A short while ago, we heard from Nicola Lathey, who set up the Owl Centre which provides diagnoses for ADHD and autism.

She was asked whether concerns about private diagnoses are fair, after the independent review raised questions about the "consistency and quality" of assessments.

"It's very difficult to answer that outright," she tells Radio 4's World at One programme.

But she adds that existing guidance and protocols are "very rigid" and "don't leave gaps for your own interpretation".

"All providers should follow the same protocols, which adhere to the CQC [Care Quality Commission] standards," she says.

Asked whether there is a difference between these standards and actual regulation, Lathey says: "The problem has arisen because providers who don't offer a medication service for ADHD have been allowed to provide ADHD assessments".

She says the CQC only regulates those with a medication service attached.

The review also raises "strong concerns about the consistency and quality of ADHD and autism assessments being carried out by independent providers," as well as "the financial incentives" associated with these assessments

• Independent providers now carry out "more than half of all NHS-funded ADHD assessments and more than a third of autism assessments", it says, citing 2026 data from the Center for Health and the Public Interest
• Spending on independent-sector ADHD provision - this is the money the NHS pays independent providers of assessments and care - has risen by around 252%in three years

Though the report stresses that it is not criticising independent provision "in principle", it says that this process runs "without consistent oversight, transparency or quality assurance".

In response, the government has promised a new Mental Health Strategy to regulate ADHD and autism assessments to ensure they are "high quality".

Image source, Getty Images

Liberal Democrat MP Layla Moran tells Radio 4's World at One programme: "I really welcome this review."

She says the Health and Social Care select committee, which she is part of, has teamed up with the Education select committee and is doing a joint inquiry into children's mental health.

She says the "thesis question" they have come to is: are children and adult mental health services "frankly broken"?

Moran says the post bag in her constituency of Oxford West and Abingdon is "chocka full" of parents of children saying they can't get help they need and "just can't afford" to get a private diagnosis.

There is "very clearly a big problem here", she says.

Miya Chahal
BBC Newsbeat

Image source, Caitlin Labonte

Caitlin Labonte describes her journey to getting an ADHD diagnosis as "long-winded".

"Before I was diagnosed I really struggled with my sleep," she says. "I actually slept through one of my A-levels so I missed one of the exams."

Around the same time, she was diagnosed with depression and anxiety but spent a year on a waiting list to check for ADHD. When she turned to a private clinic, she says "within three months I was diagnosed and medicated".

Labonte doesn’t accept that private clinics are over-diagnosing and believes patients "won't get diagnosed if they don't have it".

"We're raising more awareness," she says.

"We should be celebrating that we're getting these incredible opportunities to help more children get diagnosed, to help more women get diagnosed, more people of diverse backgrounds diagnosed."

Kate McGough
Education reporter

A young person is considered "Neet" if they are aged between 16 and 24 and are not in education, employment or training.

They could be unemployed and looking for work, or what’s known as "economically inactive", which means they’re not looking for work – which could be because of caring responsibilities, or health reasons, for example.

Nearly a million young people (981,000) were Neet between April and June this year, according to the latest stats from the Office for National Statistics. That's about one in eight young people in the 16-24 age range.

The Fonagy review was ordered to look into the rise in mental health issues among young people, as well as referrals for conditions like ADHD and autism.

Both of those can be linked to difficulties during school, including persistent absence, which can then lead to a greater risk of a young person becoming Neet.

The review's recommendations could therefore have repercussions for government policies on how to intervene earlier in young people's lives to reduce that risk.

Another review looking specifically at why the number of Neets is so high, led by Alan Milburn, is due to be published later this year.

Beth Rose
Disability affairs reporter

The charity Young Minds, which supports young people with their mental health up to the age of 25, says "now is the time for action and investment".

"For years, young people have told us they feel blamed for their mental health or accused of making it up," says Abigail Ampofo, interim chief executive.

"We hope this review goes some way to show them their distress is not their fault and the systems around them are failing."

The national disability charity Sense, which supports people with autism, ADHD and mental health conditions, says it "strongly welcomes" the review's recommendation for more individual support, but says it is "vital" that disabled people with complex needs are not "overlooked" in any reforms.

Chief executive James Watson-O’Neill says success shouldn't be measured in the number of diagnoses or shorter waiting lists, but in "whether disabled people have a better quality of life".

