Fonagy review's needs-based mental health approach will fail without serious public funding
Source: https://www.theguardian.com/profile/johnharris. "Finally, a helpful intervention in the ‘overdiagnosis’ wars. But where’s the money to answer this tragedy? | John Harris | The Guardian." October 11, 2026. www.theguardian.com
The Gist
The Fonagy review is thoughtful and mostly right, but its idea of giving help based on need rather than on a formal diagnosis only works if there is lots of new funding. The government clearly doesn't have or won't spend the money, so people will still need a diagnosis on paper to get any help, and the crisis will continue.
Conclusion
The Fonagy review's proposal to shift toward a needs-led rather than diagnosis-dependent system, while well-intentioned and largely sound, will not work and could be dangerous without substantial public funding, which the government is unlikely to provide.
Premises
- The Fonagy review is largely evidence-based and valuable: it rejects the 'snowflake' narrative, finds no evidence that overdiagnosis is occurring at scale, and proposes sensible safeguards such as regulating private diagnostic clinics.
- The review recommends moving from a diagnosis-dependent system to a 'needs-led plus diagnosis' system, and itself acknowledges this would require increased capacity, digitally enabled care, clearer national standards and sustained investment.
- At present, people with mental illness or neurodivergence can only navigate the bureaucracy and obstruction of schools, councils, social care and the DWP if they hold formal documentation confirming their condition.
- The relevant institutions are currently under-resourced and unreliable: CAMHS and social care turn people away, councils fail their obligations to neurodivergent people, and the DWP's culture is built around crackdowns and pushing people into work.
- The government is fiscally constrained and unwilling to spend: the prime minister and chancellor rebuffed the health secretary's request for NHS pay-rise funding on the same day the report was published.
Assumptions
- Without adequate funding, a needs-based system would rely on discretionary gatekeeping that denies support, so diagnosis would remain people's only reliable route to help.
- The government will not provide the 'sustained investment' the review says is necessary.
- The review's funding condition is a necessary precondition, not an optional extra, for its approach to work.
- Rationing under a needs-based model would be resolved against vulnerable claimants, given the DWP's crackdown culture and councils' track record.
- The government's refusal to fund an NHS pay rise is a reliable indicator of its willingness to fund mental health reform.
- A formal diagnosis currently functions as a practical protection for patients.