A diagnosis should not be the only door into support. Anna Bawden’s explainer of the Fonagy review makes that the central distinction: protect clinical assessment, but stop leaving people without meaningful help while they wait for it.
The 607-page review of England’s mental-health, ADHD and autism services rejects the idea that rising distress is merely greater awareness. It also makes a more careful claim about neurodevelopmental diagnoses than the overdiagnosis headlines suggest. Growing diagnosis rates and assessment queues do not, by themselves, establish overdiagnosis at scale; the report warns that the balance between underdiagnosis, misdiagnosis and overdiagnosis may be changing.
Its proposed alternative is a needs-led system, with support available through schools, GPs, community services and other settings before a diagnostic label arrives. Mental-health and neurodevelopmental support would be brought together. Specialist assessment would prioritize people facing the greatest difficulties, including self-harm or imminent exclusion from school or work, rather than simply serving the queue in arrival order. The authors say nobody should be removed from a pathway without appropriate assessment, communication and discussion.
Private assessment is part of the institutional problem, not a separate consumer choice. The review calls for stronger regulation and a ban on direct-to-public advertising of ADHD and autism assessments. The government has committed to Care Quality Commission regulation of assessments, but has not committed to the advertising ban.
The unresolved question is what “needs-led” means in practice. Earlier help would be a genuine improvement; a change in queue management without accessible support would not. The useful test is whether people can actually get help before diagnosis while retaining a route to the assessment they need—not whether the waiting list becomes easier to describe.