An independent review has found that there is no large-scale overdiagnosis of mental ill-health – despite the Government’s attempts to claim that there is.
The review found a real rise in distress, real shortcomings in diagnostic psychiatry, and real unpreparedness within mental health services to deal with population-wide misery caused by systemic failings.
In this long read, we outline the review’s findings, offer our analysis, and outline three key actions we must take to ensure the review makes real change to our mental health system.
The Fonagy review, also known as the ‘prevalence review’, came about in the wake of last year’s attempts to cut social security for Disabled people. Decision-makers sought to justify these cuts by claiming that mental health was being overdiagnosed. Many of the Government’s plans were abandoned due to the relentless campaigning of Disabled people and their organisations, but the Government remains intent on scapegoating disabled people.
The review was commissioned by the Department of Health and Social care, and conducted by a group of independent researchers, headed by prominent UK clinical psychologist Professor Peter Fonagy. The report was published on 9th October 2026. It is 600 pages long and supported by multiple annexes and additional documents.
- There is no widespread overdiagnosis of mental ill-health. Distress is on the rise across the population – particularly among young people – and people are not getting the support they need. The overdiagnosis debate is a distraction from this problem.
- Wide-ranging systemic factors are driving distress. These include poverty, financial insecurity, unemployment, and housing pressures, compounded by the lasting impact of COVID-19, climate change, and wider political instability. The report also cites the increasingly competitive nature of society, which drives loneliness and reduced opportunities for rest and community building.
- Common mental health problems like anxiety and depression are rising sharply. Indicators of psychological distress, such as worry, panic, self-harm, and fatigue are also becoming more common.
- Distress is not distributed equally, nor is access to treatment. Those most likely to need support are the least likely to access it – this is especially true for certain groups, including those in prison, care-experienced young people, poor people, racialised people, Disabled people, and queer/trans people.
- Overreliance on diagnosis is failing those who need care. The review finds that the current system relies too much on a diagnosis as a gateway to care. Too often, people cannot access care because they are waiting for a diagnosis, or find themselves with multiple diagnoses. Rather than getting support from multiple services, those with concurrent diagnoses often find themselves supported by none.
- The mental health system is disconnected and hard to navigate. We need to drastically change how mental health support is organised in order to address this. As the review states, ‘the opportunity now is not to simply manage rising demand, it is to build a better system’ (page 6).
- The report makes nine key recommendations for the Government, urging that each should be implemented within the next 12-24 months. The recommendations range from earlier intervention, prevention, and improvement of mental healthcare to the expansion of pre-existing schemes.
- The review recommends that the shift from a diagnosis to a needs-based mental healthcare system should be done through ‘developing a digitally and AI-enabled shared needs assessment’ but it is not clear exactly how this would be implemented.
- It also urges an ‘ambitious approach to scaling up safe digital and AI-enabled tools’ to improve the cohesiveness and efficiency of the mental health system. There is limited analysis of the ethical, legal, and environmental consequences of this approach.
Our take
Overall, we welcome the Fonagy review as a fair analysis of the state of mental ill-health and psychological distress across the UK. It is strong in its rebuttal of dangerous misinformation and reductive narratives around mental ill-health, particularly those which seek to trivialise it or blame people for their own despair. The review confirms what many of us have known for a long-time: distress is rising sharply, driven by avoidable systemic harms rather than personal failings.
While it is significant and validating to see these factors acknowledged in the review, much of this is not news to us. We can only hope that, now these drivers of distress have been identified by an independent review, decision-makers might actually take them seriously.
Putting the overdiagnosis “debate” to bed
We are vindicated by the finding that there is no widespread overdiagnosis of mental ill-health in the UK. We are also relieved that the review explicitly rejects the idea that increased rates of mental ill-health can be explained by increased awareness or social media-driven self-identification. We have always known these narratives to be misguided and dangerous.
The overdiagnosis label is especially inaccurate when it comes to so-called ‘severe mental illness’ (SMI), such as bipolar disorder or schizophrenia, of which the prevalence has remained broadly stable in recent years, according to the review. Far from seeking medical support, too often, many living with so-called SMI find themselves trapped within and desperately trying to escape the psychiatric system, all while carrying stigmatising diagnoses which they never sought at all. Absurdly, those same people are often seen as a burden on the system for receiving inappropriate support that they did not consent to in the first place. This is a particularly serious problem for people who are already marginalised for other reasons.
