A 600-plus page government review - yes, someone read it - has been hailed as a "generational opportunity" to rethink support for mental health conditions, ADHD, and autism. Commissioned 10 months ago by then-health secretary Wes Streeting, who claimed young people were being "over-diagnosed" and "written off," the review could shake up NHS services, the benefits system, schools, and employment support.

On the question of over-diagnosis, the report says the risk is real - but only for ADHD and autism. Experts noted that diagnoses have risen over the past 25 years, with cases now appearing to outstrip expected numbers in some younger age groups. For children aged six to 17, more than 4% have been diagnosed with autism, well above the 1-2% that studies suggest is the true level. However, they cautioned that the data is weak: evidence on true autism levels relies on surveys not conducted for nine years, forcing the team to estimate. And in some age groups, these conditions are still under-diagnosed, which shouldn't be overlooked. So while they can't yet conclude over-diagnosis is happening "at scale," they say we're moving from an era of under-diagnosis to one of over-diagnosis. They also warn that not every difficulty requires a medical response, and there's a risk of blurring the lines between diagnosable conditions and "normal human variation in brain function, cognition and behaviour."

Where the review firmly rejects the over-diagnosis narrative is mental health. Chair Prof Peter Fonagy said Streeting was "completely wrong" on that. The increase in mental distress is real - one in four 16 to 24-year-olds now experience it, up from one in six 30 years ago. Fonagy links this to economic uncertainty, social media, and loss of youth services. Unlike autism and ADHD, where true population levels have remained broadly stable despite rising diagnoses, mental health is seeing a genuine rise. But it's not severe mental illness driving it - rates of schizophrenia and bipolar disorder have remained stable. Instead, anxiety, depression, self-harm, and eating disorders are behind the surge.

Where the review does share some of Streeting's concerns is on the impact of diagnosis itself. They warn that a diagnosis can become a label that defines people by their "difficulties" rather than their "strengths and potential," hampering education, work, and relationships. Around a third of 16 to 24-year-olds not in education, employment or training (NEET) cite mental health or autism as a factor. Those diagnosed with ADHD before age 17 are four times more likely to be NEET than those without. Addressing this requires better post-diagnosis support - not just from the NHS, but from schools, workplaces, and society at large.

The review team is united in saying the support system is "falling short" for both mental health and neurological conditions. Waiting times are too long: a third of young people referred to mental health services wait over a year, and of the 900,000 people waiting for ADHD or autism checks, 90% have waited more than three months. NHS Alliance, representing health bosses, said the system is in chaos. But the problems extend beyond the NHS: support across care, education, employment, and welfare is fragmented, forcing people to "jump through hoops" and face repeated assessments and conflicting requirements.

The review says no time should be wasted. It recommends reassessing everyone on a waiting list to prioritise those most in need, ending the first-come, first-served approach. Some may benefit from non-medical support - like advice on sleep or exercise - and could even be removed from the list. Better pre-waiting-list assessments are also needed, because not every problem requires a medical solution. The quality and consistency of autism and ADHD assessments must improve, especially those done by the private sector on behalf of the NHS. Half of ADHD and a third of autism assessments are done by non-NHS providers, such as charities and private firms, which aren't subject to the same regulation - and that must change. The review also wants a ban on direct-to-public advertising of assessments.

The review calls for action within 12 to 24 months. The government has promised to act, with more details expected in its forthcoming mental health strategy by the end of the year.