Fonagy Review Challenges Claims of Mental Health Overdiagnosis in England

A government review led by psychologist Peter Fonagy examined mental health conditions, ADHD and autism support in England, finding that claims of widespread overdiagnosis are not supported by current evidence while recommending reforms to how people receive help.

The 600-page final report was co-authored by Gillian Baird and Simon Wessely. The review was commissioned by then health secretary Wes Streeting in late 2025 amid concerns about diagnosis trends, waiting lists and support gaps.

The report assessed debates around "overdiagnosis" and stated that "we cannot conclude that overdiagnosis is occurring at scale" while noting that evidence "largely do not exist" to fully resolve the issue.

Fonagy, the review chair, said Streeting was "completely wrong" to agree with suggestions that common overdiagnosis of mental health disorders was already occurring. The report said 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".

The review also said "at scale" concerns about overdiagnosis remain unproven and added that "the evidence does not show that people presenting today are less impaired than those presenting previously".

Fonagy rejected portrayals of young people as overly fragile. He wrote that "The cacophony of voices now available to a young person – most of them digital, many of them confident, few of them accountable – has made the ordinary developmental process of understanding oneself far harder than it was for me," Fonagy said.

He added, "Young people today are contending with more powerful forces than I ever faced. They are not fragile. They are outnumbered."

The report also addressed autism and ADHD, arguing that support should focus more on individual needs rather than requiring formal diagnosis in every case. Fonagy and colleagues said variation in human functioning should not automatically be treated as disorder.

The review described concerns about the meaning of neurodiversity and rejected the idea that it "has a biologising, pathologising effect". Instead, it defined neurodiversity through the statement that "variation in brain function, cognition and behaviour is part of natural human diversity rather than pathology or disorder".

The report recommended tighter oversight of private diagnostic clinics and restrictions on advertising their assessment services. It also criticized the idea that autism remains broadly overdiagnosed today, while acknowledging future risks.

In discussing public debate around autism, the review contrasted its findings with claims that autism could be causing wider mental health problems among young people. It noted that describing autism as an "illness" was contested.

A parent testimony included in the report highlighted difficulties accessing care. The testimony began, "When she was 12," and described a child receiving ADHD medication before being referred to CAMHS after experiencing severe difficulties.