Our mental health and what to do about it – with Peter Fonagy and Norman Lamb

Department of Health and Social Care (2026). Independent review into mental health conditions, ADHD and autism: final report. 

Lamb N (2026). Be more human: why mental health care is broken – and what we can do to fix it. 

Health Foundation (2026). 20 years of policy for disadvantage: lessons for the future – with Moira Wallace.

Health Foundation (2026). How to build young people’s health and participation in work and education: recommendations for government. 

Health Foundation (2025). Mental health trends among working-age people. 

Health Foundation (2025). Understanding the crisis in young people’s mental health. 

Haidt J (2024). The anxious generation: how the great rewiring of childhood is causing an epidemic of mental illness.

Health Foundation (2021). Inside the teen mind: what’s happening to mental health? – with Jean Twenge and Yvonne Kelly.

Jennifer Dixon:

There seems to be a big rise in mental ill health in Britain, particularly among the young. This is showing up in long waiting lists for care, rapid rises in economic inactivity among 16 to 24 year olds and big rises in accompanying welfare spending, and not forgetting the most important impact on individuals themselves and their families.

So, what's going on and what to do about it? Well, with me to discuss, I'm delighted to welcome two guests, Professor Peter Fonagy, who recently led and published a government review into the prevalence and support for people with mental health conditions, including ADHD and autism. And Norman Lamb, former Lib Dem MP and former Minister of State for Care in the coalition government. Norman has just written a book called Be more human: why mental healthcare is broken and what we can do to fix it. Welcome, both.

What actually is happening to the prevalence of mental ill health in Britain? Peter, you've just led with others a review, and I know there was a deep dive into these questions. Can you tell us what the headlines are?

Peter Fonagy:

Common mental disorders among adults age 16 to 64 rose from about 15.5% in 1993 to 22.5% in 2024. So it's a 50% increase in three decades, but the age pattern has inverted. So distress was once highest in midlife and now it's highest in early adulthood. Particularly amongst 16 to 24s, it's reached nearly 26% in 2024, more than twice the rate in people over 75. Little irony there. So, it is something to do with age. And it's true for the UK, but it's also true for other Western countries.

Jennifer Dixon:

And the profile of this distress, can you say something about that and trends, the kinds of conditions being observed?

Peter Fonagy:

It's having real impact. So there's decreased participation in education, in work. It's marked for women, anxiety, depression, self-harm. It's also true that the co-occurrence of disorders has increased. So acuity as well as the likelihood that if you have anxiety, you might also get ADHD or you have autism, you're more likely to have ADHD. So, that's on the prevalence side.

Obviously there's a completely different picture on the administrative side, on what is being recognised. On common mental disorders, a steady increase, as I said, over the last 20 years. On something like ADHD, the administrative prevalence, that is to say the number of diagnoses made, has skyrocketed in the last 20 years, particularly in young people. But it's marked also in self-diagnosis, it's marked in those not in education, employment, or training. So it is a very different picture for neurodevelopmental disorders, both ADHD and autism, where the increase is not this gradual increase that we have been observing. For ADHD, it got rapid, particularly after COVID-19.

Jennifer Dixon:

Could you say for the people listening what the difference is between administrative prevalence and prevalence, per se?

Peter Fonagy:

Prevalence refers to the proportion of the population sampled systematically that have a particular diagnosis. So in common mental disorders, the current diagnosis is something like 22.5%. In administrative prevalence, it is, how many do we notice? How many are referred, diagnosed on referrals, are on a waiting list, diagnosed after a waiting list? And there, the percentages are steady when you look at population prevalence, but rapidly accelerating when you look at either waiting list or diagnosis by professionals.

Jennifer Dixon:

I was involved in one chapter of the review that you had led on the wider societal factors that might be associated, but one of the features of the trends in the last decade at least is some of these conditions are far more common in socioeconomic groups that are more deprived populations than those that are less deprived, but the rate of increase was similar. Is that an accurate portrayal, Peter?

