Children and young people in England could receive mental health support without waiting for a formal diagnosis under government plans announced on 9 October. The proposed changes aim to reduce delays, address rising psychological distress and make it easier for people to get help before their difficulties affect education, employment or everyday life.
The announcement follows an independent review led by Professor Peter Fonagy, a clinical psychologist at University College London. The review found that mental distress has increased substantially among children and young people, while referrals and diagnoses for attention deficit hyperactivity disorder (ADHD) and autism have risen sharply. However, the review found that the underlying population prevalence of ADHD and autism appears broadly stable.
The government plans to use the findings to shape a new Mental Health Strategy, with a greater focus on prevention, early intervention and support based on individual needs. It also intends to strengthen oversight of ADHD and autism assessments, review advertising practices and introduce more consistent prices for NHS-funded services.
The changes are intended to address a persistent problem: people can struggle for months while waiting for an assessment, even when they need practical help immediately.
UK Mental Health Review Calls for Earlier Support
The Fonagy Review examined trends in mental health conditions, ADHD and autism, including changes in diagnosis, demand for services and access to support.
Its findings point to growing psychological distress among children and young people. The review identified several contributing factors, including social media, financial insecurity, uncertainty about the future, poorer sleep and weaker feelings of connection and belonging.
These pressures can affect concentration, relationships, school attendance and a young person's ability to prepare for adult life. When support is delayed, difficulties can become harder to manage, particularly for people dealing with several problems at once.
The report also distinguishes between mental distress and a diagnosed condition. A person may experience anxiety, emotional difficulties or problems coping at school without having received a formal diagnosis. That does not mean their need for support is any less real.
The government's proposed approach would allow people to access appropriate advice and assistance earlier, rather than making diagnosis a prerequisite for every form of help.
Diagnosis will still matter. People who need specialist assessment, medication or other clinical treatment must retain access to those services. The proposed change is to widen the routes through which people can receive help, not remove diagnostic services.
Why ADHD and Autism Diagnoses Are Under Review
The review found a significant increase in referrals and diagnoses for ADHD and autism. However, it reported that population-level prevalence of both conditions appears broadly stable.
This distinction is important because the number of people receiving diagnoses does not automatically establish how much the underlying prevalence has changed. Greater awareness, changing patterns of recognition, help-seeking behaviour and pressure on assessment services can all influence diagnostic figures.
The findings do not establish that rising diagnoses are simply the result of overdiagnosis. Nor do they suggest that everyone seeking an assessment can be adequately supported without one.
Instead, the review calls for a more considered system that recognises different levels of need. Some people may benefit from early advice, educational adjustments or community support. Others require a full assessment and specialist treatment.
The challenge for the NHS is to provide both without allowing long waiting lists to become a barrier to all forms of assistance.
Young People With Mental Health Conditions Face Employment Barriers
The review's findings also raise concerns about the relationship between mental health and employment.
An interim report from Alan Milburn's review of young people and work found that, among people aged 16 to 25 who were not in education, employment or training, 24% cited depression or anxiety as their main limiting condition. Another 22% cited autism, while 18% reported another mental illness.
These figures describe the conditions reported by this particular group. They should not be interpreted as estimates for all young people in England.
Nevertheless, they illustrate the difficulties that some young people face when trying to enter education or employment while dealing with mental health or neurodevelopmental conditions.
Without suitable support, a young person may struggle to complete coursework, attend interviews, manage workplace demands or maintain relationships with colleagues. Early assistance could help address these difficulties before they interfere further with education or employment.
Health and Social Care Secretary Yvette Cooper said the government wanted mental health services to focus more on the support young people need to remain in education, enter work and maintain their everyday lives.
The government has asked NHS leaders to examine how people can access advice, assessments and treatment more easily.
Government Plans Stricter Regulation of ADHD and Autism Assessments
The proposed reforms also seek to improve confidence in ADHD and autism diagnostic services.
The government is working towards making all diagnostic assessments for these conditions a regulated activity overseen by the Care Quality Commission (CQC), which monitors health and social care services in England.
The proposed approach would cover NHS-funded assessments, other non-NHS-funded assessments and assessments paid for privately by individuals. Integrated Care Boards would also be expected to strengthen oversight of the services they commission.
The aim is to ensure that diagnoses are based on sound clinical practice and that patients receive appropriate care, regardless of where they are assessed.
For families, the quality of an assessment can affect access to educational support, treatment and workplace adjustments. Poor-quality assessments or inconsistent clinical practice can leave people uncertain about their needs and the support available to them.
The government has also said the Health and Social Care Secretary will write to the Advertising Standards Authority about advertising for ADHD and autism services.
