The Fonagy Review: young people shouldn’t have to reach crisis point to get help
A young person shouldn’t need a diagnosis for their difficulties to be taken seriously. Nor should they have to reach crisis point before they can access support.
This is one of the key messages of the Fonagy Review, an independent review into mental health conditions, ADHD and autism in England, published last week. Its findings urge us to rethink how society responds to young people’s mental health needs.
The review confirms what Renew, alongside many other organisations working with children and young people, has recognised for some time: the rise in mental health difficulties is real. In 2024, one in four 16 to 24-year-olds met the criteria for a common mental disorder, compared with approximately one in six in 1993.
The review challenges the idea that young people have simply become less resilient and encourages us to consider the complex world they are growing up in and the pressures they face. It also makes clear that a formal diagnosis should not be a prerequisite for accessing support, recognising that young people can experience significant emotional distress without meeting the criteria for a diagnosed mental health condition.
At Renew, we have long championed the idea of going beyond labels and diagnoses to understand the individual in front of us. We believe that everyone’s experiences and circumstances are unique; meaningful support starts with understanding the person rather than simply the difficulties they are experiencing. It is therefore encouraging to see this approach reflected in the review’s recommendations for a more person-centred, needs-led system of support.
Support when it is needed – not just when it is critical
A young person may be experiencing significant emotional distress without meeting the threshold for specialist mental health services. But why should we wait until their difficulties become more severe before offering help? Early intervention can help prevent problems from escalating, improving outcomes for young people and potentially reducing the need for more intensive support later.
Our early-intervention eating disorders service for young people, supported by the Prudence Trust and the Stone Family Foundation, is one example of this approach in practice. By offering counselling to young people experiencing early signs of difficulties around eating, body image and self-esteem, the service aims to provide support before problems become more entrenched.
In its response to the review, the Prudence Trust highlighted that effective community-based approaches already exist and that the priority now must be to strengthen and build upon them. We share this view. Specialist NHS care remains essential for those with more complex needs, but it must sit alongside accessible community-based support that can help young people before their difficulties escalate.
The opportunity for change
The Fonagy Review makes a strong case for prevention, early intervention and the importance of support within local communities.
Organisations like Renew are already contributing to this work. But to ensure these services are accessible and sustainable, there must be meaningful investment and stronger collaboration between statutory services, schools and the voluntary sector.
The publication of this review presents an important opportunity. Its recommendations must not be welcomed and then forgotten. They need to be reflected in funding decisions, service planning and the way we measure success.
Improving mental health support should not focus on just reducing waiting lists or increasing access to diagnoses. A real improvement in England’s mental health support for young people would see more young people feeling better equipped to navigate their lives, maintain relationships, engage in education and look towards their futures with confidence.
We welcome the findings of the Fonagy Review. Now we must ensure its recommendations lead to meaningful action so that young people can access the support they need, when they need it.
