The Fonagy review has dealt a severe blow to arguments for cutting benefits on the grounds that autism, ADHD, anxiety and depression are being widely overdiagnosed, particularly among young people. It also quashes the claim that cutting benefits is a helpful intervention in claimants’ lives.
In fact, the review has found that “The rise in mental health problems is real, is affecting everyday functioning” and in relation to autism and ADHD that “we cannot conclude that overdiagnosis is occurring at scale”.
Crucially, Fonagy agrees with the findings of a separate review, that “increases in individual or household income improved mental health and wellbeing, while decreases worsened them”.
Background
The Fonagy review was commissioned by Labour’s Wes Streeting when he was health secretary. In March 2025, Streeting had claimed that “mental wellbeing, illness, it’s a spectrum and I think definitely there’s an overdiagnosis”. His comments attracted widespread criticism. In December he commissioned the Fonagy review “into the prevalence and support in England for mental health conditions, autism and ADHD”.
The Fonagy review is feeding into both the Milburn review and the Timms review. There is a strong suspicion that both reviews hoped that Fonagy would provide justification for reducing support for claimants with autism, ADHD, anxiety and depression.
Indeed, DWP secretary of state Pat McFadden said that he had asked members of the Timms review steering group to particularly look at the way PIP is designed [question 25] in relation to “conditions like anxiety and depression, neurodiverse conditions”.
The Fonagy review published its 600 page report last week and its findings are likely to be a disappointment to senior Labour figures.
Below we have highlighted some of the most important quotes that undermine the justification for benefits cuts.
ADHD and autism
The review points out the lack of reliable, current data about how common ADHD and autism are in the general population, explaining that “population prevalence data remain limited and less up to date than for many other conditions”. It finds that to date the evidence does not support the claim that there has been widespread overdiagnosis of these conditions, although it warns that there is an increasing risk that this will occur in the future. (Text is put in bold by the report’s authors, not Benefits and Work).
“On the basis of evidence available to us we cannot conclude that overdiagnosis is occurring at scale, particularly given the gaps in population prevalence data and data reporting. However, if present trends continue we are clearly entering a phase in which the balance of risks is changing, from previous merited concerns with under-recognition and underdiagnosis towards an increased risk of misdiagnosis and overdiagnosis, which are becoming increasingly important considerations for policy and service delivery.” [p.15 para 33]
The solution it recommends is not a benefits crackdown, however, but high quality assessment, timely diagnosis and clinical support when people need it:
“Under-recognition nevertheless continues for some groups. The increasing risk of overdiagnosis or misdiagnosis cannot mean neglecting those often overlooked. The requirement is for comprehensive, high-quality assessment and timely diagnosis where needed, while making practical and clinical support available according to need rather than diagnosis alone.” [p.15 para 34]
Most importantly, the report challenges any suggestion that rising assessment numbers mean people’s difficulties are less serious or less real:
“None of this should be taken to suggest that people’s distress or difficulties are not real. If anything, the evidence points the other way: the rising numbers coming forward for assessment have not been accompanied by any fall in severity or impairment – those now presenting are no less affected than those identified before. People are seeking answers and support for very real problems, and they are not the problem.” [p.15 para 35]
Fonagy recommends an overhaul of mental health and neurodevelopmental services, including having the Care Quality Commission (CQC) regulate all ADHD and autism assessment providers. [p.444]. Health secretary Yvette Cooper has now undertaken to ensure that all ADHD and autism diagnostic assessments, including those provided privately, are CQC regulated in future.
Mental distress
Similarly, the report finds that there has been a real increase in mental distress across the population, but especially amongst young people and that the “rise in mental health problems is real”.
“Mental distress has increased substantially across the population. Both the population and administrative prevalence of common mental health conditions, particularly anxiety and depression, has risen significantly across all age groups, but at a substantially faster rate for young people. The proportion of adults aged 16-64 years old meeting criteria for a common mental disorder increased by almost half, from 15.5% in 1993 to 22.6% in 2024. Among 16–24-year-olds it increased from around one in six to one in four, with young women now reporting the highest rates of any group. Self-harm and eating disorders have also increased among young adults. The rise in mental health problems is real, is affecting everyday functioning, and cannot be explained by greater awareness alone.” [p.8, para 17].
