He shoots, but does he score? Professor Fonagy’s independent prevalence review on mental health, ADHD and autism is finally out – what is the result?
The headlines about waiting lists and diagnosis risk drowning out some very useful findings. Three things stood out:
1. Distress is real
Rising numbers are not explained away by awareness or relabelling. Those coming forward are no less impaired than before. The system is failing: under-resourced, over-reliant on a poorly regulated private sector, with diagnosis as the only gateway to care. This is not new news, but it is important to hear loud and clear that the annual cost of mental ill health to the economy is £300 billion – and between 2015 and 2025 there was a 70% increase in young people not in employment or education, who report a work-limiting health condition.
2. Diagnosis is being put back in its proper place
The recommendation to move from a diagnosis-dependent system to a needs-led plus diagnosis system is spot-on. Support should begin when need is identified — not after months or years on a waiting list. Waiting should become an active period of support, not a passive delay. I wonder where this leaves those now on a mandatory 2 year NHS waiting list…and whether they will be offered support in the meantime.
3. A genuine pathway, not a queue
Recommendations include neighbourhood multidisciplinary teams, no wrong front door, the expert at hand principle, active waiting lists, post-diagnostic offers, participation as a measure of success. This is a coherent vision of care organised around people rather than pathways.
So far, Fonagy is on target.
But what about the opportunity to join up with policy and practice on access to green space and engagement with Nature, and community-building? Largely missed.
What about Nature and healthy futures?
There is the recognition that young people are missing opportunities for rest and recovery, including time in Nature. The evidence review notes the benefits of access to Nature during childhood, and ‘promising signals’ for psychological support and nature-based activity – including social prescribing. I’m afraid this is rather woeful. The Government’s own nature advisor has collated a strong evidence base, which doesn’t appear to have been incorporated.
There was a clear chance for a strike at a people and planet goal, and the Fonagy review has pulled it wide.
The chance to commission pragmatic trials of nature-based interventions, link greenness data to service records, and embed nature-connectedness in measurement was largely left on the table. With another strategy pending, will Government act? Or will this be another missed opportunity?
Meanwhile countless charities, community providers, therapists and coaches are doing their best to join up the dots themselves.
