A comprehensive independent review into mental health, ADHD and autism has identified a significant risk of over-diagnosis in neurodevelopmental conditions while confirming that psychological distress among young people represents a genuine and worsening public health crisis. The review, commissioned by then-health secretary Wes Streeting 10 months ago after he raised concerns about young people being "over-diagnosed" and "written off", could reshape how the NHS, schools, employers and the benefits system support these populations.
Spanning more than 400 pages, the review presents findings that challenge some assumptions while validating others. It calls for urgent action across the next 12 to 24 months to address fragmented services, excessive waiting times and the risk that diagnosis itself becomes a barrier to opportunity rather than a gateway to support.
Is ADHD and autism genuinely over-diagnosed?
The review concludes there is a measurable risk of over-diagnosis specifically for ADHD and autism, though with important caveats. Diagnoses have risen sharply over the past 25 years, and in some younger age groups the recorded prevalence now exceeds what population studies suggest is the true level. Among children aged six to 17, more than 4% have received an autism diagnosis—substantially higher than the 1-2% estimated by research to reflect actual prevalence.
However, the evidence base itself has limitations. Estimates of true autism prevalence rely on surveys that have not been conducted for nine years, forcing the review team to extrapolate from older data. Additionally, certain age groups continue to experience under-diagnosis, meaning the picture is uneven across the population. The review team emphasised they cannot yet conclude over-diagnosis is occurring "at scale", but they identified a clear trend: the era of under-diagnosis appears to be giving way to one of potential over-diagnosis.
The experts warned that not every difficulty warrants a medical diagnosis, and there is a risk of conflating diagnosable ADHD and autism with what should be understood as normal variation in how human brains function, process information and behave. According to the interim report, population-level estimates of ADHD and autism prevalence appear relatively stable despite substantial increases in recorded diagnoses and referrals, suggesting that improved identification may be capturing cases that previously went unrecognised rather than reflecting a true rise in the conditions themselves.
Why is mental health different?
The review's stance on mental health diverges sharply from its position on neurodevelopmental conditions. Chair Professor Peter Fonagy stated that former health secretary Streeting was "completely wrong" to suggest over-diagnosis of mental health problems. The evidence shows the increase in psychological distress among young people is real and substantial.
One in four 16 to 24-year-olds now experience mental distress, up from one in six three decades ago. Fonagy attributed this rise to multiple interconnected factors: economic uncertainty, the pervasive influence of social media, and the erosion of youth services that once provided informal support and community connection. This contrasts fundamentally with ADHD and autism, where diagnoses have increased while the underlying population prevalence has remained broadly stable.
Importantly, the rise in mental health problems is not driven by increases in severe mental illness. Population rates of schizophrenia and bipolar disorder have remained stable. Instead, the surge reflects conditions such as anxiety, depression, self-harm and eating disorders—conditions that cause genuine suffering and functional impairment but differ in severity and trajectory from psychotic disorders.
How does diagnosis affect young people's futures?
The review identified a paradox: while diagnosis can open doors to support, it also risks closing opportunities. A diagnosis can become a label that defines individuals by their difficulties rather than their strengths and potential, creating barriers in education, employment and relationships.
The statistics are striking. Around one third of 16 to 24-year-olds not in education, employment or training (NEET) cite their mental health or autism as a contributing factor. Young people diagnosed with ADHD before age 17 are four times more likely to become NEET than their peers without the diagnosis. Addressing this requires more than clinical intervention—it demands a shift in how schools, workplaces and society at large respond to people with these diagnoses, moving from a deficit-focused approach to one that recognises capability and potential.
What is wrong with the current system?
The review found the support system is "falling short" across both mental health and neurodevelopmental conditions. Waiting times represent a critical failure. One third of young people referred to mental health services wait more than a year for assessment or treatment. For ADHD and autism, the backlog is even more severe: of the 900,000 people on waiting lists, 90% have waited longer than three months.
The problem extends beyond the NHS. Support across health, education, employment and welfare is fragmented, forcing people to navigate multiple systems, undergo repeated assessments and meet conflicting requirements to access help. The Parliamentary and Health Service Ombudsman reported an almost 206% rise in complaints about ADHD and autism over five years, from 410 to 1,257, highlighting systemic problems in how services are delivered and overseen.
Quality and consistency of assessments vary significantly, particularly where private providers conduct evaluations on behalf of the NHS. Half of all ADHD assessments and a third of autism assessments are now performed by non-NHS providers such as charities and private firms. These external providers are not subject to the same regulatory standards as NHS services, creating a two-tier system with inconsistent quality. The Ombudsman's findings, based on analysis of 3,000 complaints, highlighted uncertainty over patients' rights to choose providers, inconsistent recognition of diagnoses across different services, and prolonged waits for both assessment and treatment.
What changes does the review recommend?
The review calls for immediate action to address waiting lists through reassessment and reprioritisation. Rather than maintaining a first-come, first-served approach, those on waiting lists should be evaluated to identify who most urgently needs help. Some people waiting for assessment may benefit from non-medical interventions—advice on sleep, physical activity or other lifestyle factors—which could resolve difficulties without requiring a formal diagnosis and might even lead to removal from waiting lists.
Better screening before people enter waiting lists is essential. The review emphasised that not every problem requires a medical solution, and earlier intervention with non-clinical support could prevent unnecessary referrals. Quality standards for ADHD and autism assessments must be strengthened, and private sector providers must be brought under the same regulatory framework as NHS services. The review also recommended a ban on direct-to-public advertising of assessments, which can drive demand for diagnosis without clinical gatekeeping.
According to the government announcement, the review was launched on 4 December 2025 and its findings are intended to inform the government's 10 Year Health Plan. The review team has set a target of 12 to 24 months for implementation of key changes, and the government has committed to setting out further details in its forthcoming mental health strategy, expected by the end of the year.
What happens next?
The final report and detailed recommendations are expected in summer 2026. These findings will feed directly into the government's 10 Year Health Plan, shaping long-term policy on mental health, ADHD and autism services. The government has pledged to act on the review's conclusions, though the pace and scope of implementation remain to be determined when the mental health strategy is published later this year.
