Link to Independent review into prevalence and support for mental health conditions, ADHD and Autism, October 2026:
Professor Sir Simon Wessely on ADHD and Autism review
Interviewed by Professor Kamran Abbasi, editor in chief of The BMJ
9th October 2026
Transcribed by AI [please check for errors with original audio, which can be accessed here]
Introduction – the voice of Professor Sir Simon Wessely:
I genuinely think it is harder now to be young, to be a young person. But people want an explanation, don’t they? Something that can be treated. Well, a need that can be addressed, sure.
We know that kids with autism are 15 times more likely to be excluded from school. And they’re also dramatically more likely to be in need. Well, there’s a cause and effect there.
People are having to wait after diagnosis for a year to get a prescription. That’s not right. People assume you’re trying to block treatment.
No, I don’t think that’s true. I just think that the rate of change has been so fast that it’s pressured, particularly primary care. 80% of GPs say there is overdiagnosis of these things. And some think it’s actually at scale. But we genuinely don’t know. And I’m not just hiding.
The private sector is producing now. Well over 60 to 70% diagnosis. And obviously it’s driven by market forces.
What happens is you get put on a waiting list. And that can, you know, it might be for a short time, but it can be for a long time. And nothing happens. And nothing is done about things that don’t actually need a diagnosis.
Welcome to the Medicine Science Podcast from the BMJ. I’m Kamran Abbasi, Editor-in-Chief.
In December 2025, the UK’s Department of Health and Social Care appointed Peter Fonady to lead an independent review into mental health conditions, ADHD and autism. The review was prompted by what many saw as a soaring increase in the rates of ADHD and AD diagnoses, particularly in younger people. Uncertainty about what was driving that has been a key question.
Is it an increase in the prevalence of ADHD and autism? Or is it a case of overdiagnosis? Secondly, with or without a diagnosis, are people able to access the support they need? Joining me to discuss all of this is Professor Sir Simon Wesley, who is a psychiatrist at King’s College London and one of the report’s vice chairs. I hope you enjoy our conversation. Simon, thank you for joining us.
It’s kind of very eagerly awaited review, clearly. I mean, it’s all of 600 pages. At least.
At least. It’s a bit more than 600. I think you’ve got the abbreviated version.
I mean, I did get through the executive summary, which was 25 pages and more. My impression reading that was, if I could just give you a horrible soundbite, which I’m sure you’re not going to like and disagree with entirely. Broken society, broken system equals broken population.
Well, you’re right. I don’t like it. I dislike that phrase, like broken NHS.
Yeah, I thought you might. Yeah, and broken society, because I think in so many ways, it’s not true. NHS is not broken.
Society isn’t broken and et cetera, et cetera. So if you said struggling, that would be fine. If you said not working well, not delivering what it should, I would be happy with that.
But I just don’t like the word broken. Okay, but those two, but they’re the elements, aren’t they? Yes. Society, system, which is, it’s letting people down.
Let’s put it that way. Yes, I think the one thing that everyone agrees in, the current system is far from satisfactory. It is letting everyone down.
It’s letting down patients. It’s letting down families, letting down professionals, letting down the NHS itself. So it’s not doing very well on any of those markers.
And you very clearly say it could do much better on those. Yes. I mean, you’ve got some very interesting recommendations, which we will come to.
What I’d like to just talk a little bit about before we get into that is some of the terminology you’re using. You’re very careful in the words that you use in the review, inevitably. I mean, you talk about mental health, because people very lazily talk about mental health as if that’s a problem.
Yes. But you very carefully talk about mental ill health. Yeah.
And I see, obviously, that was deliberate. And you’re careful to use neurodiversity when you feel that’s appropriate and use neurodevelopmental conditions to describe ADHD. Yes.
I mean, it is quite funny sometimes. There was a headline recently, I don’t know if you saw it, but it said, half of Britain’s military veterans have mental health. Full stop.
What about the rest of them? Yes. So mental health is one of the latest euphemisms. It usually means mental ill health.
Yes. In general, because it’s like blood pressure. We all have blood pressure.
Yes, because your mental health can be good. It can be something that you’re worried about. Yes, that does actually happen sometimes.
It’s your job to make that happen. Or help that to happen. No, no.
That’s not our job to do. Isn’t it? No. It’s not to make people happy.
Oh, okay. Yes, it’s to perhaps sometimes reduce the level of misery. Okay.
But we’re not here to make you happy. All right. What about the neurodiversity point then? I mean, you’re very careful to how you use that term.
Yes. There’s some disputes about that actually, but I actually think it’s an incredibly useful term. It’s a newish term.
20% now of children at school identify as neurodiverse and 20% of young adults do as well. And the point about diversity is it’s a good thing. In the rest of society, we celebrate diversity.
We don’t treat people for diversity. And it’s also reminding us that maybe the way my parents’ generation, my generation even, had a rather more strict view of how you should behave and how your brain should work and how you should converse and basically how you should be. And there were kind of rather fairly strict, kind of sometimes puritanical rules.
And obviously not everybody fits into that stereotype at all. And all neurodiversity is saying that there actually are different ways of seeing the world, different ways of behaving, which are not wrong and which are not pathological and which far from bringing ill health. In fact, as long as they’re recognised and people adapt to them and the way in which we work and teach and et cetera, adapts to the massive diversity in people’s characters and personalities, the better we all are.
And what’s happened, unfortunately, is that let’s say someone who has more traits than others. I mean, that’s all it is. Neurodiversity is about traits.
And I think when I was growing up, I was quite shy and I was certainly very bookish, definitely. I can believe that. Yes, I definitely just was.
But, you know, no time did my parents think that I needed help or a diagnosis when they probably couldn’t have gotten them anyway. But it wasn’t thought like that. And, you know, as I grew up, these things didn’t hold me back.
