Young People Are Outnumbered, Not Fragile — Patrick Butler

A rise in mental distress is not evidence that young people have become less resilient. Patrick Butler’s analysis of the Fonagy review of mental-health, ADHD and autism services in England makes the distinction explicit: anxiety and depression have increased, the impairment is real, and greater awareness alone does not explain it.

The review locates that distress in conditions rather than character. Young people face pandemic disruption, insecure work and housing, competitive pressures intensified by social media, and the loss of places to find support and belonging, from Sure Start to youth clubs. Fonagy, who writes about his own severe depression as a teenager, refuses the comparison in which an older generation’s endurance becomes proof of a younger one’s weakness. “They are not fragile. They are outnumbered.”

Butler’s more consequential point is about the machinery of help. Diagnosis has become a gate to clinical care, educational support and disability benefits. When NHS assessment takes more than a year, people remain unsupported while they wait; those who can afford a private assessment have a better chance of getting through. An administrative requirement turns differences in purchasing power into differences in access.

The review acknowledges a risk of overdiagnosis and criticises the reliability of unregulated private assessment providers. That is not a finding that overdiagnosis is already happening at scale. Treating those claims as interchangeable would erase the distinction the review is trying to preserve between recognising real difficulties and evaluating how accurately a system labels them.

Fonagy proposes identifying needs and triaging them earlier, rather than making a completed diagnosis the prerequisite for support. Butler does not present implementation as settled. The useful test is whether this changes what people actually receive: help while waiting, not simply a new way to sort the queue. The alternative to debating whether people deserve a label is asking what would let them function and participate now.