Image source, PA Media

As we've been reporting, the review has pointed to a "a very real rise" in mental health problems in young people. It lays out multiple environmental factors that have contributed, including:

• Schools:Are "more focused on high-stakes assessment", with fewer chances for "unstructured time", or physical, creative and vocational learning
• Community infrastructure:Things like youth services - have "eroded" over the past 15 years
• Jobs and living situation:A "less secure labour market", a rise in student debt, an increase in private renting alongside a drop in home ownership, and a rise in the proportion of those living with parents into adulthood
• Covid: The pandemic "interrupted" experiences that "support belonging, competence, autonomy and confidence in the future"
• The digital world: While it stresses that it's "difficult" to estimate the effect of digital environments on mental health, many online experiences - including social comparison, body dissatisfaction, sleep disruption, cyberbullying, harmful content - chime with difficulties young people raised elsewhere in the review

The report also says that there has been a "changing understanding of mental health and neurodevelopmental conditions".

It points to a "greater awareness of" and "wider use" of psychological language, which has "reduced stigma, improved recognition" and "brought previously unrecognised needs into view".

A common theme among those with ADHD and autism who we've been hearing from this morning is a struggle with access to a diagnosis and additional support.

• It took eight years until Heather Carpenter'sson was formally diagnosed with autism, but she recalls the anguish as they waited and the relief afterwards as she realised "he wasn't a bad kid and I wasn't a bad parent"
• Twenty three-year-old Jasmine King says everything in her life is "on hold" while she waits for a diagnosis - "I have no support, no medication and no full understanding of myself"
• While Christine Adams, whose seven-year-old grandson has been waiting four years for an assessment, says teams at his primary school say they can no longer meet his needs
• Amy, who got an ADHD diagnosis in 2023, says a lot of women like her go under the radar and are "forgotten about" because they don't "present in the normal way people assume ... the naughty child in school"

• Ryan and his wife first realised their son Atlas was missing development milestones when he was around 12 to 18 months, but it took three years for them to get an autism assessment - he's now nearly seven, non-verbal and still wears nappies. Ryan's main frustration is the lack of a fast-track route for children, like Atlas, with more complex needs

Imogen James
Live reporter

Today's review was commissioned by Wes Streeting last year when he was health secretary, in the wake of comments he made to the BBC's Laura Kuenssberg.

He told her he believed there was an "over-diagnosis" of mental health conditions.

Today, the author of the report Prof Peter Fonagy says Streeting was "completely wrong".

His says his findings show that "there has been a rise in distress and mental ill health amongst young people which is very, very real".

The general secretary of the National Education Union says the review shows this rise is related to "greater educational pressures, social media, loneliness and insecure housing".

Want a rundown of what ADHD, autism and mental ill health are? Read our explainer from earlier.

The report said the increase in diagnoses for those with ADHD and autism was down to the fact that many had remained undiagnosed.

But getting a diagnosis isn't a quick process. We've been hearing from people on the waiting list, who have told us how hard it is to remain in the dark.

Jasmine King, 23, has waited nearly five years for an NHS ADHD assessment and says the impact has been "unbearable".

Natasha says she's in a state of limbo, two years into her time on the waiting list.

But the risk of over-diagnosis going forward is real, given the rate at which diagnoses are increasing, our health correspondent Nick Triggle explains.

Nick Triggle
Health correspondent

Image source, Getty Images

The rise in mental distress among young people is down to a variety of factors, according to the review.

Economic uncertainty is a key one. But the authors have also cited cuts to community and youth services over the past decade, saying that has resulted in a loss of a sense of belonging and less social interaction.

Loneliness among young people has been on the rise for the past 20 years.

That rise in loneliness also coincides with the explosion in mobile phone use and the move into the age of social media.

People have become more reliant on their phones for interactions - and less likely to socialise face-to-face. This was exacerbated by Covid.

The review authors said it should come as no surprise this has lead to more distress because research shows personal relationships and feeling part of a community are crucial to good mental health.

Rozina Sini
BBC Your Voice

Lauren Tann is an occupational therapist in Derbyshire who works with children with high functioning autism and ADHD.

One of the biggest issues among those she works with is children with "extremely low self-esteem due to the failings in support".

Tann says in the most extreme cases, she's seen children as young as 10 experience self-hatred and self-harm.

She says it's important to help those with these conditions and "educate the rest of the population on the difficulties they face and therefore reduce the associated mental health risk".

She also warns that with a growing population, the number of people with these conditions is also due to grow.

On top of that, Tann adds, "the lack of appropriate diagnosis previously means adults did not know their struggles were due to this".

Rozina Sini
BBC Your Voice

Christine Adams from Tameside has shared with the BBC her seven-year-old grandson's struggles with getting diagnosed.

