The Fonagy review: what should come next?

Professor Jess Deighton, Director of Research

Having played a small part in this review, I know how much collective effort went into this comprehensive assessment of the state of the nation’s mental health, from unpacking recent prevalence trends to providing recommendations in a complex and fragmented context.

As a prevention researcher, I particularly welcome the focus on tackling drivers of mental health problems. Mental health strategies often neglect wider factors, like poverty, loneliness, educational pressures and sleep, which can significantly impact risk of mental ill health. As a cross-government plan, the new strategy is a golden opportunity to tackle these risks through a joined-up approach.

The review's key message is that support should not be contingent on diagnosis. This is crucial if we are going to provide early help and prevent problems escalating. However, in a context where need vastly outstrips the support on offer, accurately identifying and meeting will require significant system rewiring. Integrated community support, such as early support hubs, will be essential to this.

Local data intelligence will also be vital to understanding how needs vary between communities and ensuring that resources are directed where they can have the greatest impact. The #BeeWell programme, which was founded by Anna Freud, The University of Manchester and the Gregson Family Foundation, provides a fantastic model for this.

Dr Lesley French, Director of Schools and Clinical Practice

The review asks us to look carefully at diagnostic quality and the relationship between diagnosis and need. Crucially, it doesn't establish that there has been widespread overdiagnosis. What matters is that young people's needs are recognised and met. The strategy should make sure that no child or young person has to wait for a diagnosis to be completed before they get support.

Schools are one important part of the system around children, alongside families, health services and the wider community. If the strategy asks more of schools, it must come with the practical support and investment to deliver it, not pile on new expectations without the resources to match.

The strategy should also question how we respond to school absence. That means understanding why a child isn’t attending and distinguishing unwillingness from inability. Anxiety, unmet learning or sensory needs, bullying and family difficulties can all play a part, often together. This isn’t about abandoning attendance expectations. It’s about understanding the barriers and agreeing a realistic, supported route back into education. This can be achieved by schools, families and mental health teams working in partnership, supported by the government.

Dr Georgia Pavlopoulou, Neurodiversity Programmes Lead

As a neurodivergent researcher whose work draws on observational data studies, alongside listening to and learning from hundreds of neurodivergent people, I welcome a needs-based approach to supporting autistic and ADHD young people. However, the strategy must use it to remove barriers, not create new forms of gatekeeping.

Behind the prevalence figures are real people whose needs are too often misunderstood, underserved or left waiting. Progress shouldn’t be measured by the number of diagnoses, but by whether needs are met and whether young people feel they genuinely belong.

This will take a cultural shift. We need to move away from stereotypes based on ethnicity, gender or “functioning”, away from pressure on young people to mask their needs, and away from one-size-fits-all solutions. In their place, the strategy should back neuroinclusive approaches that give young people agency, dignity and choice.

Belonging is fundamental. Being included in a school or health service where you don’t feel safe, heard or able to take part is not real inclusion.

The strategy should drive workforce development, more accessible services and co-production that goes beyond consultation to genuinely sharing power. At Anna Freud and UCL, we’re already seeing what this looks like, with lived-experience experts leading training, providing peer coaching (including through our NHS-funded Autism Central service) and shaping how research is put into practice.

Bez Martin, Head of Participation

The Fonagy review presents a welcome opportunity to strengthen how children and young people access and experience mental health support. I particularly welcome its emphasis on earlier intervention, responding to individual needs and creating a more accessible and responsive system.

As the government looks to turn these recommendations into a mental health strategy, children’s rights must be at its heart. Article 12 of the UNCRC reminds us that children and young people have the right to be heard and to influence decisions that affect their lives.

I hope to see the strategy build on the review's recommendations and ensure children and young people are meaningfully involved in shaping, delivering and evaluating services. This includes recognising the diversity of their experiences and ensuring participation is inclusive and accessible.

Ultimately, the strategy should not only improve access and outcomes but also strengthen children's agency, ensuring services are developed with them, not just for them.

Dr Camilla Rosan, Consultant Perinatal Clinical Psychologist and Clinical Research Lead

In my opinion, it's rare to see a government review this compassionate and nuanced. 120 experts fed in and Peter Fonagy acknowledges that they disagreed 'so productively and kindly'. There are no easy answers, but here's is what I want to see actioned in the strategy with early years in mind.

First, it must close the baby blind spot. No national funding is ring-fenced for under-five mental health, and specialist early years services reach only around 4% of families who need them.

It should also find ways to reach the more than 115,000 women and birthing people each year we identified through the Integrate project, whose mental health difficulties fall below the threshold for specialist support. The strategy should deliver joined-up mental health pathways from pregnancy through preschool in every area.

Finally, support for emerging autism or ADHD-related needs shouldn’t wait for a diagnosis. Early years often see difficulties first and should be part of providing early support. Assessment matters too: trauma, adversity and sleep difficulties can look alike, so the strategy should back good quality, regulated assessment that draws on what parents and nursery staff see.