- Published
It has been called a "generational opportunity" to rethink support for both mental health conditions and ADHD and autism.
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It → publish → conditions
The review, commissioned by then-health secretary Wes Streeting 10 months ago after saying young people were being "over-diagnosed" and "written off", could have major implications for NHS services, the benefits system, schools and employment support.
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people → commission → services
Its 600-plus pages contain a host of conclusions and recommendations.
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pages → contain → conclusions
Over-diagnosis is a concern
The report is clear that there is an increasing risk of over-diagnosis, but only when it comes to ADHD and autism.
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it → be → ADHD
Experts said a rise in diagnoses over the past 25 years meant cases now appear to be outstripping the expected number in the population for some younger age groups.
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cases → say → groups
They gave the example of children aged six to 17 – more than 4% have been diagnosed with autism.
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% → give → autism
That's well above the 1-2% that studies suggest is the true level.
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studies → suggest → %
But this comes with a big caveat.
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this → come → caveat
Evidence about the true level of autism relies on surveys that have not been done for nine years, so the review team have had to estimate what has happened since.
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what → rely → years
And there are some age groups where these conditions are still being under-diagnosed, and that should not be overlooked.
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that → be → ?
It is why the review team said it could not yet conclude over-diagnosis was happening "at scale".
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diagnosis → say → scale
But there is certainly evidence to suggest we are moving from an era of under-diagnosis to one of over-diagnosis, the experts said.
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experts → be → diagnosis
They warn not every difficulty requires a medical response and there is a risk of blurring the lines between diagnosable ADHD and autism and what should be considered the "normal human variation in brain function, cognition and behaviour".
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what → warn → function
Mental health is different
Where the review team very clearly rejects the idea of over-diagnosis is with mental health.
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rejects → reject → health
In fact, the chair, Prof Peter Fonagy, has said Streeting was "completely wrong" on that.
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Streeting → say → that
He said
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He → say → ?
the increase in mental distress is real – one in four 16 to 24-year-olds are now thought to experience it, up from one in six 30 years ago.
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olds → think → six
He links this to a variety of factors including economic uncertainty, the impact of social media and loss of youth services.
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He → link → services
This contrasts with autism and ADHD.
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This → contrast → autism
While diagnoses have increased, the true level in the whole population (regardless of whether they have come forward or not) has remained broadly stable, according to best estimates.
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they → increase → estimates
What is not happening with mental health, though, is an increase in severe mental illness.
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happening → happen → illness
Population rates of schizophrenia and bipolar disorder, for example, have remained stable.
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rates → remain → example
Instead, what is driving the rise is conditions such as anxiety, depression, self-harm and eating disorders.
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driving → drive → anxiety
Young people being written off
Where the review experts share, to some extent, Streeting's concerns is on the impact of diagnosis.
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share → write → diagnosis
They said there was a risk it ends up closing doors to opportunities.
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it → say → opportunities
It can, they said, act as a label that defines them by their "difficulties" rather than "strengths and potential".
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that → say → difficulties
This then hampers them in education, work and relationships.
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This → hamper → education
Around a third of 16 to 24-year-olds not in education, employment or training (NEET) report their mental health or autism as a factor.
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third → report → factor
Those diagnosed with ADHD before the age of 17 are four times more likely to be a NEET than those without.
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Those → diagnose → those
Addressing this, they said, would require better support post-diagnosis.
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they → address → diagnosis
System failure
Another area where the review team is united in its view is that the support system is "falling short" of what people need for both mental health and neurological conditions such as ADHD and autism.
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people → unite → ADHD
A third of young people referred to mental health services wait more than a year, while of the 900,000 people waiting for ADHD or autism checks, 90% have waited more than three months.
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% → refer → months
In the lead up to publication of the report, NHS Alliance, which represents health bosses, said the system was in chaos.
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system → represent → chaos
But this goes further than the NHS.
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this → go → NHS
The report said support across care, education, employment and welfare remains fragmented, with people having to "jump through hoops" and face repeated assessment and conflicting requirements to get support.
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people → say → support
Act now, before it's too late
No time should be wasted in tackling these challenges, the review says.
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review → act → challenges
On long waits, it says everyone on a waiting list should be reassessed so that those most in need are prioritised for help.
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those → say → help
Some of those waiting may benefit from non-medical support, advice about sleeping better or getting more physical exercise, for example.
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Some → wait → example
That may even lead to some being removed from the waiting list.
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some → lead → list
There should also be better assessments before people are placed on waiting lists too.
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people → place → lists
…and 6 more, not listed.
The Aporia
