Guidance

Independent review into mental health conditions, ADHD and autism: terms of reference

Published 4 December 2025

Applies to England

Background   

Over the last decade, there has been progress in reducing stigma, and an increase in public awareness of mental health, ADHD (attention deficit hyperactivity disorder), autism and the importance of psychological wellbeing. At the same time, we have seen a real increase in the prevalence of common mental health conditions, with:

• a recent NHS England survey identifying that 1 in 5 people have a common mental health condition
• ADHD being estimated to affect 3 to 5% of the global population according to the National Institute for Health and Care Excellence (NICE)
• recent NHS England estimates suggesting around 1% of the adult population in England may be autistic

In parallel, demand for NHS support has risen sharply, creating an urgent need to better understand how individuals are presenting to services and how best to meet people’s needs and improve outcomes.

NHS mental health, ADHD and autism services have never fully met the needs of the population in a tailored, personalised or timely way. Gaps in current provision have serious adverse impacts on individuals, families, communities and the wider economy.

This mission-led government is committed to meeting this challenge and adopting a population-level approach in order to:

• raise the healthiest generation
• increase healthy life expectancy
• reduce suicide
• reduce economic inactivity

To support this ambition, the government is launching this independent review to understand the prevalence, trends and inequalities associated with:

• mental health conditions
• ADHD and autism

This review will cover children, young people and adults.

The review will examine:

• the factors behind trends in prevalence
• the impact of clinical practice, including social and cultural factors and the risks and benefits of medicalisation
• ways to promote the prevention of mental ill health
• ways to create resilience and improve early intervention

It will also seek to identify approaches to provide different models of support and pathways within and beyond the NHS, supplementing clinical support and care so that people receive the right support at the right time in the right place.

This will support the implementation of the 10 Year Health Plan and the shift from hospital to community, analogue to digital and sickness to prevention.

Scope

This review will focus on mental health conditions, ADHD and autism. It will explore:

• the similarities and differences between mental health conditions, ADHD and autism regarding prevalence, drivers, early intervention and treatment
• the co-occurrence of these conditions
• the inequalities in prevalence, access and experience
• the current challenges facing clinical services
• the current extent to which diagnosis, medicalisation and treatment improve outcomes
• the differences between the levels of need and disorder for mental health conditions, ADHD and autism
• the role that medicalisation of mental health conditions, ADHD and autism plays, including the associated risks and benefits
• the role and effectiveness of short versus long-term interventions to support recovery and/or improve quality of life

This review will have separate chapters for children and young people, and for adults.

Purpose  

The purpose of the review is to provide advice and recommendations to the government on:  

• evidence on trends in mental health conditions, ADHD and autism in the population over the last decade, including:
  • factors that have contributed to drivers in prevalence for children, young people and adults
  • how these changes have affected demand for NHS mental health, ADHD and autism services (including assessment)
• evidence on inequalities in accessing support for children, young people and adults across the spectrum of need
• evidence on the role of diagnosis for children, young people and adults, including:
  • changes in diagnostic pathways, criteria and process over the past 10 years
  • the value of diagnosis to individuals
  • barriers to receiving a diagnosis and its impact on receiving support
  • the role of the independent sector in diagnosing individuals with mental health conditions, ADHD and autism
• evidence on the role of medicalisation in mental health conditions, ADHD and autism, including the appropriateness, potential harms and the difference between non-clinical need and disorder
• evidence on the role of medication in treating mental health conditions and ADHD, including the long-term outcomes of pharmacological treatment for young people and adults
• the role of preventative care and early intervention across the life course, including support for those waiting for services and ways to reduce demand and waiting times, working with relevant government departments to explore cross-sector opportunities to support this approach and create the conditions for good mental wellbeing

This work will include international comparisons covering prevalence, diagnostic systems and cultural factors influencing diagnosis.

Outputs  

The review will take 3 to 6 months and will provide a short report for Department of Health and Social Care ministers, setting out conclusions and recommendations.

The report will include recommendations for responding to rising need, both within government and across the health system and wider public services. These recommendations will consider the diversity, inclusivity and accessibility of interventions required for different groups.

In its report, the review will seek to present differing perspectives where they exist, including when the evidence is contested or incomplete, while aiming for a balanced consensus that provides clarity.

Leadership  

The government has appointed Professor Peter Fonagy to chair this review, supported by Professor Sir Simon Wessely and Professor Gillian Baird as vice-chairs and an advisory working group of cross-system leadership and experience. The chair has overall responsibility for the review and its outputs.

Governance  

The review will appoint an advisory working group, involving a multidisciplinary group of:

• leading academics
• epidemiological experts
• behavioural scientists
• charities
• people with lived experience

This group will directly shape the recommendations and scrutinise the evidence.  

Engagement

The review will work closely with people with lived experience of mental health conditions, ADHD and autism across different age groups, including young people, and reflect under-represented groups.

It will also consult closely with parents and carers, key partners, and wider clinical and academic experts in mental health conditions, ADHD and autism as appropriate.   

The review team will also consult other relevant reviews and taskforces, including reports by the independent ADHD Taskforce, to ensure its conclusions and recommendations are aligned.

Devolution   

The scope of the review is England.