Poverty
The review does not make recommendations on benefit rates or eligibility, but makes it clear that reducing household income increases mental distress. This seriously undermines any argument that cutting benefits for young people will increase their motivation and chances of obtaining employment.
“A systematic review of 136 studies found that increases in individual or household income improved mental health and wellbeing, while decreases worsened them, with the largest effects seen when people were lifted out of poverty.” [p.344]
It also concluded that poverty is a root cause of mental distress:
“The social determinants review concludes that poverty is “inextricably linked to most social determinants of mental health, and could be considered a root cause”, and that no public health approach to mental health that fails to address it is likely to achieve its aims.” [p.344-345]
Not only that, but the way benefits changes are introduced can be a cause of mental distress:
“… the design of the benefits system is itself a mental health intervention, for better or worse. The rollout of Universal Credit in England was associated with a 6.6 percentage-point increase in psychological distress among those affected, equivalent to tens of thousands of additional people crossing the threshold for clinically significant distress.” [p.344]
So, Fonagy provides strong support for the argument that cutting benefits, such as the universal credit health element and PIP for young people, will make matters worse rather than better.
Other passages may offer ministers support for changing assessments, but they do not remove these warnings about poverty, financial protection and unsuitable work:
“Diagnosis remains important evidence of need but should not automatically be interpreted as evidence of fixed or permanent incapacity. As the Review has noted, diagnosis can open doors, but it can also close them. With the exception of people with severe or profound intellectual disability, with or without autism, describing someone as having fixed and permanent incapacity may have serious unintended consequences.” [p.372]
Employment
The report is also very clear that focusing on pushing people into work too soon and without regard to the quality of that work can make matters worse. It is also clear in its conclusion that for some claimants, social inclusion may be a much more important goal than job search.
On insecure and unsupported work, Fonagy explains:
“Low participation should not be interpreted as lack of ability, motivation or aspiration. Work is not invariably beneficial, and an early return is not always appropriate. Secure, well-designed and supported work can promote recovery, while insecure or unsupported work can worsen mental health” [p.363]
The report stresses the need for “financial protection” for people whilst they move towards participation:
“For many mental health and neurodevelopmental conditions, functioning changes over time. Financial protection should therefore sit alongside timely treatment, adjustment and employment support where participation is realistic, so that systems protect people without creating avoidable barriers to future re-engagement.” [p.372]
It also stresses the importance of not seeing employment as the only worthwhile outcome:
“Participation extends beyond education, training and paid employment. Relationships, community involvement, volunteering, physical activity and meaningful roles all contribute to a full life and, for people with autism with severe or profound learning disability, or the most severe and enduring mental illness, these may be the central participation outcomes. An employment-only measure would exclude people with the greatest support needs.” [p.373]
Achieving “stability, connection and practical support” may be much more vital than looking for a job:
“For people with lifelong high support needs, social inclusion, valued relationships, meaningful activity and quality of life should themselves be core outcomes. Social inclusion remains one of the largest unmet needs for people with severe mental illness. Unpaid carers also need to be included: caring can restrict their own employment, relationships and participation, particularly where high support needs within a family require a parent or other carer to leave work. Other groups – including young people who are NEET because of long-term sickness or disability, people in insecure or gig work, and those affected by homelessness, substance use or the criminal justice system – may need routes into participation that begin with stability, connection and practical support rather than job search alone.” [p.373-374]
What happens next
The Fonagy report contains findings that challenge the major arguments used to justify benefit cuts, particularly claims of widespread overdiagnosis and the assumption that reducing financial support will help young people into work.
Its findings will not, we suspect, stop either of the forthcoming reviews from making recommendations that are likely to increase, rather than reduce, harm to claimants. But we hope that claimants and campaigners will find the extracts above of value when challenging any such recommendations.