I still am part of it, actually, and indeed probably stood me in good stead in life. But I definitely was odd. I mean, I think I was.
I shan’t comment. No, but I think I was, actually. I think I was.
But those are traits. But when you say, sorry, just traits, often people say neurodiversity traits. I mean, that doesn’t really mean anything.
Well, I think it does. Does it? I mean, for all neurodiverse, then? Well, everyone is diverse. So that’s true.
But some people have, you know, the diversity is in some of the way in which they communicate, behave, think. And you can say that genetics play a huge part in it, actually, a very huge part. But the key thing about neurodiversity is it’s something to, you know, be pleased by rather than anything else.
We’re all different is what you’re saying. Yes. And one of the, you know, we’re almost jumping ahead here, but one of the things that occurs to me and others as well, and Will Davis writes about this brilliantly in NRB quite often, is that let’s say you are struggling in something, you’re finding some particular aspect of school, the workplace really doesn’t suit you at all, and you’re feeling troubled, isolated, whatever.
And that happens probably, you know, a huge amount of time. Yeah. But if the only way that you can, you know, get these issues resolved or solved or recognised is by ending up with a diagnosis, which neurodiversity is not a diagnosis, it’s one of the reasons why not surprising that so many people flock to this, because it’s the only way they can get attention now.
Yes. And if they don’t do that, they are completely ignored. Yes.
Because the example you gave about mental health just now, people use the same language about neurodiversity. So-and-so is neurodiverse. Meaning that they require some kind of therapy, treatment.
No, it doesn’t mean that at all. Neurodiversity is definitely not a diagnosis. That’s the whole point.
It’s not a diagnosis. They may need, you know, different ways of being taught or different periods of all sorts of millions of things that a good teacher or a good employer or a good supervisor will spot. But they don’t necessarily and indeed shouldn’t need a diagnosis to get some of those issues resolved.
But now the position we’re in now is that they do. And now, you know, both my daughter-in-laws are teachers and they recognise what’s going on in the classroom far better than any doctor would or a GP would. And yet they’re not able to get it sorted until someone like us, me and you.
You more than me. Well, probably not, actually. It’s a photo finish on which of us does the least clinical work.
But, you know, to be serious, though, is that now the gateway, the diagnostic gateway is so powerful that without it you don’t count. And then what happens is that you get, you know, pushed into a groove which is itself quite inflexible. And that’s the problem with diagnosis.
It is quite inflexible. It has the criteria, whatever it is, DSM or ICD, and that’s what it is. And the other point we know is actually there’s this huge overlap.
We went through that period of thinking that neurodivergence, going on to now neurodevelopmental disorders, are completely separate now from mental disorders, mental health. But they obviously aren’t. What are you talking about with the classification? Yeah.
So the classification has straitjacketed us into thinking that these are separate concepts. And yet, I don’t know, I can’t remember now, but 40 to 50, 60 percent of young people with a diagnosis of autism also have mental health diagnoses and vice versa. Lots of people who have got common mental disorders, which have been rising, also have quite a lot of traits of autism or ADHD.
But we have so siloed it. Yes. We have completely different assessment pathways.
Yeah. So we’re not looking at thinking of the whole person. Exactly, we’re not.
No. I mean, that’s a cliche, of course. It is, but it’s a kind of, it’s a truism.
Yes, it is. And so one of the, you know, I think one of the key recommendations we’ve got is to have a single common pathway. Okay.
Because what’s happening at the moment is that you go on one pathway, whatever it is, autism, say, then you get to the end of the queue X months, years later, but you’re told, actually, no, you haven’t got that. And so you have to go all the way back to the beginning and start another queue. Yeah.
And, you know, You’ve got mental ill health. Yeah, because you are also, you might, and indeed, at that moment in time, the most important thing going on might be crippling anxiety. Yeah.
And, you know, not getting to school because of that. So you’ve cut to the central theme of, to me, of the report, which is this, is differentiating what occasionally you describe as recognition in the report versus diagnosis. And to me, that sounds like it’s people being aware that they might have autism or ADHD versus then having the clinical diagnosis.
Yeah, that is a theme as well. We know now that a quite considerable part of the population do identify with autism or ADHD. And half of them have also been seen by a professional.
Yeah. And presumably given the diagnosis, but the other half so far have not. And that is another sociocultural phenomenon that’s happening now.
We talked about the rise of neurodiversity, but the rise of identity and people who identify with autism or ADHD. So what do you mean by that? Well, they basically say, yes, self-diagnosis if you want. But it’s a bit more than that.
I can self-diagnose myself of having a cold, but I don’t think of myself as a person with a cold. I wouldn’t describe myself as that way. Slightly facile, but I wouldn’t.
And it’s also true in most of the disorders that today in psychiatry deal with, people do not normally describe themselves as, you know, they will use, I have depression, but they will not say I identify as depressed. Okay. That’s unusual.
But are you saying people use that language specifically? It’s because, well, it’s because the younger generation have a much richer use of language in this area than we do. Okay. Using much more both developmental and mental health terminology in a richer way than the kind of almost dull way that epidemiologists and psychiatrists like me do.
And, you know, that’s something that’s changing in society. That’s just the way it is that they do that. And that means particularly in the neurodevelopmental world, people do actually feel this is part of their identity.
Yeah. And so be it. Yeah.
And see it as a positive, right? They can do, or they might not. They might not, but they can see it as a positive. I think one of the reasons why the rates of disorders are going up, though, is because those boundaries can be crossed sometimes.
And I saw quite recently an ad, you know, came on because I’ve been looking at lots of stuff on autism and ADHD. So you get it. It flows into your… Of course, your feed.
Yes, exactly. And this is an advertisement for a clinic that does neurodiversity assessments. Now, the whole point about that is you don’t do a neurodiversity assessment.
It’s not a diagnosis. No, no. But presumably that particular clinic is giving out diagnoses.
