NHS Diagnosis Crisis: Streeting Launches Major Review into ADHD, Autism, and Over-Diagnosis Fears

(By: BBC)

Introduction

The escalating pressure on the UK's National Health Service (NHS) mental health and neurodevelopmental services has reached a critical inflection point, marked by soaring demand, debilitating waiting times, and a contentious public debate over diagnosis rates. In response, Health Secretary Wes Streeting has initiated a comprehensive, independent review aimed at dissecting this multifaceted crisis. This inquiry, led by the highly respected clinical psychologist Professor Peter Fonagy, is tasked with the delicate balancing act of determining if there is evidence of over-diagnosis in conditions like Attention Deficit Hyperactivity Disorder (ADHD) and general mental health, while simultaneously identifying critical gaps in the support system that leave truly vulnerable people abandoned.

NHS Diagnosis Crisis: Streeting Launches Major Review into ADHD, Autism, and Over-Diagnosis Fears

The Political and Clinical Imperative

The launch of the review follows months of heightened political tension surrounding the welfare and health systems. Health Secretary Wes Streeting himself contributed to the initial controversy earlier this year when he suggested that mental health conditions were being "over-diagnosed" and that too many individuals were being "written off." Recognizing the complexity and sensitivity of the issue, Streeting later acknowledged these remarks as a case of "foot-in-mouth syndrome," committing instead to an evidence-based approach.

NHS Diagnosis Crisis: Streeting Launches Major Review into ADHD, Autism, and Over-Diagnosis Fears

His decision to commission a rigorous, independent review underscores the necessity of moving the conversation from political rhetoric to clinical facts. Streeting emphasized the need to look at the issue through a "strictly clinical lens to get an evidence-based understanding," arguing this is the only path to ensure "everyone gets timely access to accurate diagnosis and effective support."

Crucially, the review is being conducted against the backdrop of a significant, government-wide push to tackle the growing welfare bill. While the Department of Health and Social Care (DHSC) insists the health review is operating separately from these welfare reforms, the two issues are inextricably linked. The increase in working-age adults claiming disability or incapacity benefits—a rise from almost three million in 2019 to around four million as of March—highlights the massive societal cost of poor mental health and undiagnosed neurodevelopmental conditions. This context makes the findings of the Fonagy review vital not just for the NHS but for the nation's economic and social stability, even though a formal diagnosis is often not a strict prerequisite for receiving welfare support. The government has faced significant political backlash, even from within its own party, over proposals to cut disability benefits, highlighting the political volatility of policies affecting the mentally and physically ill.

The Undeniable Surge in Demand

The data unequivocally demonstrate a sharp and sustained increase in reported mental health challenges and neurodevelopmental symptoms over the last two decades. NHS figures reveal that the number of adults aged 16 to 64 reporting mental health problems has climbed significantly, reaching 22.6% in 2023-24, a notable jump from 17.6% in 2007. These rates are disproportionately high among young people and the unemployed, pointing to underlying societal, economic, and educational stressors.

NHS Diagnosis Crisis: Streeting Launches Major Review into ADHD, Autism, and Over-Diagnosis Fears

The increase in reported ADHD symptoms is similarly striking. Approximately 14% of adults now report experiencing symptoms of ADHD, compared to just 8% in 2007. This steep rise is where the question of "over-diagnosis" becomes most pertinent, as clinical experts estimate that only about 5% of the population, or less, have clinically diagnosable levels of the condition. While increased awareness, driven in part by social media, encourages more people to seek assessment, the sheer volume of self-reported symptoms has created an impossible bottleneck within the NHS.

The consequences of this demand are severe and human. The DHSC acknowledged that the acute pressure means people with genuine, often severe, needs face "long waits, have to navigate overstretched services, experience inequalities in care, and feel abandoned." This abandonment is tragically illustrated by the case of Jenny Tan, a 23-year-old student whose diagnosis of anorexia took nearly two years, by which point her condition was described by hospital staff as one of the worst cases they had encountered. For patients like Tan, the idea of "overdiagnosis" is bitterly ironic, as they fought relentlessly for recognition and care.

The Dual Mandate of the Fonagy Review

Professor Peter Fonagy's review is designed to rigorously examine two interconnected areas. The first is to establish a clear, clinical baseline for diagnosis and define the standards of "good quality care." This is essential for tackling any potential misdiagnosis while simultaneously ensuring that clinical criteria are robust and consistently applied across the NHS.

NHS Diagnosis Crisis: Streeting Launches Major Review into ADHD, Autism, and Over-Diagnosis Fears

The second, and perhaps more transformative, mandate is to investigate the efficiency of the entire referral pathway. Government sources and many clinicians believe one factor driving the long waiting lists is that a significant number of people are being referred onto specialist treatment pathways when their needs could be met through earlier, non-clinical interventions.

London GP Professor Sir Sam Everington, President of the Royal College of GPs, articulated this concern clearly, noting a sharp increase in mental health-related workload and highlighting the societal trend toward medicalization. He pointed out the pressure, often originating from social media, for people to acquire a "medical badge" of anxiety or depression. Everington argued that much of what is being presented is simply "the ups and downs of everyday life" and warned against the dangerous message that there is a "pill" or a "silver bullet" to resolve all distress.

The review will therefore strongly focus on preventative and foundational support. This includes exploring how services can provide practical assistance, such as help with social or financial issues, or a short, focused burst of talking therapy, much earlier in the patient journey. Current investment is already targeting increased support in schools and expanding general talking therapy services, but the review will seek to formalize and expand these types of interventions to act as a crucial filter, reserving highly specialized and resource-intensive diagnostic services for those with the most acute and complex clinical needs.

Stakeholder Consensus and the Path Ahead

The announcement of the review has been cautiously welcomed by mental health and neurodevelopmental organizations, who view it as a necessary step toward systemic change. Dr. Sarah Hughes, chief executive of the mental health charity Mind, stated that the review represents a "huge opportunity to really understand what is driving increasing levels of mental illness, especially among our young people." This perspective places the emphasis not on individual fault or exaggeration, but on addressing the underlying societal forces creating widespread distress.

NHS Diagnosis Crisis: Streeting Launches Major Review into ADHD, Autism, and Over-Diagnosis Fears

The National Autistic Society underscored the urgency of the problem, pointing out that while the number of people seeking assessments might be leveling out, the average waiting time for autism diagnosis is "rocketing," demanding immediate action to prevent further harm.

In conclusion, the independent review ordered by Wes Streeting and led by Prof. Peter Fonagy represents a pivotal moment for the UK’s mental health landscape. It demands an honest assessment of both the capacity and methodology of NHS services. The challenge is to navigate the contentious political terrain to deliver a genuinely clinical and evidence-based set of recommendations. The ultimate goal must be to design a system that not only ensures timely and accurate diagnosis for those with life-altering neurodevelopmental and mental health conditions but also implements a robust, accessible, and preventative framework that addresses the natural stresses of modern life without resorting to unnecessary medicalization. Only through such comprehensive reform can the NHS alleviate its unsustainable burden and ensure that all individuals receive the appropriate level of support when and where they need it most.