NHS 'system failures' as ADHD and autism care demand soars, report warns

The NHS in England is hurtling towards a "world of system failures" due to an overwhelming surge in demand for mental health, ADHD, and autism care, a new government-commissioned inquiry has revealed. The review, led by Professor Peter Fonagy, warns that those in need are left without adequate support ^[1].

The inquiry found a growing risk of overdiagnosis for autism and attention deficit hyperactivity disorder (ADHD), urging ministers to tighten regulations on private clinics. Many individuals are turning to these clinics because they face lengthy delays for NHS assessments ^[1].

Experts behind the review are pushing for care to be provided based mainly on an individual's needs, rather than solely on a formal diagnosis, to cut down on years-long waiting lists. The report highlights that people often wait "weeks, months or years" for NHS support because help is "locked behind waiting for a diagnosis" ^[2].

Professor Fonagy dismissed the idea that young people are "snowflakes" or less resilient than previous generations. He stated that the rise in mental health problems is genuine, impacts daily functioning, and cannot be attributed merely to increased awareness ^[1]. Life has become harder for young people due to increased uncertainty, financial pressures, and a lack of hope for a better future than their parents [1, 2].

The number of people experiencing mental distress has significantly increased across all age groups in England since the 1990s, particularly among those under 18. The proportion of 16- to 24-year-olds with a common mental disorder jumped from approximately one in six to one in four between 1993 and 2024 ^[1].

At the close of last year, over 560,000 people in England were awaiting an ADHD assessment, a 17-fold increase since 2019. Another 254,000 were on waiting lists for an autism diagnostic assessment, bringing the total to more than 800,000 ^[1]. Nearly 90% of these individuals had been waiting for at least three months.

While the review did not conclude that overdiagnosis is currently happening on a large scale, it suggested that the UK has reached a "tipping point" where the risks of misdiagnosis and overdiagnosis are becoming increasingly significant [1, 2]. The report noted that 4.6% of 6-11 year olds now have an autism diagnosis, a 20-fold rise, and 3.88% of 12-17 year olds have an ADHD diagnosis, a 15-fold increase, since 2000 ^[2].

The review also raised "strong concerns about the consistency and quality" of private ADHD and autism assessments. It recommended that ministers ban direct-to-public advertising for such services and ensure all clinics are regulated by the Care Quality Commission ^[1]. Health Secretary Yvette Cooper said the government will ensure all firms providing these tests are regulated ^[2].

Professor Simon Wessely, vice-chair of the review, cautioned that a diagnosis can sometimes label individuals as incapable, when they might be able to achieve things ^[2]. The report advocates for a "needs-led" system, where individuals can receive support for symptoms like anxiety or lack of concentration sooner, without requiring a formal diagnosis [1, 2]. The story was first reported by The Guardian and Mirror.