Saying you’ve got neurodiversity. Or are they going on to say… Well, I think, I imagine that’s probably what is happening. Yeah.
But, you know, strictly speaking, you shouldn’t be… You know, you don’t do assessments for other forms of diversity. Yeah, no, I agree with you. I mean, it seems to me, I mean, obviously having children and using social media, et cetera.
People aren’t as clear in using language. We’re agreeing on that as you are being now. And so to many people, the fact that they would define themselves as being neurodiverse and then someone’s confirmed that they are would seem to them to be, well, that’s validation for me thinking that I’m different in some way.
Yes, it would do that. And we know that people both in neurodiversity, but also in getting diagnoses when they’re done correctly and so on, do find it very validating. They definitely do.
They get a lot of people. And if you look at some of the films, work done, for example, on people in TikTok and things like that, you find, you know, children saying how, you know, they’re very relieved and pleased. And some, I remember saying we’re joyful.
That’s obviously a change in the way that diagnosis has been seen. It’s been seen not as most of our lives in psychiatry, people have not been joyful when they received. And I think it’s because they feel validated.
They feel that they’re treated better. They understand themselves better. Other people understand them more.
And so this is, again, another social change that’s come about. And we’re very careful not to say you shouldn’t have diagnoses because they do a lot of good to a lot of people. And even if nothing else happens, many people feel more valued and treated better.
Okay, so when we say there’s been a rise, what are we saying there’s a rise in? Well, now then, okay. Now we’re talking as it were. So, I mean, I know this is mainly a professional audience, but be a bit technical.
Well, not technical, but be clear. So we have separate trends happening in society over the last 20-odd years. So the one that’s easiest is that there’s simply no doubt at all that depression and anxiety as diagnosed conditions have been steadily increasing now for 20-25 years.
So that’s mainly depression and anxiety, but also eating disorders a little bit and things like deliberate self-harm have gone up as well. That’s not a diagnosis, but mainly depression and anxiety, mainly affecting children and young people and mainly affecting girls and young women. And it’s increased by around 50% during that period, which is in public health terms quite a lot, gone up from maybe one in six to about one in four in a CYP, children and young people, audience.
And people keep saying this is a genuine increase. I don’t like the word genuine. I think it’s an increase.
Of course it’s genuine. How could it not be genuine? The rates have gone up steadily, never increasing in speed or anything, started long before COVID, continued during COVID and has continued after COVID. So that’s the first change.
And that’s a change in the true prevalence of the disorder. It is more common by 50%. We can talk if you want about why and all that kind of stuff, but it’s happened.
Now it’s a bit more complex if we switch now to the developmental disorders. Because for a long time, it didn’t look like there’d be much change in the prevalences of either ADHD or autism. And the graphs were pretty flat.
There was considerable under-recognition and under-diagnosis. That’s been known for a while, but it wasn’t getting commoner. And we’re not entirely sure where we are with that now, because the last decent study was in 2017 in this country.
It is a while ago, and that’s probably one of the more silly decisions the last government took was to not repeat it. And I’m 99% sure that it will be repeated now because we really need the data. But only two years ago, the ADHD taskforce led by Anita Thumper out of NHS England said that there didn’t seem to be much evidence that actually it’s changed very much.
Now, it might have done, but possibly the estimate we came up with is around something like in children and young people, again, maybe for ADHD, maybe 3, 3.8%, 7%, something like that. This is the prevalence in terms of diagnosed prevalence? No, no, no, in the community. Oh, in the community.
And it’s estimated from looking at the trends, they have been creeping up a little, and if you extrapolate it forward, you’ve got it. But it’s a bit of a guesswork. Yeah, okay ditto in autism Again, we haven’t had good data Really good data, but the general consensus has been that if there is a change, it’s not dramatic However, if you then looked at the graphs of the what we call administrative prevalence That’s number of diamonds numbers known to the NHS basically. Yeah So that’s diagnostic probe it’s called administrative or diagnostic that has changed beyond recognition in in autism for example, we’ve seen Since 2000 when the beginning start of the change started in common mental disorders It’s gone up by 20 fold in 6 to 11 year olds and 44 fold in 12 to 17 That’s huge very big and for autism slightly less, but not much less again Sixfold in the younger group and then in the kind of teenage groups up to 15 fold during that period now These are really big changes when you so but when you say diagnosed by whom well known to the NHS known to the NHS.
Yes. So what does that mean? well, it means basically that you can get those you can get the the data from the CRPD the t somebody has a diagnosis Somebody’s there is a record of them. Yeah, and that’s the best way to find it Yeah, nearly all and most of those are not seen in secondary mental health care service.
Some are most are seen in primary care Yeah, so this one some people will be confused because you’ve talked about the community prevalence and you say that’s not changed That’s me. That hasn’t moved very much. We don’t think so.
No. Yeah, and certainly I don’t think it’s moving Even if it is moving, it’s not at the same rates as the diagnostic prevalence. Yeah, and Then we come on to okay Let’s start out with the easiest option Which is that this is simply kind of unfinished business as it were I said that these conditions have been overlooked which they have particularly in girls and young women and They’re not always easy to diagnose or they’ve been given other labels condom disorder quite often things like that So are we playing catch-up? Well, we are and we can see that People are coming forward now who are more aware Of these issues and in themselves and society is more aware of them And so this is you know What’s the word to bring bringing these things are more people talk about them? Yeah There’s social changes around them as well the rise of neurodiversity which can add to this as well All of these things could be happening.
Well, they are happening. Yeah now but the problem you get is at what point will do they ease off and In orthodox thinking as you get towards the known Prevalence of I don’t know breast cancer prostate cancer, whatever You can the graph will start to level off because eventually you have reached kind of ceiling You never get everybody but you maybe have got 80 to 90 percent of the known cases and the graph will slow down and then level Off and be in steady state and basically just new incident cases coming every year. Okay, those graphs have not done that They show no signs whatsoever of levelling off continue to yes So either the prevalence is much higher than we think.