She says he's been waiting for an autism and ADHD assessment for more than four years. While he has an education, health and care plan (EHCP) in place at a mainstream school, the school's special educational needs coordinator thinks they can no longer meet his needs.

"Everyday life can be very stressful and difficult, but without a diagnosis possible treatment and professional input cannot happen," Christine explains.

"The system is failing."

Image source, Christine Adams

Hazel Shearing
Education correspondent

Image source, Getty Images

The review shows the rise in mental health conditions is related to “greater educational pressures, social media, loneliness and insecure housing”, the general secretary of the National Education Union says.

Daniel Kebede says plans for Year 8 pupils in England to sit reading tests will “add to pressure at school”.

He says young people are “waiting too long” for mental health appointments and “missing vital education in the meantime”.

“Teachers are not specialists and cannot carry on picking up the pieces," he says.

Nick Triggle
Health correspondent

When Wes Streeting claimed young people were being over-diagnosed with ill mental health, ADHD and autism, he caused controversy.

The review team is adamant the rise in mental distress is real – placing the blame on economic uncertainty, the impact of Covid and social media.

But the same is not true for ADHD and autism. It said the proportion of the people in the population with those neurodevelopmental conditions was broadly stable.

Instead the increase in diagnoses that had been seen was down to the fact many had remained undiagnosed, the review said. Greater awareness had seen more people come forward for help, but there was now a risk of over-diagnosis.

It said it could not say that was happening at scale currently, but the risk certainly going forward was real given the rates at which diagnoses were increasing.

This is particularly in younger age groups where they already appeared to be outstripping the expected number of cases in the population – although they said they could not be absolutely certain because of weakness in the data.

Joe McFadden
Health reporter

I’ve been speaking to Natasha, a 32-year-old airline worker who has been on an ADHD waiting list for over two years - which has left her in a state of limbo and adding to the stresses of everyday life.

Natasha suspects she has autism as well as ADHD but wants to get diagnosed through the NHS. This, alongside the already long wait for an ADHD diagnosis, has discouraged her from seeking further help.

“I don't want to tell people, 'oh, I have ADHD' if I don't know for sure that I actually do have ADHD.”

“It's really expensive to get a piece of paper that you don't trust," she says. “And because I also think I have autism, that's two diagnoses."

“If it's not thorough, it's just money down the drain,” she adds.

Compared to others, Natasha has lower support needs but says there are things that could be done to make it easier for her - and, as the report highlights, currently the main way to get help is through a diagnosis.

“I'm exhausted a lot of the time,” she says. “I mostly get stuff done but it just feels like I'm living my life on hard mode.”

Erica Witherington
Disability affairs reporter

Jasmine King, 23, has waited nearly five years for an NHS ADHD assessment and says the impact has been "unbearable".

"I don't want ADHD," she says. "I want help for whatever it is I'm struggling with."

She remembers sitting at the back of the exam hall at school with extra time and rest breaks, crying as other pupils completed their papers.

She believes people whose difficulties have the greatest effect on their daily lives should be assessed sooner.

"I am late everywhere and arrive at most places in tears from all the stress of trying to be on time," she says.

In one job, she says she was criticised for being "too slow" and not using initiative. Trying to keep up left her stressed and exhausted, she says.

"Everything in my life is on hold. I have no support, no medication and no full understanding of myself."

She can't afford a private assessment and says repeatedly contacting her local ADHD service has brought no answers.

"I don’t see the waiting ever ending," she says.

Image source, PA

Today's review forms part of the government's 10 Year Health Plan for England which was published last year under Keir Starmer's government. It's now a mantle that has been picked up by Andy Burnham's government.

The plan has three pillars: hospital to community, analogue to digital, sickness to prevention.

In August, the government announced a £343m expansion plan to open more than 150 NHS mental health centres in England - including centres for walk-in support and emergency departments - building on a previous initiative.

Health Secretary Yvette Cooper has welcomed the findings of the Fonagy review and says they show "the importance of early intervention to address mental health and neurodevelopmental conditions".

The government will work on a new Mental Health Strategy that will regulate ADHD and autism diagnostic assessments and ensure they are "high quality", she says.

Dr Nick Broughton, who leads the national priority programme for mental health at NHS England, has called the review "a landmark moment" for our understanding of mental health needs across society, in particular among young people.

Broughton says the NHS is "ready to play its part" in giving young people the best chance of succeeding "in a complex and ever-evolving society".

He points to steps the health service has already taken to address challenges, such as ensuring six million pupils can access NHS mental health support in schools.

Broughton adds that NHS teams are also "making it easier for people to get support for ADHD and autism conditions before and after diagnosis".