The government has committed to developing earlier, needs-led mental health support in England following an independent review that identified increasing psychological distress and weaknesses in access to assessment and treatment.
The Department of Health and Social Care published its response on 9 October alongside the final report of a review chaired by University College London professor Peter Fonagy. Ministers intend to use the findings to shape a forthcoming Mental Health Strategy, rather than claiming the proposed service reforms have already been delivered.
Fonagy was supported by vice-chairs Professor Sir Simon Wessely and Professor Gillian Baird. The review examined trends in mental health conditions, attention deficit hyperactivity disorder and autism, as well as the effectiveness of existing services and the evidence behind growing demand.
Its authors found a substantial rise in mental distress, particularly among children and young people, influenced by interacting pressures including financial insecurity, poorer sleep, social media and reduced feelings of connection. They also identified substantial increases in referrals and recorded diagnoses of ADHD and autism.
The report draws an important distinction between growing administrative prevalence, which reflects people recognised by services, and underlying population prevalence. It concludes that the latter appears broadly stable or has increased more modestly for ADHD and autism, while stressing the limitations of outdated population data and the need to avoid simplistic conclusions about diagnosis.
The reviewers also warned that individuals frequently experience overlapping difficulties that do not fit into a single diagnostic category. Delaying all support until a formal diagnosis is completed can leave people without appropriate help during long waits.
Ministers have endorsed the principle of supporting people according to their needs, with advice and interventions made available earlier in schools, colleges and communities. A clinical diagnosis and specialist treatment would remain important where appropriate, including when medication or more intensive care is required.
Health and Social Care Secretary Yvette Cooper has asked NHS leaders to examine how advice, assessments and treatment can become easier to access. The work will feed into a cross-government strategy expected later in 2026, with the detail of local delivery still to be developed.
The review has consequences for education and employment because delays in effective support can affect attendance, qualifications and participation in work. Its analysis also draws on Alan Milburn’s Young People and Work Review, which identified health-related barriers among young adults outside employment, education or training.
Earlier intervention may help people remain engaged in learning or employment, but the announcement does not provide measured evidence that the proposed reforms have already reduced absence, improved recruitment or returned a specified number of people to work.
Another significant area concerns the oversight of independent providers conducting ADHD and autism assessments. The Fonagy Review recommends changes to commissioning, funding and regulation, including making all diagnostic assessments a Care Quality Commission-regulated activity.
The government says it will work with NHS England and the Care Quality Commission towards that objective, covering NHS-funded, privately funded and self-funded assessments. The regulation is a proposed future arrangement, not a claim that every provider became subject to new rules on 9 October.
The department will also examine advertising practices. The review recommends banning direct-to-public advertising of NHS-funded ADHD and autism assessments, while ministers have committed to raising concerns with the Advertising Standards Authority about potentially misleading promotional activity.
A proposed national tariff would address another part of the market. NHS England will consult on standardised payment arrangements for NHS-funded ADHD and autism assessments, follow-up services and post-diagnostic support, with an intention to introduce final arrangements from April 2027.
Neither the tariff amounts nor their final application have been set by the October announcement. Independent assessment providers and healthcare commissioners will need to consider the outcome of consultation before determining how contracts or service models may be affected.
The review reports that independent providers conduct more than half of NHS-funded ADHD assessments and more than a third of autism assessments, making consistent quality, oversight and value for public expenditure material issues in commissioning decisions.
The response also references existing programmes, including mental health support teams in schools, community services and a £4bn package for children with special educational needs. That package is not an additional £4bn mental health allocation created by publication of the Fonagy Review.
The proposed changes will require coordination between NHS services, schools, commissioners and providers. Their success will depend on whether people obtain suitable assistance earlier, diagnostic quality is maintained and new oversight improves accountability without further restricting service capacity.
The October development establishes the review’s findings and the government’s direction of travel. The timetable, funding and operating rules for individual changes remain subject to future strategy, consultation and implementation decisions.
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