We are hopeful that this review might finally put the overdiagnosis debate to bed. We are equally hopeful that it might help more people to see this narrative for what it is: an attempt to scapegoat those made most ‘vulnerable’ in society for issues we did not create.
A challenge to diagnostic psychiatry
Elsewhere, we were surprised and encouraged to see such a clear challenge to diagnostic psychiatry in the review. It highlights how making support conditional on diagnosis can leave people waiting longer for the care they need, while also clarifying that people experiencing distress without a diagnosable condition must be supported. In addition to this, the review acknowledges that diagnosis can complicate people’s access to support, particularly when a person has multiple diagnoses, and especially when these span physical and psychiatric conditions.
‘People are seeking answers and support for very real problems, and they are not the problem. The problem is a system that leans too heavily on diagnosis as the route to help and cannot keep pace.’ (page 15)
The review’s analysis of psychiatric diagnosis as something that can be helpful and/or harmful, depending on the person and the context, is balanced. We agree that the current mental health system relies too heavily on often inappropriate and limited diagnostic categories. We also agree that people would be better served by an alternative approach, which focuses on people’s needs rather than their diagnoses. Any new system must lead to more, rather than less support.
We welcome radical reform to the psychiatric system, but maintain our position that this can only be led by those with lived experience.
What next?
We will continue to push for real change in the mental health system. which can and must only be led by those most affected. Some key actions we can take to that end are as follows.
- Demand systemic solutions to systemic harms
The review suggests a shift from a diagnosis-based health system to ‘needs-led’ one. This could be an important opportunity to overhaul the mental health system as we know it.
However, we must be careful not to let a focus on individual needs obscure the systemic drivers of mental ill-health that the report itself identifies. While improving opportunities for human connection or well-supported work would undoubtedly be helpful for many, we must also address the broader issues at the root of the problems mentioned in the report. This means tackling the climate crisis and the corporations driving it, and guaranteeing high quality, affordable and accessible housing, for example.
The review finds that the drivers of mental ill-health are deeply rooted in our society, so the solutions must be bold.
- Fight media misinformation
Disabled people have been drawn into the culture wars through irresponsible and dangerous reporting about our lives. Reporting occurs either without us entirely, or with us but often in ways that are extractive and harmful.
We must continue to tackle misinformation, which we are already seeing in relation to the Fonagy review. For example, some misleading headlines could lead readers to believe that ADHD and autism are being widely overdiagnosed, which is not what the review found. While it acknowledges a risk of overdiagnosis, the most consequential findings of the review are that mental distress has risen across the population – driven by structural problems – and that the mental health system needs radical reform in order to give people comprehensive support regardless of diagnosis. Fonagy and his team are clear that the debate on overdiagnosis is a distraction from this issue.
When it comes to ADHD and autism, the review finds that the recorded diagnosis of both conditions is approaching – and, in some cases, exceeding – expected levels based on available data about their prevalence across the whole population. However, it also acknowledges that this data is outdated and unreliable. This is why it cannot conclude that widespread overdiagnosis is occurring.
We will continue to fight misleading narratives about mental ill-health, neurodivergence, and disability.
3. Keeping eyes on tech
The review confirms much of what we have long known about NHS mental health services: they are fragmented, difficult to access and hard to navigate. As a result, patients often find themselves facing assessment after re-assessment in order to access support.
While the review suggests ‘radical reform’ in some places, it falls short on its ideas for how to join up mental health, social care, employment, and education. In almost all instances, it suggests scaling up ‘digital and AI-enabled tools’ with limited analyses of the ethical, environmental, data, and human rights implications this kind of solution poses.
The NHS is already intent on increasing its use of AI, as evidenced by its pledge to shift from ‘analogue to digital’ in its plan for the next 10 years.
The misguided rolling out of poorly regulated, for-profit technology is already a problem within the NHS and we can expect this to be further complicated by increased interest in AI-enabled tools. Patients are harmed by experimental technologies such as Oxevision, and NHS Trusts can find themselves embroiled in costly legal battles as a result of their use.
The involvement of big tech companies such as Palantir in the NHS is part of the same problem. Such companies advertise themselves as offering efficient solutions to the problems of the NHS but are elsewhere providing services for military operations, border enforcement, genocide, and policing. If political instability and climate change are, as the review finds, contributing to the mental health crisis, then those who profit from them have no place in our health service.
NSUN will continue to demand that the NHS does not uncritically accept AI adoption as the answer to its problems. Where tech is used we will fight for it to be done responsibly and in the best interests of patients, not corporations.