Yeah, which seems unlikely or we are getting towards the kind of tipping point and moving into from an area predominantly under diagnosis and then we get on to Some discussions about the concepts of misdiagnosis and even overdiagnosis. Yeah, so is it overdiagnosis? Okay, let’s do it in turn. Okay Yeah, so the very first thing to say is that All of these concepts under Time mid diagnosis misdiagnosis Diagnosis are all usually failures of systems.
Okay failures to recognise more Failure to diagnose or to over diagnose they’re talking about systems. They’re not talking about people Yeah, and yet a lot of people think they are So they think that overdiagnosis. Is it really about some people are swinging the lead, you know, they’re not really ill.
Yeah but it absolutely in the system. It does not mean that it doesn’t mean that people don’t do that No, but that’s not what these concepts mean No, and the second thing is they are well known concepts in medicine We kind of think they only happen in psychiatry, but that’s rubbish. No So yeah and a Misdiagnosis has been around since the first doctor, of course.
Yeah it’s not controversial and of course It’s it’s basically getting it wrong. Yeah, I mean all three have been around. Well, yes, they probably have yes, but yeah, but misdiagnosed in particular and of course It happens in medicine.
And of course it happens in psychiatry. Yeah, and it’s basically You know, you give the wrong diagnosis or a partial diagnosis Now it does give us problems because you in the medical field I know misdiagnosis is a problem as well Yeah, but at least you do finally have the kind of fallback position of you often do have a blood test a scan Yeah, some nice piece of technology that can draw the line. Yeah now it’s not as simple as that We know that yeah, but nevertheless we don’t have that at all.
No, no, we might do the guy that got the Nobel Prize earlier Yeah, sweet. That’s true. That’s true.
Come on like be coming to our rescue Yeah, I don’t think so for some time You know, there’s always hope yeah, but we haven’t got that. So we are dealing always with dimensional disorders Yeah, and we’re trying the line is very arbitrary and actually very difficult I mean having have done one rotation in psychiatry. There was obviously a degree of subjectivity.
Well, it’s a hugely subjective Well, it’s yeah, it is that it’s not a degree. It is subject. It is subjective Yeah, and therefore it’s difficult and there are real problems when it’s sadness depression Hmm, could someone’s failure to make eye contact could it be autism or could it be anxiety? Yeah, you know all of these are difficult things exactly.
We try and get round it by say, okay. It’s not just that It’s also having functional impairment which is why I probably wasn’t you know Impaired when I was a very bookish kid in libraries wasn’t but other kids could be or distressing. I wasn’t distressed but others are But even that’s very subjective.
Yeah, so it’s harder and Where those lines are can change and on the margins we can easily make mistakes. I misdiagnose Yeah, but there are circumstances when this gets worse. Okay, and that’s the situation we’re in So in a situation of dramatically increasing demand We’re in a situation where assessments now Are often being done pretty fast.
Let’s put it that way. Yeah where people don’t have access to GP records where People are siloed into a pathway determined to get to a certain diagnosis Yeah, and where we have handed over control of at least half of our diagnosis to the market Yeah, and in those circumstances misdiagnosis is going to be more common Yeah, or inevitably and that’s the I mean you’re differentiating that specifically from overdiagnosis Well, is it a component? I’m specifically saying yeah, and remember in all these cases Yeah, people, you know people, you know, they’ve gone to the GP something’s wrong. Yeah, you’ve got the wrong diagnosis Yes, yeah or partial or very common is that the person is fixated on one diagnosis Let’s say autism and it’s missed.
Yeah, okay, or vice versa. Got it. Yeah, and that again is a misdiagnosis.
Yeah, so that is happening GPs definitely, you know, we’re hearing from GPs are very unhappy with the current situation. Yeah, and they’re reporting that We have a problem because we lack I mentioned we lack the good, you know epidemiological data Yeah, the way we could answer all this is to go back and re-diagnose the 1.4 million people who diagnosed. Well, that’s obviously absurd yeah, no one’s going to do that and they shouldn’t and You know We are where we are and also the providers the people are doing the diagnosis are not being transparent with the data Only 10 out of 120 companies are providing data to the NHS database.
So yeah, we are really Quite a lot in the dark. Yeah So If you were to kind of weigh up misdiagnosis Well overdiagnosis is getting now closer to medicalisation over realisation in which you have either You’ve been wrongly identified by a faulty screening test things like that or What you’ve got is something that actually isn’t going to be, you know You’ve been told that you have a problem when actually you either don’t or you do but it’s of little significance Yeah, and isn’t going to affect your life. Yeah until you know about it.
So that’s more overdiagnosis now We don’t we really don’t know where we are. Yeah, I mean Yeah, some elements of overdiagnosis, of course because that’s been there since time immemorial and the question people say Is this happening at scale which is the latest word for a lot? We don’t know. Yeah, I think probably not. But because we are we’re at this tipping point of where You know The graph should start to slow down by now and it’s not and it’s and we’re going over what we think of the prevalences Yeah, what we can say is if we do nothing Yeah, and those trends continue we will be moving into an era in which overdiagnosis also becomes a problem.
Yeah People will say that it’s been a problem for many years already. Well, it could be. Yeah, I agree Yeah, and obviously that is GP’s, you know, yeah. GPs say there is overdiagnosis of these things and something kids actually at scale But we don’t we genuinely don’t know and I’m not just hiding.
No. No, I appreciate you Yeah, well you talked about the markets for example, the market would drive misdiagnosis and over yes, it was yes, that’s correct Yeah, and one of the features of a market though. Is it certainly? You know, it’s great American data on this.