Peter Fonagy:

That is an extremely accurate portrayal, and I want to formally acknowledge your contribution and thank you for it. But I would want to say that that's true for population prevalence. What is perhaps not so true is that the administrative prevalence, that is the number of recognised diagnosed cases in the health service, are following the same parallel trends. So it is also true that administrative prevalence has increased somewhat in those in most deprived groups of neurodevelopmental disorders, but in the less deprived groups, it has increased more rapidly to the extent that the discrepancy that had been there, for example, in autism between more deprived, less deprived group in ADHD, between more deprived, less deprived group, is closing.

Jennifer Dixon:

That's very, very interesting, isn't it? Norman, I wondered if you had any observations when reading the report.

Norman Lamb:

So first of all, really welcomed the report and it's going to be an incredibly valuable piece of work in enhancing our understanding of a very complex set of issues. I'm also conscious that I am a layperson here and I'm engaging in a conversation with a clinical expert, so I defer to Peter. But these are in a sense a reflection of the society that we live in and the way in which society is changing. I think it's becoming more complex to grow up in today's world. There's the whole issue of social media, and it's not to suggest that everything comes down to the problem of social media, but clearly, it is a factor and I think the report reflects that.

And I was quite taken by the analysis that Jonathan Haidt did in his book, The Anxious Generation, where he talks about these two factors that fall in play as parents become more anxious about threats and risks in the real world, and this dramatic increase in presence in the virtual world, and a sort of retreat into the bedroom, less contact between young people. And you sense now that you could be a 25-year-old living in the middle of London in a densely populated area and yet be acutely lonely and isolated. Society's becoming more atomized. Some of the old ties that bound us together, the institutional ties have loosened. And on top of that, we've got a very angry, aggressive public space, where debate is not conducted in a decent civilised way too often. And I think all of these factors added onto the impacts of financial stress and so forth, make it a very difficult time, particularly for young people, I think. And that is reflected in this rise in distress levels, sometimes tipping over into diagnosable ill health.

Peter Fonagy:

I think Norman is, as usual, putting his finger on where the most important issues lie. As Norman points out, there is more pressure, in terms of the labour market offering and insecure work and unaffordable housing for young people. And also, when they're supposed to be building their life, there being less resources for them available. I think we cannot avoid identifying that as being a major issue.

But there's also, as Norman pointed out, increased loneliness. And around 60% of adults with common mental health conditions report loneliness or isolation, contrasted with 16% of those without a mental illness. And at that point, you have to say there is something causal about this. Loneliness has been increasing. One statistic that really lives with me, between 2010 and 2023, there has been a reduction of 73% in investment of young people services by local authorities. So, that throws young people back into their homes, but also onto social media. So it's really more loneliness is not simply because young people want to be lonely. It's not simply caused by parental anxiety or social media. It is also something that we have changed in society.

And one thing that I would want to talk about just very briefly is something that's not often mentioned, which is the opportunity for young people to recover from stress, because play time, break times, green space, sleep, these are things that we all use to recover from stress. If we have social media, the main impact of social media may not be the terrible messages, and I don't want to be an apologist for social media, the terrible content that's there, but also that it actually is addictive, makes people do it in preference to sleeping or exercise or face-to-face interaction.

Norman Lamb:

And of course, Peter, it is designed to be addictive as well, that I think has to be confronted. The way the algorithms work are designed to keep us watching and doom scrolling and so forth, and something that afflicts adults as well as young people.

Jennifer Dixon:

Yeah. This downtime I think is a really important point. This is just my own anecdotal example of my daughter. Her and her friends, their favourite book was something called My Year of Rest and Recuperation, which is by an author who wrote a book about staying in bed for a year. And this was very, very popular amongst her peer group, extraordinarily so, about someone does writing a book from their bed, but it obviously chimed quite considerably.

And Peter, your point about the local authority spend, we had on the podcast a few months ago, Moira Wallace, who headed up the Social Exclusion Unit under Tony Blair, and described in a 200-page report how all the investments that were made to improve social inclusion over the Blair years were then turned back in austerity. And the dials went in a very positive direction under the Blair government, which was teen pregnancies, antisocial behaviour, and then of course, surprise, surprise, the dials went in the opposite direction with all the cutbacks.

