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Charities and campaigners are calling for a systematic overhaul following an in-depth review into the prevalence of mental health conditions, autism and ADHD.
A government review which found that mental distress has increased significantly over the past three decades in young people must be a “watershed moment”, charities have warned.
The independent report into the prevalence of mental health conditions, autism and ADHD, led by British psychoanalyst Peter Fonagy, argued the system cannot continue as is, with too many unable to access support and their conditions worsening as they wait for a diagnosis.
The 607-page document was commissioned last year by then health secretary Wes Streeting amid concerns about growing assessment waiting lists and diagnoses.
In the report, Fonagy is emphatic that mental distress has “increased substantially across the population” and the rise cannot be explained by “greater awareness alone.” About one in four 16 to 24-year-olds are now thought to have a common mental disorder such as depression or anxiety, up from one in six in 1993. Meanwhile, self-harm, eating disorders, PTSD, OCD and drug dependence have also increased. However, rates of severe mental illness, such as schizophrenia and bipolar disorder, have remained more stable, while hazardous drinking has declined.
The report finds that the proportion of children aged six to 11 with an ADHD diagnosis has increased more than sixfold in five years, and for 12 to 17-year-olds more than 15-fold, to 2.7% and 3.9% respectively. More than 560,000 people are currently waiting for an ADHD assessment, while the number stands at 254,000 for autism assessments.
While the numbers do not themselves establish that overdiagnosis is “occurring at scale,” the report says, “the evidence suggests we are entering a phase in which the balance of risks between underdiagnosis, misdiagnosis and overdiagnosis may be changing.”
Fonagy and his colleagues found exponential growth in NHS spending on independent-sector ADHD services, with an increase of 252% over three years, and called for tighter regulation of these private companies.
The report also examined the pathways to receiving support, arguing it should not hinge on receiving a diagnosis, but instead should be given at the point of need.
More help should be made available within schools, GP practices, community services, social care and family hubs, he urged.
Waiting lists for assessment should also be “actively reviewed”, so that those with the highest needs are prioritised, rather than the first-come, first-served system continuing, it was argued.
Response to findings
Health secretary Yvette Cooper has welcomed the report. She said mental health services need to change to focus more on the early support young people need to stay in education or work or to “keep their lives on track.”
Work will commence on a new mental health strategy which will seek to make all diagnostic assessments for ADHD and autism regulated by the Care Quality Commission she added, so that people can be “confident that assessments are high quality and that the NHS is not being overcharged”.
Nuffield Trust Chief Executive Thea Stein, said that the report brought a “much-needed focus” to the growing levels of distress seen across the population, particularly among young people.
“It makes a powerful case that we have asked too much of diagnosis and simultaneously done too little to provide the practical support needed by people experiencing distress,” she added.
Andy Bell, chief executive of the Centre for Mental Health, said that the rise in mental distress must be tackled systematically by addressing “the wide range of stressors that are doing harm” and putting in place better and faster support where and when it’s needed.
“It means expanding early support hubs for young people, offering help and support without the need for a referral or appointment, in every community,” Bell said.
Mental health charity Mind is urging the government to adopt a same-day open access model, where people who reach out for help get an “immediate, meaningful response” on the same day.
Sarah Hughes, Mind chief executive, said the review demonstrated that the growing need for support is not due to a ‘snowflake generation’ or a case of overdiagnosis.
“This report needs to be a watershed moment,” Hughes said, “to make the change that people want and need to see.”
