Proposals to limit the number of patients being formally diagnosed with attention deficit hyperactivity disorder have been attacked as "rationing" healthcare and pushing children and adults to self-diagnosis via social media. The comments came before a government review due next week, which is expected to say that patients with ADHD symptoms should not automatically be formally diagnosed, but should be "triaged" and offered support without the need for a formal diagnosis. Details of this "needs-based" system, first revealed in the Times, would mean NHS services target those most acutely affected by ADHD, such as those at risk of self-harm or unable to work. Less severely affected people may not be referred for a formal diagnosis to NHS clinics but would be offered help according to a "holistic" assessment of their needs. ## Why the Review Was Commissioned The government's independent review of mental health conditions, autism and ADHD was commissioned in December by the then health secretary, Wes Streeting, amid concerns over the sharp rise of people making sickness benefit claims due to mental health, autism and ADHD diagnoses. Led by Prof Peter Fonagy, a clinical psychologist and psychoanalyst at University College London, the interim review concluded that the system forces children and adults to obtain a formal diagnosis in order to get support. The scale of the backlog is large. Official figures show patients are waiting years to be assessed, with 800,000 people on NHS waiting lists, while complaints about autism and ADHD services in England have more than tripled in five years. Growing numbers of adults and young people with ADHD are not in education, training or work, of whom about 100,000 are on health-related benefits due to their condition. The ADHD taskforce calculated the cost of undiagnosed, untreated ADHD at 17 billion pounds. ## What Would Change for Patients Fonagy's review will recommend that only patients who would benefit from a formal diagnosis, such as those needing medication, would be referred to ADHD clinics. Under the proposed holistic needs-based assessment, patients would be triaged according to their difficulties and ability to cope at school, college, work or other settings, and offered targeted early support regardless of whether they had a diagnosis. Experts said such support could include one-to-one help for children to cope with lessons, quiet rooms in schools, classes to help parents support children with ADHD symptoms, and encouragement for employers to offer staff with ADHD flexible hours. The final report is expected to propose a similarly holistic approach to supporting people with autism, and to mental health more widely. ## Charities Say It Is Rationing But experts said the proposals would in effect introduce rationing of health services, noting that schools and workplaces are already able to offer early support without a formal diagnosis. Henry Shelford, the chief executive of ADHD UK, said the review proposed "rationing". "There is no 'mild' ADHD. Diagnosis requires evidence of a debilitating impact on your life. We already have a clinically drawn line of need," he said. "Without a formal diagnosis, it appears we will be left to self-diagnose via social media. Schools and businesses shouldn't be forced to rely on TikTok to know when to put in adjustments and support." Shelford said that, on average, a woman with ADHD would die nine years younger than her peers and a man seven years younger. "In almost any other area, those numbers would have this treated as a health emergency, but the stigma and misunderstanding around ADHD means instead we're treated as an inconvenience and proposed to be 'disappeared', untreated, from the waiting lists," he said. "Diagnosis means people turning their lives around, more people in employment and succeeding in careers." Investing in ADHD services offered a high return, he argued, noting that last year the NHS spent 574 million pounds on a single weight-loss drug because treating people meant they could get back to work. "The same is true of ADHD, with cheaper medication and better evidence." Mel Merritt, head of policy and influencing at the National Autistic Society, said: "Denying people a diagnosis will only worsen inequalities experienced by people who are autistic and autistic people with ADHD." Andy Bell, chief executive of the Centre for Mental Health, said people need speedy access to effective help and that a diagnosis can help people understand their distress, but effective support can also be provided without one — in schools, workplaces and young people's hubs. "No one should be left without the right mental health support, or made to wait for many months for essential services, at risk of getting worse while they're waiting," Bell said. A government spokesperson would not comment on the forthcoming report but confirmed Fonagy's final report will be published shortly and will inform the country's new national approach. The dispute ultimately turns on what a diagnosis is for. Fonagy's review treats it as a gateway whose cost sometimes exceeds its benefit; the charities treat it as evidence — the clinically drawn line, in Shelford's words — that unlocks legal entitlements at school and at work under equality law. Stripping the gateway while promising support elsewhere leaves those entitlements hanging on assessments no statute defines, which is precisely the gap the charities say they will press parliament to close when the final report lands next week.