And Norman, you mentioned Jonathan Haidt. We haven't had Jonathan on the programme, but we have had Jean Twenge, who was a close colleague of Jonathan's, who wrote the book iGen and talked there about the role of social media and particularly its effect in the US after 2011.

So a lot of horrible challenges and pressures, and we're not even talking about schools and the pressures they're under to achieve academic results, because Norman, you said that these are problems of advanced industrial societies that we're not alone in. But the question then is, given that they are so profound and intersecting, what to do about it? Because we are seeing very considerable impacts, not just in the figures that were reported in Peter's report, but also in the needs analysis that Alan Milburn's doing and so on and economic inactivity. So I guess this could not be a bigger issue, could it really? Where on earth do you begin with this, to try to counteract some of these trends? And let's start with Peter.

Peter Fonagy:

Well, our recommendation, perhaps the most important one, is to reverse the sequence from one where you wait, you assess, you diagnose, and then offer support, to one where you recognise the need, you understand the need, and you begin support, and then you establish diagnosis where it's needed, and you review and adapt if necessary. So, this is giving an opportunity for two things to come into play. One is early intervention, and we knew that early intervention is more effective than late, because the brain establishes itself in a particular pattern. But more important, the current system is incompatible, it's in-amicable with prevention. And over successive governments, particularly since the Blair era that you had mentioned, we have disinvested in prevention, and prevention has to be the major part of the answer to the problem.

Norman Lamb:

The UK doesn't compare well when it comes to a central government focus on how we prevent problems from happening in the first place. And Charlie Mayfield incidentally in his current work on work and mental health and so forth, highlights the fact that we don't devote sufficient investment and attention to how we prevent problems. Our tendency is to invest in responding to crisis when everything is far too late. So, I think there is an issue there for the central state and indeed local authorities as well to shift the dial. We say it, one of the top priorities for the government on the NHS is a shift to prevention, but we've got to work out what that means, particularly in terms of our health and our wellbeing.

Secondly, I would say that we need to start from year zero or indeed before year zero, understanding that the whole of your life trajectory is starting in those early years. We know that there's a strong correlation between bad things happening to you in childhood and the emergence of ill health, distress, both physical and mental ill health later on in life. When I was Chair of the Science and Technology Select Committee, we looked at evidence-based interventions in early years to support parents to be effective in their parenting and to prevent trauma, abuse, neglect happening in the first place. And cross-party committee recommended that evidence-based interventions should be available everywhere across the country. Of course, it was rejected by the then government, this was back in 2018, and it was just down to local authorities to decide how to prioritise their spending. But it does seem to me that if we know something about effective ways of supporting parents to be effective in our parenting, then surely, we should make those approaches available everywhere.

We need to focus on what happens in school. Finland always wins out on the happiest countries in those international assessments. And one thing that I noted was that their school curriculum is much broader and richer, I think, than ours, with a great emphasis on music and art and drama and so forth. And I think there are some consequences to narrowing our curriculum down as much as we have done in this country. We've already touched on it, access to nature and experience of nature and beauty. These are things that help give purpose and meaning to life, and yet very often are denied to people.

And there's a lovely example in the book of a wellbeing woodland in Yorkshire, where school children just go and play it in beautiful woodland and they go at the same time as army veterans who are recovering from all sorts of difficult experiences. But learning out in the wild, testing yourself, building friendships, sometimes making mistakes and going too far, this is the way in which we learn how to become resilient and how to flourish in later life, I think. And so often we've lost access to these experiences, particularly if you're living in an inner city.

I would also touch on a beautiful example from Norway where the clinical psychologist recognised how the system wasn't working, particularly for young people, and she created a new service as part of the state funded system in a locality. Her approach was simply to open the doors, to say that, ‘We will ask you what matters to you when you come. We won't have waiting lists, we will just see you when you need help. We will build relationships. We'll jointly problem solve.’ And she purposefully avoided defaulting to diagnosis and to medication. And she ran this service, she called them help centres, for some 10 years. And in that period of time, avoided endless diagnoses of young people and just focused on intervening really quickly, solving the problem that might've been the cause of the distress in the first place. And I find that so attractive.

