School pupils should get help for ADHD (attention deficit hyperactivity disorder) and mental health issues without a diagnosis, a major report is set to say.
The landmark review into the rising mental health, autism and ADHD diagnoses is expected to find that young people should not be left to languish on long NHS waiting lists before accessing support, according to sources with early sight of the recommendations.
Professor Peter Fonagy’s review into the question of overdiagnosis of these conditions, expected on Friday, is set to recommend a fundamental shift towards community-based mental health support rather than sending people down clinical pathways with long waiting lists.
It is expected to conclude that rising rates of distress are “real” and leading to a surge in diagnoses across mental health, ADHD and autism, with people increasingly having “comorbidities”, meaning multiple conditions at once.
Schools at the heart of early intervention
Services geared towards these conditions should be brought closer together so that people presenting with distress can access help more quickly, without having to go down an official clinical pathway before accessing support.
This is likely to involve “open access” to a “longer, fuller conversation” about what people need when they first present with an issue, a source with early sight of the report told The i Paper.
This means there should be a greater variety of entry points into support so that the current 10-minute GP appointment is not necessarily the first point of call.
This is likely to involve placing schools at the heart of early intervention for young people, with other potential models including early support hubs, social prescribing, physical activities, family help and youth provision.
It is hoped that this approach would bring down NHS waiting lists, giving those with “common” conditions such as anxiety the early support they need and those with “severe psychological conditions” faster access to clinicians, it is understood.
It comes alongside upcoming reforms to special educational needs and disabilities (SEND), which have been designed so more children can access help on a “needs-led” basis rather than relying on a diagnosis.
The new SEND legislation, officially announced in the King’s Speech in May, was expected to be published in November but faces delays caused by the change in Prime Minister, The i Paper understands.
It is set to see more pupils taught in mainstream schools with greater access to one-to-one teaching assistants, small group support and specialists such as educational psychologists without needing a specific diagnosis.
Autsim and ADHD ‘not over diagnosed’
Prof Fonagy’s report is expected to find that the rise in mental ill-health and distress among children and young people is real, rather than being primarily explained by increased awareness or changing diagnostic practices.
It will argue that diagnosis should not be the gateway to mental-health support, with young people able to receive help based on their needs before they reach a clinical threshold or receive a formal diagnosis, as previously reported by The i Paper.
It is expected to find that while autism and ADHD are not overdiagnosed at scale in the UK, there are pockets of overdiagnosis and misdiagnosis, with private ADHD clinics set to face regulation to prevent diagnosis from being inflated.
Most people are not seeking support without showing signs of challenges associated with these conditions, while a growing number may be incentivised to seek a diagnosis because support – including benefits such as PIP – can be difficult to access without one.
First of three major reports
Prof Fonagy’s review is the first of three major reports set to inform the Government’s approach to reforming the welfare system to address rising distress and get more young people into work.
Nearly one million young people aged 16-24 are not in employment, education or training (NEET) and the cost of out of work and disability benefits to this age group is £8.1bn.
It will be followed by Labour grandee Alan Milburn’s review into youth joblessness, which is expected to recommend wholesale changes to the welfare system to support young people into work and cut the benefits bill.
It is expected to be published after the Budget, with savings not expected until 2027, as previously reported by The i Paper.
Milburn is calling for “targets” for mental health waiting lists in the same way as there are for physical health, telling an event during Labour’s annual conference it is “one of the great anomalies in public health policy that there are very rigorous targets for physical health and no targets for mental health”.
He is trying to ensure there is earlier intervention for young people with mental health problems, who are often languishing on waiting lists. He told another fringe event by the Centre for Young Lives and Future Minds on Monday that young people expected immediate access to support.
“If you are on a health disability benefit today as a young person, you stand a 50 per cent chance in 15 years time of still being on that benefit and not working. And that is a disaster for your mental health and your prospects. We’ve got to change the model.”
He said that “everyone loses” in the current system where those with a “low-level disorder” sit on the same waiting list for a clinical pathway wait list as those with severe mental health issues, meaning everybody is “stuck in a queue”.
The Timms Review into personal independence payments (PIP) is also expected to be published in the coming months, and will recommend a complete overhaul of disability benefits to support more people into work, with some claimants encouraged to swap cash for other forms of support such as therapy.
The Fonagy review was launched by Wes Streeting in his former role as health secretary under Sir Keir Starmer to examine soaring patient demand for services relating to mental health, autism and ADHD.
A Government spokesperson said: “Last December, we asked clinical psychologist Professor Peter Fonagy to lead an independent review, examining the prevalence of – and support for – ADHD, autism and mental health conditions.
“Professor Fonagy’s final report will be published shortly, and will inform our new national approach in this area.”