The Fonagy review: what it found, and what must change for people with mental illness

After nine months of work, the Government-commissioned Independent Review into the prevalence of mental health conditions, ADHD and autism has published its findings. Sarah Anderson, our Head of Policy & Influencing, looks at the Review’s findings and what it means for people living with mental health conditions.  

What did the Review find?  

The Independent Review (also known as the Fonagy Review after Professor Peter Fonagy, who led the work) has found a significant decline in people’s mental health, particularly in young people. The prevalence of common mental health conditions has risen from 15% to 25%, and there has been a huge increase in demand for NHS services. 

There is clear evidence of rising distress, especially in young people, and these rises are being seen across society. These rises in distress are showing in different ways. There has been an increase in markers of fatigue, sleep issues, worry and concentration, which were previously stable for most of the century. These findings are worrying and tell us that aspects of healthy, fulfilling lives we have previously taken for granted are no longer guaranteed. 

We are concerned that although severe mental illness (SMI) prevalence has remained stable, people are still not receiving the treatment and care they need and that the most unwell people often experience the poorest health and social outcomes. People living with SMI still have exceptionally high rates of unemployment, housing instability, social exclusion, and physical health problems. Access to evidence-based psychological therapies for people severely affected by mental illness falls substantially short of need, meaning that many people end up in crisis without early intervention. The system is failing to meet demand consistently, and the groups with the highest need are often the least well served. This must change in order to address the huge human, economic and social cost these problems are causing, and will continue to cause unless something is done. 

The language of mental health does not always help us understand how severely people are impacted by different conditions. It is important to note that the Fonagy Review uses SMI to refer to people living with illnesses such as psychotic disorders, bipolar disorders, and personality disorders. We know that people can be severely affected by ‘common mental health disorders’ such as anxiety and depression, and more work needs to be done to understand these people's experiences and outcomes. 

What could be behind the rising number of people living with mental health conditions? 

We must address what is driving poor mental health across the country and give people the treatment they need when they need it. The significant decline in people's mental health appears to have begun in 2014, starting before the pandemic. It is clear, however, that the pandemic's effects have had a significant impact on people and their experiences of distress. The review also identifies sea-changes in key elements of daily life; education and work driving rises in distress, as well as the role of social media, artificial intelligence, and digital change.  

What does the Review recommend?  

The review recommends moving from a system that is dependent on a diagnosis to access support, to a needs-based system where people receive help earlier. Under this model, support does not wait for a formal diagnosis; neurodevelopmental and mental health pathways are integrated, with specialist care protected and directed to those with the greatest need. 

It makes several key recommendations, including: 

• Tackle the drivers of mental distress and ill health through an ambitious approach to prevention, early intervention and improving public mental health and wellbeing. 
• Protect specialist services to ensure that people with severe mental illness retain timely access to specialist care and do not lose out as other parts of the system are reformed.   
• Improve data collection and evaluation for mental disorders, ADHD and autism 

What might we see next, and what might look different for people living with mental health conditions?  

Mental healthcare needs to break the cycle of escalating need and responding to crisis and instead support good mental health through early intervention, trusted care and personalised treatment and support where we live. The Community Mental Health Centre model is an example of what the future of mental health support could look like, with people being able to access services for a range of needs in a joined-up coordinated way. To make the recommendations of the Fonagy Review a reality, the Government must commit to properly funding solutions as part of the upcoming spending review, so that we might see meaningful change for people living with mental health conditions. 

The stark differences in who receive treatment means equitable access is vital, so having a mental health condition isn’t made worse by which illness you have, who you are or where you live.  

These recommendations land at a pivotal time, with our new national leadership vowing to tackle the nation’s persistent challenges. Young people who are not in education, employment or training (NEET) have been a particular area of focus since Labour has been in power, as has the social security system. We are expecting two further major reviews; the Milburn Review and the Timms Review to be published by the end of the year, and it is key that their recommendations complement these to ensure a future where mental illness does not limit what people can do, be or achieve.  

We urge the recommendations to be taken forward into the promised Mental Health Strategy, with a commitment to properly fund public mental health and treatment and support. 

About the author

Sarah Anderson is Head of Policy and Influencing at Rethink Mental Illness. She leads the charity’s work with government and decision-makers to improve care, treatment and support for people living with severe mental illness. Follow Sarah on LinkedIn.