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. 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. 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. He lamented that an array of social and economic circumstances had piled unprecedented pressure on young people. 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.
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