The review recommended banning direct-to-public advertising of NHS-funded ADHD and autism assessments. The government says it wants people to receive accurate information and to be protected from advertising that may encourage unnecessary assessments.
These proposals are still part of a wider reform process. The announcement does not mean that every assessment provider is already covered by a new regulatory requirement.
NHS ADHD and Autism Services Could Get National Pricing
NHS England plans to consult on a national set of prices for NHS-funded ADHD and autism services.
The proposed tariff would cover diagnostic assessments, support after diagnosis and follow-up appointments. The government intends the system to improve consistency, make public spending more transparent and reduce unwarranted differences in the costs of services.
NHS England intends to introduce the finalised payment arrangements from April 2027.
The pricing proposal comes alongside plans to review clinical guidance with the National Institute for Health and Care Excellence (NICE). The government and NHS will consider the review's implications for existing ADHD and autism guidance and work to implement relevant recommendations.
Consistent prices alone will not eliminate waiting lists. The results will also depend on staffing, available appointments and the ability of providers to deliver assessments and follow-up care to the required standard.
For patients, the practical test will be whether these changes improve access to reliable assessments and appropriate support.
Mental Health Support in Schools to Expand by 2029
The government is also pursuing measures intended to make support available earlier in schools, colleges and local communities.
Mental Health Support Teams are due to reach every school and college by 2029. The government says the programme will reach nearly 800,000 additional children and young people during the current year.
A further £7 million is earmarked for Early Support Hubs in 2026/27.
The government has also announced a £4 billion package for children with special educational needs and disabilities. The wider package is intended to improve inclusion in schools, expand access to specialist support and provide training for teachers.
Separately, the government plans to invest £1.8 billion over three years in its Experts at Hand offer. The programme is intended to bring professionals, including speech and language therapists, occupational therapists, specialist teachers and educational psychologists, into mainstream schools, early years settings and colleges.
For younger children and their families, the government plans to expand access to practical support throughout the first 1,001 days, from pregnancy to a child's second birthday. Building on the Healthy Babies programme already established in 75 local authorities, the expansion is intended to improve support for infant feeding, parental mental health and the development of strong relationships between babies and caregivers.
These initiatives address different needs and should not be confused with a single mental health funding package. Their effectiveness will depend on how the programmes are implemented and whether families can access the services they require.
NHS Mental Health Spending Forecast to Reach £16.1 Billion
Government plans also include expanding NHS Talking Therapies, with a target of enabling 915,000 people to complete a course of treatment by March 2029.
The government says mental health spending is forecast to reach £16.1 billion this year. It is also rolling out 159 new mental health centres and mental health emergency departments across communities.
The aim is to improve access to timely help and give people more opportunities to seek assistance before their condition reaches crisis point.
However, spending forecasts and service targets do not guarantee that every patient will receive treatment quickly. Results will depend on staff availability, local service capacity and the ability of different parts of the health system to work together.
The government plans to set out further measures in its cross-government Mental Health Strategy later this year.
Mental Health Charities Warn That Delivery Matters
Mental health organisations broadly welcomed the review's focus on earlier intervention but stressed that recommendations must lead to practical improvements.
Andy Bell, chief executive of the Centre for Mental Health, called for action to address rising distress, particularly among young people. He said the government, local authorities, the NHS, businesses and civil society all had a role in improving mental health outcomes.
The Mental Health Foundation also welcomed the report. Its director of policy and influencing, Alexa Knight, urged the government to prioritise prevention and focus on reducing the distress people experience.
Rethink Mental Illness chief executive Mark Winstanley warned that people with severe mental illness must not lose access to specialist services as community support expands. He stressed the importance of timely treatment for people with complex or acute needs.
Barnardo's chief executive Lynn Perry highlighted the overlapping pressures facing some children and families, including poverty, insecure housing and special educational needs. She called for an action plan with clear measures to hold organisations accountable.
Professor Subodh Dave, president of the Royal College of Psychiatrists, also called for shorter assessment waits, better access to specialist treatment and sufficient investment in the mental health workforce.
The shared concern is that early support must complement specialist care, not replace it. People with severe mental illness and those who need formal ADHD or autism assessments must continue to receive appropriate clinical attention.
What the UK Mental Health Strategy Must Deliver
The forthcoming Mental Health Strategy will set out how the government intends to respond to the review's recommendations. Its impact will depend on whether people can access help earlier, whether assessments become more consistent and whether specialist services have enough capacity to meet demand.
For families, the difference will be measured in practical terms: how long they wait for help, whether schools can provide appropriate support and whether a diagnosis leads to the treatment or adjustments a person needs.
The government's proposed shift is clear. People experiencing mental distress should not have to wait for a formal diagnosis before receiving appropriate help. But delivering that change will require more than a policy announcement.
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