We've ended up with this sort of learned helplessness in this country that waiting lists are an inevitable feature of our system. However awful it may be, there's nothing we can do about it. Examples in places like that demonstrate that it's not an inevitability, that you can provide help when it's needed. And I think that would be an enormously valuable innovation in our country.

Jennifer Dixon:

There's a nice piece related to that in the summary of Peter's report where, Peter, I was very struck by this. You say, ‘In short, population prevalence is not administrative prevalence. Distress is not disorder. Diagnosis is not need, and support is broader than treatment.’ So, it's this last area we've just been discussing in particular, I think. And some of those examples absolutely resonate. Peter, would you add anything to that?

Peter Fonagy:

I think Norman will be pleased with our recommendation in terms of focusing, just like the Norwegian psychologist that he cites, on need. And as soon as the need emerges, you put support in place, not put support behind a diagnostic wall and even thresholds that you have to reach in terms of your acuity before any kind of support becomes available, which is paradoxical to the extent, almost to lunacy, so.

Norman Lamb:

Peter, I totally agree with your conclusion there, and I so much welcomed it. It's funny that we all preach the principle of early intervention and yet the system actually delivers support usually at the latest possible moment. It's completely the wrong way around.

Peter Fonagy:

Exactly. But there are things that we could do even just modifying, say for example, the education system. We know that things like the culture of schools makes a massive difference. Teachers are enormously important as a source of support, and integrating mental health interventions with the educational system and establishing mental health support teams actually turned out to be enormously helpful. So, getting away from a system where we put silos where silos do not need to be and integrate them, because the same child, whether it's being looked after by DFE or it's being looked after by DHSC or CWP, it's the same family, working more locally. I think there's so much that we could do that we are not doing for reasons that are actually quite hard to understand, Jennifer, quite hard to understand. Probably tradition comes into this in a way that's really most uncalled for.

Jennifer Dixon:

And those things, Peter, are they things national government isn't doing or are there other things in what you were just saying?

Peter Fonagy:

There are three levels of it. One is, national government can't do but can make space an opportunity to do. Secondly, with now moralities and more local resource distribution, there was a great deal that we could do to adjust to local resources. But most important, wellbeing is part of how we behave towards each other as a human community. And for that to be taken seriously and to be reinforced and rewarded and encouraged is of enormous importance.

If I can just give you one example, which is profound. To me, during COVID, we measured everything and we measured infection rates. I'm sure you're familiar with this paper in this in the Lancet. 173 countries measured infection rates that differed dramatically even between countries that were very close to one another and wasn't predicted by deprivation or other preparation for infections or any of the things that you'd expect. What predicted it was one question on the World Bank survey, which is, ‘How much would you trust a person you do not know?’ And that question predicted difference of orders of magnitude in the rates of infection. And the reason is obvious, because if you trust the people next door, you trust your government and you do what the government tells you. And if you do not, then you're suspicious and you encourage this culture of isolation and lack of community that Norman started talking about, which I feel is so much the driver to the mental health problems that we are facing.

Norman Lamb:

I should just mention another example that I include in this book, Be More Human. Schools are required to measure so many different things, which could be extraordinarily confusing for them and you can lose sight of what you're trying to achieve. But actually, if all schools are measured on the wellbeing of children, it means then you focus on that and you see which schools are doing better than others, but you create the conditions in which children can learn. And the more you do that, of course, then it improves our knowledge, the evidence base for what works to achieve better wellbeing, and you end up with more rounded human beings and probably almost certainly more economically successful human beings.

Jennifer Dixon:

So if you stand back from all of this, it looks to me like a multifaceted, at least 20-year mission to try to ameliorate some of the trends that we've seen. And Norman, you've spent time in central government, you know how difficult doing this type of thing is, both constructing something that is comprehensive and intelligent, especially in a resource constrained environment, but also actually secondly, having the consistency over time to be able to deliver something. So, I guess that's a big question. Where next given your experience?

And I suppose just tacking in a second point onto that, we do have a possibility now for more devolution, and both of you have mentioned the importance of locality here and to make local choices and trade-offs and take risks in a way that you can probably do if you know people more at a local level. So, how do we move forwards on this, particularly with Andy Burnham being here, new government, he's talking about good growth, but he's also talking about good lives as well.

