Shifting the focus from Autism and ADHD to Mental Health does not change who we are as neurodivergent people: Reflections on the Fonagy report
Note to Reader: This article is my personal response to the upcoming public release of the Fonagy Report, which examines autism, ADHD, mental health and the increasing demand for diagnosis and support. I share my concerns about the current political discussions surrounding disability and access to services, drawing on my own experiences to explain why neurodivergence, mental health, physical health and our everyday circumstances need to be considered together.
Topic Includes: Autism - ADHD - Neurodiversity - Mental Health - Disability Rights - Political Policy - Access to Support
How Might a Shift in Referral Pathway Impact Our Neurodivergent Community?
As an adult-recognised autistic and ADHD woman, I have been following the current political discussions about autism, attention deficit hyperactivity disorder (ADHD), mental health and access to support with growing concern. While I welcome efforts to improve mental health services, I worry that placing greater emphasis on mental health without fully recognising neurodevelopmental differences could mean that our needs and experiences as neurodivergent people are overlooked or misunderstood.
The government-commissioned review led by Professor Peter Fonagy is examining mental health conditions, autism and ADHD, including increasing demand for diagnosis and support. This is taking place alongside wider discussions about disability benefits, public spending and access to services. Although the review is separate from the proposed changes to Personal Independence Payment (PIP) discussed in 2025, these developments raise questions about how our experiences are understood, whose needs are recognised and what support will be available.
Mental health support is important, particularly given the experiences of anxiety, depression and other difficulties across our community. However, our mental health cannot always be understood separately from our neurodivergence or the circumstances in which we live. Differences in how we think, communicate and process information interact with our relationships, working environments, financial circumstances and access to support. A narrow focus on mental health risks overlooking these connections.
What my own experience has taught me
Being recognised as autistic and ADHD in adulthood helped me understand experiences that had shaped much of my life. Over time, I have developed practical strategies, learned how to respond to my needs and gradually found ways to participate more fully in everyday life. This has included moving from part-time to full-time employment, albeit in a slightly clumsy, chaotic way!
Appropriate healthcare has contributed to some improvements in my health and wellbeing, although this is very much an ongoing journey. Medication for ADHD and perimenopause, including a low-dose antidepressant, alongside more recent treatment for a respiratory condition, has helped me manage aspects of my health. Greater self-understanding, access to resources and opportunities to participate in work and society have also made a difference.
I have not become less autistic or less ADHD. What has changed is my understanding of myself, my health and the circumstances in which I live. My experience has shown me that meaningful support often involves several things working together rather than addressing individual needs in isolation.
Of course, my experience is not a blueprint for everyone else. Across our neurodivergent community, we have different needs, responsibilities, resources and opportunities, all of which can change throughout our lives. Our ability to work, manage everyday activities or live independently should not determine whether our experiences are recognised or our needs regarded as worthy of support.
This is particularly relevant when considering what a greater focus on mental health might mean for our community. Treatment for anxiety or depression can improve wellbeing, but it does not necessarily address differences in sensory processing, communication, attention or everyday functioning. Where autism or ADHD has not yet been recognised, mental health treatment alone may leave important needs unidentified.
Understanding Neurodiversity, Neurodivergence and Diagnosis
Neurodiversity, neurodivergence and diagnosis are related concepts, but they do not mean the same thing. Understanding these distinctions is important when considering how our experiences are recognised and supported.
Neurodiversity refers to the natural and expected diversity of human minds. We all differ in how we think, learn, communicate, process information and experience the world. It is not a diagnosis or a term that applies only to autistic and ADHD people. It encompasses variation in human cognitive functioning, including differences associated with neurodevelopmental conditions, mental health difficulties and acquired neurological conditions.
Neurodivergence describes ways of thinking, processing information or experiencing the world that differ from what is generally considered typical. It is a broad, non-clinical term used by many people to describe their experiences, including those associated with autism, ADHD, dyslexia and other cognitive differences. Some people also include differences associated with mental health conditions or acquired changes in cognitive functioning. There is no universally agreed boundary around the term, and not everyone with these experiences identifies as neurodivergent.
Diagnosis serves a different purpose. It is a formal clinical process through which particular conditions are identified using established assessment criteria. Diagnosis can help people understand their experiences and access treatment, services and support. However, a diagnosis does not create someone's neurodivergence, and the absence of one does not make their experiences or support needs any less real.
The Importance of Self-Identification
I am particularly concerned about the apparent dismissal of self-identification within discussions surrounding the Fonagy Report. For many autistic and ADHD people, obtaining a formal diagnosis is not straightforward. Long waiting lists, financial barriers and the continued under-recognition of certain groups mean that some people spend years trying to understand their experiences without formal recognition.
Self-identification can be an important part of this process. It can help us make sense of lifelong experiences, connect with others and identify strategies that support our wellbeing. For some, it is the first time we feel understood and validated. This does not mean that self-identification and clinical diagnosis serve the same purpose, or that appropriate assessment is unnecessary. Rather, we need to recognise the value of self-understanding, particularly when formal identification remains difficult to access.
I worry that dismissing self-identification risks invalidating people who already face barriers to recognition and support. We should be working towards more accessible diagnostic pathways while respecting those who have not yet been able to access them. Our experiences as neurodivergent people do not begin only when a diagnosis is confirmed.
Towards Recognition of Neurodiversity
Through my work at ND Perspective and in my forthcoming book Balance, I explore what it means to recognise neurodivergent experiences as part of human diversity. The aim is not to make everyone think, behave or function in the same way, but to understand how our individual characteristics interact with our health and the environments in which we live.
Recognising neurodiversity does not mean overlooking disability or distress. Some neurodivergent people experience substantial difficulties with everyday activities, communication, sensory environments or maintaining their wellbeing. Others encounter barriers because services, workplaces and communities are designed around particular expectations about how people should function. These experiences can overlap and change throughout our lives.
Understanding our needs also does not mean we always have the resources or opportunities to meet them. Access to healthcare, education, employment, financial security and supportive environments can influence our ability to participate. These circumstances are shaped not only by individual choices but also by the organisations and systems surrounding us.
As the government continues to review mental health, autism and ADHD, I would like to see discussions move beyond diagnostic numbers and the cost of services towards a fuller understanding of our lives. Improving mental health care should complement rather than replace appropriate recognition of neurodevelopmental differences. Our services and support systems need to reflect the diversity of the people who use them.
Accepting neurodiversity as part of human diversity should not require neurodivergent people to demonstrate particular strengths, achievements or levels of independence. Nor should improvements in wellbeing or participation be interpreted as evidence that we no longer experience disability or require support.
Shifting the focus does not change who we are as neurodivergent people. But it can change whether our experiences are understood, believed and appropriately supported.
As these discussions continue, I believe it is important that our community has opportunities to share our experiences and contribute to decisions that may affect our lives.
How do you think a greater focus on mental health within autism and ADHD referral pathways might affect our neurodivergent community?
I welcome your thoughts and experiences in the comments. With contributors' permission, insights shared may also help inform a future ND Perspective community article exploring different perspectives within our community.
Let's reimagine inclusion together,
Jess xx
Jessica Dark – Founder of ND Perspective and author of Balance, due for publication on 19 November 2026