Helping people before they receive a diagnosis is a good principle. Without funding and enforceable access, it can also become a way to leave them with neither support nor the documentation needed to demand it. John Harris’s response to England’s Fonagy review turns on that distinction.
He welcomes the review’s rejection of claims that young people are simply fragile, and its finding that the evidence cannot establish autism or ADHD overdiagnosis at scale. A possible future risk of misdiagnosis is not proof that today’s applicants are inventing their difficulties. Harris also supports tighter oversight of private diagnostic clinics.
His concern is the proposed move from diagnosis-dependent provision to a “needs-led plus diagnosis” system. In principle, schools and services would respond to difficulties rather than requiring people to finish a long assessment queue first. But the report itself says the change requires increased capacity, clearer national standards and sustained investment. Earlier recognition of need does not supply the staff or services to meet it.
Harris quotes a parent’s account of a daughter who self-harmed, struggled to access child mental-health services and eventually received an autism diagnosis, only to encounter further barriers at school and in social care. The diagnosis did not produce adequate help. That is an argument for making support real, not for assuming the paperwork has no value: in an obstructive system, a formal diagnosis can still be one of the few tools families have.
This is the implementation question behind the reform. Does needs-led care give people another route to assistance while preserving access to assessment, or replace an imperfect entitlement with discretionary help that an underfunded service can decline? Harris’s column is a warning about that risk, not evidence that the proposed system has already failed. The promise becomes meaningful only when people can actually use it.