It does produce a badly regulated market Yeah does to produce overdiagnosis. It definitely does. Yeah across the board.
Yeah, and This is why You know, we are concerned about the market failure happening at the moment we Believe that this evidence, you know from well first of all Some people are perfectly happy with it and lots of service users are very pleased. They get seen. Yeah quicker I’ve got a diagnosis.
Well, yes, and some of the companies are perfectly good and do provide data But others don’t so what we’re asking for is that we have a level playing field that If you are in this and remember the private sector is producing now well over 60 to 70 percent Diagnosis and obviously is driven by market forces. Of course Yeah, so we’re gonna say look you need to be subject to the same regulation the same commissioning and the same Standards the same reporting requirements and many are not subject to this and I can’t see any reason Why we should not have the same standards that apply in the NHS Yeah, I mean in principle, of course that seems like the right thing to do by implementing that it’s gonna be difficult Well, I don’t think so and it’ll take time Yeah, I mean some people think that we should well some people actually do think we should just shut them down But obviously we can’t do that and some are perfectly. Okay.
Yeah NHS has relied on the private sector Yeah to deal with waiting lists since I was quite young I think yes It’s evening out the standard of contracting and commissioning. Yeah, and quite a lot of them aren’t commissioning Aren’t commissioned actually and we also know that the variation in costs is huge Yeah, you can you know the cost of an assessment there is fivefold around the country. Well, that’s not right but people obviously are turned to private sector because they’re I mean they’re waiting for to be seen and Evaluated for a diagnosis and it’s not again and come back to that absolutely fundamental thing.
This is a system failure It’s not a person failure. Yeah, the know they have problems or their child has problems Yeah, and obviously I can fully understand if they can afford it. They’ll go quicker Yeah, that does create quite big inequalities in the system, but it’s not a criticism.
It’s just a statement of fact Yeah, but that leads to the I think probably the kind of mind shift I think you’re arguing for in the report, which is to focus on need. Yes, primarily Well, yes need plus diagnosis Yeah, but not but don’t put off the need waiting for a diagnosis. That’s exactly right yeah, and I think that’s you know, a really important concept because what happens is You get put on a waiting list and that can you know It might be for a short time and it could be for a long time and nothing happens Yeah, and nothing is done about things that don’t actually need a diagnosis All sorts of things can be done changes in the classroom changes at work Simple things more help for parents.
You can give therapies if you want You don’t need a diagnosis from a doctor to do stress management or psychoeducation Want to do social prescribing? Yeah that you don’t need a diagnosis. Yeah, you do in America I don’t get paid but in the UK you don’t yeah, and yet that’s not done Yeah, and then they wait and wait then they get a diagnosis or they might be sent back to the next queue or worse They get it and then there’s still a treatment gap So let’s say someone’s got us, you know reasonably severe ADHD then and medication is is it could be helpful? And they still don’t get it. Yeah, so and there’s no follow-up.
So we know that most are only seen once Yeah, and then they’re still back to square one. So we’re suggesting for example an ADHD passport Yeah, so you don’t need to get so long as you’ve got a proper good assessment, you know You don’t need to keep you know, keep being reassessed and telling the same story Yeah, and it would be could easily be fitted in. How do you get a passport then? Well, you get one because again in a regulated scrutinised Set up.
Yeah, whether it’s NHS or not where there is confidence in the quality of the diagnosis It’s not done in five minutes. They look at the notes have the GP records Yeah, you know that they’re up to standard. Hmm, and that’s it seems to me quite reasonable, but if they’re up to standard Yeah registered with the CQC.
Yeah a lot or not. Some are this is the provider. This is Yeah, sure.
Yeah, but if the provider isn’t your GP, yeah But now there is evidence that it’s been a proper, you know assessment Yeah, and the GP won’t have to do it all over again Okay, and maybe you know what you can’t force anyone to do anything, but it would be sensible then to carry out You know, whatever is the best treatment? Yeah So that’s at the point. You’ve got a diagnosis. Yes, but while you’re waiting, I mean you’re talking about support now, aren’t you? Oh, yes.
I mean all the different forms of support. Yeah, which shouldn’t wait for a diagnosis Which may be done may obviate the need for a diagnosis. Yes. Not because there may be many different reasons why someone is needing that sport and we’re also saying that that at the moment We’ve got to be more sophisticated in how we manage the diagnostic process and triage So yeah, not everybody is the same.
We should Prioritise the most severe the child with autism who’s nonverbal Learning disability who’s probably gonna have lifelong care needs. Yeah. Yeah I mean we should we should be prioritising the most severe and that’s not happening No at the moment in the way that it should because of the dilution effect.
Well, it’s not Yeah, I wouldn’t put a dilution effect Because it’s just If we’re doing a first-come first-served, yeah But we need a more intelligent system. Yeah, we also need one We think for example really important a kid that is a high risk of exclusion from school should be prioritised Yeah, because if they do get excluded and you know 200,000 or something nice terrible, but that is that is a really life-changing step Yeah, and that’s one of the big risk factors for becoming what we call the needs. Yeah.
Yeah, not in education Or employment or training? Yes, so that would be a reason to fast-track someone if they’re about to get kicked out of school Yeah, and because that starts a slippery slope. Yeah We know that kids with autism are 15 times more likely to be excluded from school And they’re also dramatically more likely to be a neat. Yeah.
Well, there’s a cause and effect exactly. Yeah, so
Exactly. Yeah. So I was going to get on to the impact of all this, which is, I think you quantify in the report is 300 billion pounds per annum in England.
I’m not sure how hard that estimate is. Yeah. Yes.
I’m not either. I mean, we know it costs a fortune. It gets people’s attention.
Yes, I know. I know it does. But I was slightly, you know, we know it costs a lot.
It’s a lot. And we know that the cost of not early into missing early intervention is supposed to be 17 billion a year. Okay.
