Government pledges earlier mental health support without requiring diagnosis

The government has pledged to overhaul mental health support in England, promising earlier intervention for children, young people and adults without requiring them to wait for a clinical diagnosis before accessing help.

The commitment follows the publication of the Independent Review into prevalence and support for mental health conditions, ADHD and autism on 9 October. Chaired by clinical psychologist Professor Peter Fonagy, the review found that mental distress has increased substantially among children and young people, with contributing factors including social media, financial insecurity, uncertainty about the future, poorer sleep and reduced feelings of connection and belonging.

While referrals and diagnoses for ADHD and autism have risen significantly, the review found that population-level prevalence of the conditions appears broadly stable.

The government said it would respond through a new Mental Health Strategy, due later this year, with a renewed focus on prevention and early intervention. Support in schools, colleges and communities is intended to help people before their difficulties escalate, while timely diagnosis and treatment will remain available where clinically appropriate.

Professor Fonagy, Head of the UCL Division of Psychology and Language Sciences, said: “Our findings show a system under immense strain, where diagnosis has increasingly become a very narrow pathway to finding support for distress caused by complex and wide-ranging factors. This Review’s recommendations offer a roadmap to shift from a diagnostic labelling model to a flexible, needs-led system.”

He added: “Diagnosis remains essential and must be protected - what has to change is that it is no longer the only door through which help can be reached. If we judge success by a person’s overall wellbeing and ability to take part in work, education, and staying connected to their community rather than by a narrow mechanism like diagnosis, we can shift to a system that intervenes early in communities and safeguards specialist capacity for those with severe needs.”

Health and Social Care Secretary Yvette Cooper said the review demonstrated the importance of early intervention and the need for services to change so that young people could remain in education or work and keep their lives on track.

She said: “Professor Fonagy’s review has shown the importance of early intervention to address mental health and neurodevelopmental conditions and the huge distress these can cause. It is clear that mental health services need to change to focus more on the early support young people need to stay in education or work or keep their lives on track. We will set out our response in a new Mental Health Strategy in the coming months, building on the new mental health services we are already providing in schools and in the community.”

The government also plans to strengthen oversight and regulation of ADHD and autism assessments, working towards making all diagnostic assessments a Care Quality Commission-regulated activity. The proposed changes would cover NHS-funded, non-NHS-funded and self-funding patients.

Other measures include asking the Advertising Standards Authority to consider advertising practices relating to ADHD and autism services, and working with the National Institute for Health and Care Excellence to review the implications of the report for its clinical guidance.

NHS England will also consult on a national set of prices for NHS-funded ADHD and autism services, covering assessment, post-diagnostic support and follow-ups. The government intends for new payment arrangements to be introduced from April 2027, with the aim of improving consistency and transparency in the use of public money.

Cooper said: “Based on the review findings, we will also take action to strengthen the oversight of mental health and neurodevelopmental services, and make all diagnostic assessments for ADHD and autism CQC-regulated, so people can be confident that assessments are high quality and that the NHS is not being overcharged by independent or private providers.”

The wider package of measures includes expanding Mental Health Support Teams to every school and college by 2029, with nearly 800,000 additional children and young people expected to be reached this year. The government is also investing £7 million in Early Support Hubs in 2026/27 and plans to expand support for families during the first 1,001 days from pregnancy to a child’s second birthday.

It also plans to invest £1.8 billion over three years in its Experts at Hand offer, bringing professionals including speech and language therapists, occupational therapists, educational psychologists and specialist teachers into mainstream schools, early years settings and colleges.

NHS Talking Therapies is being expanded to enable 915,000 people to complete a course of treatment by March 2029, while 159 new mental health centres and mental health emergency departments are being rolled out across communities. Mental health spending is forecast to reach £16.1 billion this year.

Dr Nick Broughton, National Priority Programme Director for Mental Health, Learning Disability and Neurodevelopmental Conditions at NHS England and the Department of Health and Social Care, said: “This is a landmark moment for how we better understand the mental health needs across society, in particular the struggles many young people are now facing.”

He added: “We have taken important steps in addressing these challenges, with six million pupils now able to access NHS mental health support in schools, and we’re making it easier for people to get support for ADHD and autism conditions before and after diagnosis.”

The review’s findings prompted calls from mental health organisations for the government to move quickly from recommendations to action, with concerns that growing distress and long waits are leaving people without appropriate support.

Andy Bell, chief executive of Centre for Mental Health, said: “There is no longer any doubt about the rising prevalence of mental ill health in England, or its impact on people’s lives. So it’s time to take effective action to turn it around.”

He said the new Mental Health Strategy offered an opportunity to implement the review’s recommendations, adding that local government, the NHS, business and civil society also had a role in improving the nation’s mental health.

The Mental Health Foundation welcomed the report’s focus on prevention. Alexa Knight, its Director of Policy and Influencing, said: “The prevalence review findings could not be clearer - there has been a real, observable and substantial increase in mental distress across the UK. This crisis was never down to overdiagnosis. We now must move past unhelpful arguments about whether levels of poor mental health are real, and instead focus on reducing the preventing people are experiencing.”

The foundation said it looked forward to working with the government to ensure the recommendations were delivered and prevention prioritised.

Barnardo’s chief executive Lynn Perry highlighted the impact of long waits and fragmented services on children and families, particularly where mental health difficulties overlap with poverty, insecure housing and special educational needs and disabilities.

She said: “Through our services at Barnardo’s, we see children and young people in distress while facing long waits for assessments, diagnoses and support. This unacceptable situation is holding children back - it’s weighing them down in the classroom and playground - and it’s having a profound, often life-long effect on their health, education, relationships and future opportunities.”

Perry called for an action plan with clear measures to hold different parts of the system accountable for improving children’s health.

The Royal College of Psychiatrists also stressed the need to reduce assessment waiting lists and expand access to specialist treatment. Its president, Professor Subodh Dave, said: “Those showing initial signs of distress shouldn’t need a diagnosis to access basic levels of support at school, work or within their communities.”

He added that people with the most complex needs must retain timely access to psychiatric expertise, backed by investment and an expanded workforce.

The government said further action would be set out in its cross-government Mental Health Strategy later this year.