Steering orders review into mental health and ADHD diagnoses

Health Secretary Wes Streeting is launching an independent review of the rising demand for mental health, ADHD, and autism services in England.

It will look at both whether there is evidence of overdiagnosis and what gaps in support exist.

The government said it was already investing in expanding services, but there are long waits for therapy in many areas.

NHS figures show rates of mental health problems and ADHD have increased significantly over the past two decades, and the government believes there are people on waiting lists who do not need treatment.

He announced the new review, emphasising the need for a strictly clinical approach to gain an evidence-based understanding. That’s the only way we can ensure everyone gets timely access to accurate diagnosis and effective support.”

It comes as ministers are seeking to tackle a growing welfare bill, although the Department of Health and Social Care (DHSC) has stressed this review is running separately.

While some benefits require people to demonstrate how a health condition is affecting their ability to work, a formal diagnosis is not strictly necessary for many.

Earlier this year, the government was forced to climb down on planned cuts to disability benefits, including for those with mental health conditions, after facing a major backlash from more than 100 of Labour’s own backbenchers.

But on Monday, the prime minister promised a renewed push to reform the welfare system, which he said had “trapped people in poverty” and written “young people off as too ill to work.”

Clinical psychologist Prof Peter Fonagy is leading the new review, which will publish its findings in the summer.

Prof. Fonagy said the aim was to “test assumptions rigorously and listen closely to those most affected, so that our recommendations are both honest and genuinely useful.”

NHS figures indicate that the number of adults aged 16 to 64 reporting mental health problems reached 22.6% in 2023-24, up from 17.6% in 2007.

Rates are higher among the young and the unemployed.

Meanwhile, 14% of adults are reporting ADHD symptoms, up from 8% in 2007, although experts believe only around 5% or just under have clinically diagnosable levels of ADHD.

As of March, around four million working-age adults in England and Wales claimed either disability or incapacity benefits— up from almost three million in 2019, according to research from the Institute for Fiscal Studies.

The DHSC said the increased pressure on the NHS meant that, “for too long, people with acute needs have faced long waits, had to navigate overstretched services, experienced inequalities in care, and felt abandoned when support was needed most.”

One of those affected is Jenny Tan, a 23-year-old student from Surrey. It took nearly two years for her to get her diagnosis of anorexia, by which time the hospital told her she was one of the worst cases they had ever seen.

She describes the concept of overdiagnosis in her context as a joke. “I fought so hard for a diagnosis; it took years,” she added.

The review will examine the functioning of NHS services and identify potential early support interventions.

Government sources said they wanted to establish a baseline for diagnosis and what good-quality care looked like.

It is thought one of the factors in long waits was that people who did not necessarily need treatment were ending up being referred on to waiting lists when practical support, such as help with social or financial issues or a short burst of talking therapy, could provide the solution.

Schools have already made investments to enhance support and expand their talking therapy services.

London GP Prof Sir Sam Everington, who is president of the Royal College of GPs, said his workload with mental health patients has “sharply increased” in the last few years

“There’s a lot of pressure from social media for people to have a diagnosis.

“So you give everyone a medical badge for anxiety, depression, or a medical diagnosis, when a lot of this is just the ups and downs of everyday life.”

“I think the message we often convey is that we have a solution to someone’s problem, suggesting that there is a pill or a silver bullet that will resolve everything.” Well, it’s not.”

Mental health charity Mind welcomed the government’s announcement and signalled their willingness to contribute to the review.

“This is a huge opportunity to really understand what is driving increasing levels of mental illness, especially among our young people,” chief executive Dr Sarah Hughes said.

The National Autistic Society said, “We need urgent action because, while we are currently seeing the number of people seeking an assessment levelling out, the average waiting time is rocketing.”