To be honest, actually, with you, I’m not always totally fussed about those things. I mean, let’s take the NEET issue. Even if we didn’t save a single penny, we should still be stopping people from starting their lives.
Yeah. In that NEET situation. Not in education, employment, and training.
They need to be in one of those things. Yes. Because if you start your life that way, if you didn’t have a mental health or condition beforehand, you will soon.
We’ve known that for nearly 100 years. Yeah, exactly. Yeah.
So, but I think it probably would, you know, it would save money, which is good. It could be reinvested into the system. Yeah.
I mean, like you, I’m not putting the money first, but that’s something that I saw in the report. No, but you know, the case for helping people not to get into that situation is overwhelming on every level, including economic. Yeah.
But we’re here to talk about the psychiatry, the social. Sure. The medical and the case for that.
Yeah. It’s overwhelming. Now, when you talked about the increase in various, the prevalence of various different disorders, we didn’t then talk about the why you mentioned the why.
I mean, why do what I mean, is there a common explanation or what is it? There’s some common explanations that cut across all the diagnostic categories. And, you know, I’ve been saying this for quite a while now, but let’s actually finally catch on a little bit is that I genuinely think it is harder now to be young, to be a young person. And, you know, if you look at the key thing here is since the second world war, like my colleague, I’m saying the same stuff, forgot to say since the second world war.
And then lots of people wrote, said, yeah, my dad was on D-day. That’s much tougher. Obviously.
All right. Yeah. Obviously.
Yes. We’ll give you that. Yeah.
But since the second world war, each generation has done relatively speaking, better than their parents. Yeah. Just the fact.
The fact of my family, probably yours, et cetera, in all sorts of ways. I had free university, completely free education. Didn’t have to do national service.
I was able to soon after qualifying by a flat. I never heard of climate change. Nobody had all of these things.
You had job security. Yeah. Job security.
And I knew if I stayed with the NHS, I would have a bloody good pension. Yeah. None of these things are true now.
And the world is a much more unsatisfactory place. I wish that had social media, by the way, I think you’d have had a better time at university. But on the other hand, I would have missed.
You’d have read fewer books. Yes. But it’s certainly not the only cause of this.
I don’t think anybody really thinks that. But all of those things have come together and to create a more anxious generation who look forward to the future, not optimistically. Well, the future isn’t that optimistic.
No, it’s not. Well, that’s the whole point. Yeah.
The wars that they’re kind of seeing. Climate change and that. And the fact being some of them will really struggle to get into.
You haven’t got a secure job. You can’t buy a flat. Can’t buy a flat.
Yeah. Unless mom and dad can help. So it is a much more troubled world.
And particularly, again, remember, these trends are more common in young girls and young women. Yeah. So I think that kind of brings a lot of these issues together.
And in short, you’re saying it’s environmental. Yes. Oh, yes.
Yeah. Well, it’s not genetic. No.
Well, genes will play a part. Yeah. I mean, genetic would mean there’s something that’s changed about.
Yeah. Well, this environment is changing. Yeah.
And there’s quite a good argument, actually, that again, we go back to traits which are very genetic. Yeah. And then you encounter the covid shock, for example.
Yeah. And then you might have been on the edge and then that pushes you over this arbitrary boundary we have into what we call caseness. Yeah.
And then you might then require more help. Yeah. Yeah.
So that’s a kind of gene environment. Yeah. It’s not the only explanation for this.
Yeah. The one that actually surprised me quite a lot is the tremendous change in sleep habits in a younger generation. Yeah.
And how that has really declined. I didn’t realise that. No.
Tell us what did you find? Well, I can’t remember what the figure is now. It’s not in my notebook. But what’s the pattern of the pattern? Well, both much harder to go to sleep, but also much harder to stay awake.
Yeah. That’s because they’re doom scrolling. I don’t really know.
My kids are left. There’s an element of sleep in sleep is a predictor. Poor sleep is a predictor.
Yeah. Of quite a lot of mental health problems. The increased bullying that happens online.
It was not invented by social media. And that is probably, in my view, the single worst thing on mental health. Yes.
And this comes back to the other point. If a teacher spots that a kid has been bullying, they don’t need a diagnosis to do something about it. That’s probably the most powerful intervention you can do.
Yeah. So this goes back to one of the central arguments, which is that get away from being obsessed with diagnosis. Yeah.
Yeah. It’s too much now hangs on it. Yeah.
And if we can remember, we know we’re both doctors without diagnosis. The NHS would collapse in a day. Yeah.
We wouldn’t be able to do research. I mean, it would it would be just the most horrible society to live in. So no one’s saying do away with that.
But perhaps you can avoid it or you can do something first. Yeah. Now, you see, you’ve emphasised the social, cultural, environmental origins of this.
Now, not everybody would agree with that. I mean, people are looking for a sort of biological explanation. Sure.
And they wouldn’t want to like what you’re saying. Well, I’m not sure about that, actually, because I mean, you know, the biological explanation is still there. Yeah.
But what and who knows what we’re going to discover? Yeah. Particularly in the more extreme cases of autism. You know, it’s like schizophrenia, etc.
It looks like a brain disorder to me. Yeah. But cleverer people than us may one day find more than we know at the moment.
Yeah. But also saying that there are social factors. Well, there isn’t really a disorder in the world.
There’s not in which there is not. Yeah. You know, but people want an explanation.
Sure. It’s something that’s they can be treated. Well, they want to.
Well, a need that can be addressed. Sure. Yeah.
And, you know, if if the need is for a different style of teaching because I’m not fitting in or that a child is so too scared to go to school because there’s nowhere where they can feel, you know, they can go and escape for a while, the hell of a blue or whatever. Yeah. Or a child is getting vulnerable to being bullied or picked on because they’re a bit different.
