We need to stop arguing about mental health and neurodiversity – and start understanding it

The Department of Health and Social Care commissioned an Independent Review into Mental Health Conditions, ADHD and Autism to look at rising demand for mental health, ADHD and Autism services and what is driving it. The review, chaired by Professor Peter Fonagy, Professor Gillian Baird and Sir Simon Wessely, published its interim report on 31 March 2026. Here Professor Fonagy gives an overview of the key findings.

In recent years, Britain has changed the way it talks about minds.

Referrals for ADHD have risen sharply. Autism diagnoses have increased across schools and health services. Around one in five adults now meets criteria for a common mental health condition. Waiting lists stretch into years. Families, teachers and clinicians all describe a system under strain.

Behind these figures lies something real. But also something uncertain.

Are more people experiencing distress and dysfunction? Almost certainly, yes—particularly younger people.

Are we also recognising, labelling and responding to that distress and dysfunction differently? Again, yes.

The difficulty is that we have tended to collapse these questions into one. We talk as if prevalence, diagnosis, demand and need are interchangeable. They are not.

This is what the Independent Review into Mental Health Conditions, ADHD and Autism, which I chair with Professor Gillian Baird and Sir Simon Wessely, is trying to disentangle.

Our interim report does not offer conclusions. But it does set out something that should shift the debate.

First, there is credible evidence of a real increase in distress, especially among young people. It is not just more frequently reported—it is, in many cases, more impairing. Anxiety, loss of confidence and difficulty concentrating are rising, and these changes are affecting education, work and daily functioning.

Second, the systems designed to respond are not working well enough. Too often they are slow, fragmented and difficult to navigate. Diagnosis has increasingly become the gateway to support, even where it may not be the most appropriate first step in getting people the right support and tools to live well. This creates pressure on assessment pathways and leaves many people waiting too long for help.

Third, the picture is not the same across all conditions. For ADHD and autism, the best population data suggest relatively stable underlying prevalence, while diagnoses and referrals have increased dramatically. That does not mean one set of data is “right” and the other “wrong”. It means different things are happening at the same time: changes in recognition, changes in help-seeking, and systems that increasingly channel people towards diagnosis in order to access support.

Fourth, fairness matters. There are clear differences in who is recognised, who receives a diagnosis, and who is missed altogether. We already know that some groups—particularly older adults, some ethnic minority communities, and those in the criminal justice system—may still be under-identified. At the same time, others are entering diagnostic pathways in growing numbers, often because it is the only way to secure help.

What emerges is not a simple story of “more illness” or “too much diagnosis”. It is a more complex and less comfortable reality.

Distress is real. But how we interpret and respond to it is shaped by the systems we have built.

Those systems can amplify demand as much as they respond to it. When support is tied tightly to diagnostic labels, demand for diagnosis will rise. When early, accessible help is limited, difficulties escalate. When pathways are fragmented, people circulate within them.

This is why the answer cannot sit with the NHS alone.

Mental health, autism and ADHD are shaped not only in clinics, but in schools, workplaces and communities. Educational expectations, social environments, digital lives, family pressures and economic conditions all play a part in how distress emerges and how it is understood.

So must the response.

We need a system that is more proportionate, more responsive and less dependent on diagnosis alone. One that can offer support earlier, in a wider range of settings, and in ways that are aligned to need rather than determined by labels.

That does not mean abandoning diagnosis. For many people, it remains essential—for understanding, for treatment, for access to support. But it does mean being more precise about what diagnosis is for, and what it is not.

There is another, quieter issue that we must also confront.

For all the progress we have made in raising awareness of mental health, we have not always been clear about what that awareness is for. We have encouraged people to recognise distress and seek help. We have been less clear about how to stay well, what different kinds of help are available, when clinical intervention is needed, and when other forms of support might be more effective.

That uncertainty now feeds the very pressures we are trying to address.

The Review’s task is not to take sides in an already polarised debate. It is to ground that debate in evidence, to separate what we know from what we assume, and to identify where our systems are helping—and where they are getting in the way.

Because the question we face is not whether we should care more about mental health and neurodiversity. We should.

It is whether we are responding in the right way.

And at present, too often, we are not.

Read the interim report: Independent review into mental health conditions, ADHD and autism: interim report

Professor Peter Fonagy is Head of the Division of Psychology and Language Sciences at UCL; Consultant to the Child and Family Programme at the Menninger Department of Psychiatry and Behavioural Sciences at Baylor College of Medicine; and holds visiting professorships at Yale and Harvard Medical Schools. Until 2024 he was Chief Executive of the Anna Freud Centre, London.