Back in late 2025, when Keir Starmer’s grip on the Labour party was loosening and Reform UK was still in its pomp, the then health secretary, Wes Streeting, commissioned what the government called its “Independent review into prevalence and support for mental health conditions, ADHD and autism”.
Probably the only useful thing he could have done if it really IS independent, of course…
Here, it seemed, was not just an inquiry into England’s ever-extending waiting lists for the diagnosis of mental illness and neurodevelopmental conditions, and the dire lack of support for people who experience one or both of them. The review would also dovetail with two other huge issues: mounting claims of “overdiagnosis”, which Streeting had appeared to partly endorse, and the government’s drive for the reform of so-called welfare.
And no doubt it had orders to reject those claims, and it followed them.
Last Friday saw the publication of the 600-page final report Fonagy had co-authored with Gillian Baird – a specialist in paediatric neurodisability – and the psychiatrist Simon Wessely. And, as so often happens with such inquiries, its interpretation suggested the media’s equivalent of a Rorschach blot. One of the Guardian’s headlines was “No ‘snowflakes’: mental health review says today’s youth have it harder and harms are real”. The Mail, by contrast, yelled out a rather different message – “Rush to diagnose ADHD and autism can damage children” – while the Telegraph went for “ADHD surge fuelled by benefits, report warns”.
When he appeared on Radio 4’s Today programme, Fonagy said that Streeting had been “completely wrong” to agree with suggestions of the common overdiagnosis of mental health disorders. When it comes to autism and ADHD, he and his colleagues’ report says that “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”. But it also insists that right now, “we cannot conclude that overdiagnosis is occurring at scale”, and points out that any data that might settle this festering argument “largely do not exist”. This is not the kind of stuff that suits a world that craves simple binaries and polarised shouting, but it speaks an undeniable truth.
And what suggestions did it make?
For the most part, in fact, it is hard to disagree with what the review points out. But among its conclusions lies one troubling proposal – that provision for both mental illness and so-called neurodivergence can and should often be led by observations of need rather than formal diagnosis
Whose need?
The review, by contrast, is altogether more calm and evidence-based: for a bundle of reasons, it says that overdiagnosis and misdiagnosis may well be a future risk, but we can guard against those dangers by more closely regulating private diagnostic clinics (which are often partly NHS-funded) and stop them advertising their services. These are proposals that many autism and ADHD insiders agree with.
Of course it would be private clinics at fault, and not the sainted NHS…
By way of lessening an increasingly frightening crisis that is partly centred on pitifully long waits for formal diagnoses that can easily be ignored, it suggests moving towards a more “needs-based” approach, which echoes the government’s plans for special needs education.
But without sufficient money, “needs-based” help is likely to amount to very little at all.
There will never be ‘sufficient money’, its an impossibility.
Meanwhile, the Department for Work and Pensions still has a culture built around crackdowns and pushing people into work. Councils repeatedly fail to meet their responsibilities for the care and education of neurodivergent people. And, in the absence of properly funded change, both they and people suffering mental illness only stand even a faint chance of pushing their way through an almost impossible mess of bureaucracy and obstruction if they have pieces of paper confirming that their condition – or conditions – are real and true.
Because if you have a piece of paper issued by the government or its agents, that cures all, right? Shall we ask the men in frocks?
