in putting together the forthcoming mental health strategy, which is due by the end of the year.
In her response, she promised that the NHS would provide a “needs-led” system under which people would get much faster care. She has asked NHS England to establish how it can provide faster advice, assessments and treatment.
She said: “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.”
She also pledged to ensure all private assessment clinics are regulated but did not commit to the advertising ban Fonagy said was needed.