And now they’re terrified to go to things, you know, are helped by social interventions. Of course. Yeah.
Yeah. But this is much broader than that. And by the way, there is, you know, stimulants are effective.
Yeah. We’re not quite sure how effective for how long. Yeah.
But they certainly are effective. Yeah. And, you know, people are having to wait after diagnosis for a year to get a prescription.
That’s not right now. But then again, there’s a rise in prescription. Well, it would be a rise.
Yeah, sure. Now, we want to be careful that we don’t go to in the US. Stimulants are also used for academic purposes, less so here than still at the moment used for therapeutic purposes.
And I think NICE is going to look at the guidelines again because I think they’re pretty much way out of date. OK.
So this is an area of a very acute controversy. I mean, how do you think your report is going to be received? Well, yes, I think we’re speaking today and tomorrow we’ll see because the press conference today. Yeah.
I think it will be a big split. And I think it’s fairly predictable. Some of the press will say that we are telling you all along, you know, it’s all about overdiagnosis.
It’s not what we said at all. But some will jump to that conclusion. Others will point to where we discussed the hazards of diagnosis because there are downsides to diagnosis.
Every doctor knows that. Just as every patient knows there’s hazards to prescriptions, there’s hazards to diagnosis. Others will pick up the fact that we need more support at an earlier stage and that we need to intervene earlier.
Which is the message you’re trying to get across. Yes. And we need to really try and reduce exclusions from school.
And we need to look after better those who are not in, you know, to help people get into the world of education and work again. All the positive things that we need to do. Yeah.
I’ll pick that up. Yeah. So I think people will pick up what they want to hear.
Yeah. I mean, I’ve got children that age, under 30. 30.
Yeah. Okay. Under 30.
Are they a snowflake generation? Oh, that’s easy. No. I mean, literally.
I think we’ve already answered that. Yeah. We know that.
But I just want to get that clear from you. Excluding, you know, my dad was on D-Day and got sunk. Yeah.
Okay. But excluding that generation. Yeah.
No, they’re not. They’re dealing with much more complicated things than we did. Life is generally harder.
Yes, it is generally harder. And that, but it’s more than that. That sense of progress that we had.
Society was getting more tolerant. We were able to travel more. We certainly, every generation lived more comfortably.
I remember cash points coming. Oh my God. And central heating.
You know, these things change. Yeah. I mean, to be honest, that generation, and I mean.
But it’s not just, it’s just each generation has become more prosperous and used to a peace, a peaceful society, a society that is not boiling, all of these things. And now none of that’s true. Yeah.
But I mean. So of course they’re not. I mean, I think they’re the opposite of snowflakes.
I mean, they’re very thoughtful, considerate and generally care a lot about the world. They seem to know a lot more about it than we did at that age. I think that’s true.
Well, I don’t know. It depends which book you read. But definitely our students are incredibly involved.
And for them, the number one issue is climate change. Yeah, rightly so. So you describe in the report a system that’s not working.
We’ve discussed that. And we need to recognise the need for care. And I think one quote, I mean, it’s in one of your, it’s in your recommendations, which I think kind of captures it.
I mean, you say in short population prevalence, which we discussed is not administrative prevalence. We discussed that distress is not disorder. Diagnosis is not need and support.
Support is broader than treatment. That’s very good. Well done.
That’s your report. Probably your words. So, I mean, to me, that captured, you know, the arguments you were trying to get across.
However, what does this now mean then? You’ve mentioned some of them. What would be the key recommendations now? Well, okay. I mean, I think some of the strongest ones are, for example, to have a single common pathway.
Okay. Not split off. It’s that disorder, that disorder, that’s the disorder there.
We know they overlap. We know they co-occur. We know that you can, you know, you can make the mistakes and miss the most important or whatever.
So single common pathway is, I think, probably the one I would put the most store on. Then trying to, you know, bridge the treatment gap. You know, if you get a diagnosis which requires treatment, we should be bloody well providing it.
Okay. And we’re not. Because people will assume you’re trying to block treatment.
No, I don’t think that’s true. I just think that the rate of change has been so fast that it’s pressured, particularly primary care, which is pressured anyway. I think it’s, no, I don’t think it’s a conspiracy or anything.
No, no, I’m not saying it is. Well, some people do think that. But no, I just think when you see that rate of change, it’s not surprising that the system buckles.
Yeah. I think it is important that we better regulate the private sector. Okay.
And including, for example, you know, we have a ban on direct to consumer marketing of prescription medicines. Well, I think diagnostic services should also be similarly regulated. So that, I mean, that’s a pretty big change.
Well, because, I mean, on social media, you know, you can be getting. Yeah. Well, I don’t think, I think, I think, I think that that does, there are perverse incentives on the provider side.
And indeed, the provider side themselves have said that. They said that in a report they wrote a couple of months ago. And the FT yesterday, one of them said something like, it’s not at all surprising that standards have been cut for numbers.
I think he said something like that. He was acknowledging that the pressures. Because they’re overwhelmed.
Well, they’re creating the market in that sense. But I can’t remember what the exact quote was, but he was admitting that it’s more important, the volume is more important than the quality, I think he said. And he was speaking for.
Yeah. So I don’t think that’s right. I don’t think that it’s wrong that we have the private sector, but I think it’s wrong that they have a, um, are not, uh, regulated in the way.
Exactly. So I think that’s very important. Yeah.
And, and then I think there’s a role for them. So I think there is. Yeah.
So I put that high up, um, put up very high, please do not, you know, do not put off dealing with needs that can be met because you haven’t yet seen whatever it is, the doctor, the psychologist, whatever. And, um, and then next one would be to finally, um, bring the, the mental health support teams into every school. They’re not there at all.
Okay. And already really good things have been done. I sure starts coming back.
I mean, that’s great. Why should they never gone? Yeah. But anything on early intervention, parental support, things like that is important.
