Perhaps the single most important finding of the independent review into mental health, ADHD and autism in England, published last Friday, is that mental distress across the population, and particularly young people, has substantially worsened. Its chair, Prof Peter Fonagy, told the BBC that the former health secretary Wes Streeting had been “completely wrong” to suggest that conditions and disorders were being overdiagnosed.
Mr Streeting acknowledged his mistake. But some rightwing politicians and commentators have leapt on the notion that medicalisation of ordinary states of mind is behind the huge rise in young people seeking help. This review should bury that idea. Instead, this should be a moment to face facts. First, that the rises in psychological distress, and the need for support with neurodevelopmental differences, are real and tied to social changes. Second, that current services are not up to what is being asked of them.
Fifteen years after the phrase “parity of esteem” gained prominence – the idea being that people with mental ill health have equivalent entitlements to those with physical illnesses – it is a long way from being realised. Years-long queues for mental health care and neurodevelopmental support are not even included in official waiting-list figures.
The difficulty comes in deciding what to do about this, particularly given the fiscal rules under which the government has chosen to operate. One proposal already accepted by ministers is for stronger regulation of ADHD and autism assessments. Currently, many of these are delivered by private providers, with no common standards in a market with low barriers to entry; such a situation should never have been allowed, though long waiting lists have driven the demand for their services.
There is no straightforward fix to the wider set of problems. The experts are right to say that access to services should be based on need, not labels. It is reasonable to challenge the way that a diagnosis has become a “door to support”, both in mental health and special educational needs contexts. But the more important question is how this situation came about. The answer is that demand overwhelmed services, and diagnosis-based thresholds became a form of triage. On the critical question of resources, the report has less to say.
It recommends stronger accountability for mental health in the Department of Health and Social Care – an excellent idea, and probably a precondition of improvement – and suggests that this and other proposals should be incorporated in the upcoming mental health strategy. Beyond that, it argues for a 10-year plan, one aim of which would be to roll mental health and neurodevelopmental support into one service.
This is an ambitious agenda, which deserves a serious response. But while Prof Fonagy may be right that some reordering of waiting lists could be managed at relatively little cost, it is inconceivable that broader reforms can be achieved without new funds. And while the report refers repeatedly, and rightly, to the need for investment, it does not explicitly state that budgets should increase as a proportion of overall health spending; nor does it make the case for waiting list targets.
Did the authors fear that such demands would be ignored? So far, Yvette Cooper has followed her predecessor as health secretary in saying relatively little about mental health and young people. Now is the time to show that she is listening.
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