Norman Lamb:

Well, I jointly chaired something called the Health Devolution Commission with Andy Burnham in the early 2020s. And so I know that he's serious about this, and I totally share the importance of devolving power from the centre. We are about the most centralised country of any in Europe, apart from Malta, and they probably have a good reason to be centralised given their size, but that has to be part of it. We also have to recognise that keeping ministers in place so that they actually have the chance to develop an understanding and then deliver an agenda is critically important. The constant turnover of ministers is completely destructive of anything meaningful or purposeful happening in central government.

I do think that Allie McGovern gets it. I've been impressed by her so far. So I would just love her to be able to stay in position for a good period of time and to start to develop a mission. And it goes way beyond health, of course. And so it has to be led, I think, to a large degree by Downing Street and by the Prime Minister. But I think this is central to the country's future prosperity and happiness.

And actually, you talk about difficult at a time of financial constraints, but actually much of this doesn't require more money spent. It's about how we spend the money and spending it more effectively and earlier on. And if you do that, you will save money further down the track.

Jennifer Dixon:

So I think we're nearly out of time, but perhaps if I can just finish with, what's the priority in the short term that you'd both like to see?

Peter Fonagy:

We have taken away much of the support which young people rely on, and we've replaced it with phones, with social media, with academic pressure. So to me, the priority is rebuilding that support, a campaign for young people's wellbeing. Not increased awareness, we've got increased awareness coming out of our ears. It's actions, it's simple actions that people can do. And effective integration depends on shared priorities, strong leadership, but also joined up commissioning, data sharing, collective focus on prevention and early intervention. All these are eminently doable and having a collective sense of that pragmatic deliverable part from the government.

And the Blair labour government, you mentioned it, sure start, turned out to have been a wonderful initiative, halved crisis interventions in the teen years. So there is so much that we could do, but it has to be something of a campaign, something that we join together on.

Jennifer Dixon:

And probably across government. Do you agree, Norman? What would be your top things?

Norman Lamb:

Yeah. Well, I endorse everything that Peter has just said. I think a central mission of government to try to create a more preventive state, where we recognise the importance of investing in the services that Peter has described. And successive governments, including, I should say, the coalition and GILTI of stripping away the preventive elements of support at times of financial constraints. And that's been a false economy for the country, I completely recognise that.

But I would say finally, as part of that shift towards a preventive state, I'm hopeful that the Alan Milburn review will come up with a credible plan. It is surely scandalous that we have about a million young people not in education, employment, or training. The waste of human talent is deeply shocking. The impact that that has on the lives of the people affected is awful. The economic cost is vast. And so, developing a credible plan to enable young people to get into meaningful employment would be such a precious achievement for this government to put off.

Jennifer Dixon:

So, I hope you enjoyed that conversation with Peter and Norman. Lots to chew on there and familiar themes. The three things I think I took away is firstly, the rise in mental distress is absolutely real and concentrated among the young. It's harder to grow up now, and this seems to be a phenomenon of modern industrialised societies, not least in Western Europe.

The second thing is, obviously this is multifactorial and lots needs to be done. There really does need to be a long-term cross-government mission to address it over 10 to 20 years. And the good thing is, is that there's been diagnoses recently of the type for Peter's review, and also that there are opportunities now with devolution to try to do something a little bit more creative and ambitious.

The third point that I think Norman was saying, and I agree with, investment does help. We know it does, but it's not just about investment. This isn't about a change of mindset. We are spending enormous amounts already in the public sector on various things, and not least in coping with some of the trends that we've been discussing today. A change in approach, a recognition about what's going on, and a commitment across party to do something about it, I think would be the place to begin.

We'll put the relevant links in the show notes to Peter's recent report and Norman's book, Be more human, both of which I really encourage you to read. I think they're both really insightful and thoughtful about the issues. And meantime, thanks as ever to Sean and Leo at the Health Foundation, to Paddy and his team at Malt Productions. And it's goodbye from me until next time, Jennifer Dixon.