You talk about digital interventions and AI. Yeah. I’m not the best person to speak on that.
We know purely AI solutions, um, are not, they’re not at the moment. So when Chris Whitty always says we shouldn’t get scared of AI, we should think it should be regulated, assessed exactly the same as any other intervention in medicine, which I think is a really good way of looking at it. Yeah.
And however, there’s a lot of enthusiasm. Well, there’s always enthusiasm. No, but particularly around AI, but we certainly know that supported systems where there is support, um, digital solutions with, with support do better than ones without.
We do know that, but I’m not the person really to talk on that very much. Okay. Okay.
And we, we spoke about better data. Um, oh yeah, now that’s an easy one. Um, we absolutely have to have better data.
It’s ridiculous. There are areas where we don’t know about, I’m almost a hundred percent certain that will be accepted and we can’t get ourselves into the situation where we really can’t answer like the easy, what should we think? Come on. How, how, how much is the overdiagnosis problem? I don’t know.
So that’s ridiculous. Yeah. Yeah.
Somewhere between zero and 300 billion. Okay. I mean, you’ve got, you’ve got, I mean, you managed to produce 10 recommendations.
I mean, you probably, there are more than that, but when you boil it down, there are 10 major ones. The last of the other one, the other one again is this general principle that because of the, you know, this expansion, a bit of the diagnostic categories, they’re really soaring in numbers. It’s a great danger that we forget a basic principle.
Those are the greatest needs should get the greatest support, the quickest. Uh, and, um, and that’s definitely happening because the, sorry, that is going to happen. No, it’s happening now, squeezed out.
No, sorry. Because the fiscal envelopes haven’t changed very much, but the demand has. Yeah.
And the, those who least able to, to advocate for themselves, um, are the families will tell you, you know, these kids are going to have lifelong needs. Yeah. So then, but their needs, they aren’t getting, their needs aren’t being met is what you’re saying.
They’d be less met. Less than less met. Yeah.
And there’s good evidence from saying, for example, that that’s happening. Yeah. And we mustn’t ever allow that to happen.
No. Yeah. Your final recommendation is one about cross-government is about a cross-government mental health strategy.
Yeah. How are you going to make that happen? Oh, you’re being, you’re being mischievous here. Well, I mean, obviously, I think a lot of things need to be solved across government, but how’d you do it? I don’t.
You’re better placed than me to answer that. I mean, this is not the first time people have suggested this. This is not the first time that governments will have accepted this recommendation.
If it genuinely, truly happens, it will be the first time. Yeah. Um, and the way governments works is, you know, mysterious in some areas.
Yes. Um, I do think, um, oh, I mean, we’re, we’re drifting into politics that I don’t want to drift into. It’s not my dimension, but, um, but it is absolutely right.
We’ve still got issues around poverty, housing, homelessness, same thing, sorry, discrimination, um, all of these things, which we’ve always known. It’s not nothing new to talk about them. Um, it doesn’t mean that they don’t count.
Yeah. But when you talk about, you know, with the wise, social, cultural, environmental, of course, any solution needs to be cross-government. Yes, of course it does.
The health sector alone can’t deal with it. Well, no, it certainly can’t. In the education sector.
Um, and by the way, you know, we, I said that we moved away from really serious issues around under diagnosis, but there are areas where it is still serious in the prison state and the secure estate, et cetera, and children’s homes, issues like that pretty much overlooked and where I’m sure that there’s a lot of under, under, underdiagnosed, um, ADHD and autism. I’m sure there is. Okay.
And yet nobody really does much. So there are areas as well. So this is an issue for the criminal justice system as well.
Okay. So a lot of work’s gone into this, Simon, you produced, you know, with others a very, you know, very, very comprehensive, 150 others, 150. I mean, just one final question.
I mean, one of, in the introduction, um, the chair describes some very lively dissent and conversations.
Simon Wessely: [Laughs] Okay. I don’t remember that.
Kamran Abbasi: It’s there in black and white.
I mean, what would be the, what are the top two or three areas of dissent? Do you think of disagreement? Do you think, um, out? You mean, well, within the review, I think we’ve signed up to whatever’s in the review. Yes. But once it’s public, what will divide people?
Well, it’s going to still be, you know, people are going to react differently to the issues around, um, where are we talking about mis or overdiagnosis.
And I think a lot of that is from a fundamental misunderstanding of what those terms mean, which is why we devoted time to explain that. I just want to say again, it is talking about systems, not people. Um, and it is not, and people are worried they’re going to lose their diagnosis.
No one’s proposing that. And they really aren’t. Um, or that, you know, that, that for some reason they’ll be found.
I don’t know. People have got lots of fears out there. Um, but obviously around benefits, things like that.
Well, we’ve not talked about that now, but, um, or that this is rationing by another name. No, I don’t think it is. I really generally don’t believe it is.
And I think indeed, probably because, um, the costs of what we want to do are going to probably show this isn’t rationing. I think in the long run, it will definitely save money if it’s implemented properly, but in the short term, no, it won’t. No, no.
Okay. Well, let’s finish on a, on a positive. If you were to think, you know, what success look like for you from this? Okay.
I tell you what, success will not look like, you know, what’s the size of the waiting list? How many prescriptions have we got through? How many diagnoses we made? I think success will look like, if I was going to use one word, it’d be participation again, that people are now more participating in school. They’re more participating in economic life. They’re more able to, you know, participate more in family life and more able to, um, uh, become part of an active part of the community again.
So a lot of them are living isolated, you know, lives at the moment, uh, not participating. And, and it’s not an outcome we normally talk about, but I think increasing participation in those four areas, community, school, work, and home, that would be what success would look like. A good and hopeful message to finish on.
Simon, thank you for your time today. If it happens, of course, that is what we would like to see. We would.
Thank you. Thanks Kamran.