Why we welcome Professor Fonagy's review of mental health, ADHD and autism
We at Central Health London wholeheartedly welcome Professor Peter Fonagy's Independent Review into Mental Health Conditions, ADHD and Autism.
As always, Professor Fonagy has brought his formidable understanding of psychology and human development, together with a meticulous and rigorous analysis of the complex and interacting factors driving the rise in mental health difficulties, to produce a thoughtful, evidence-based and pragmatic framework for tackling one of the most pressing challenges facing our healthcare system and society.
We are enormously grateful to Professor Fonagy and his colleagues for bringing such clarity, insight and practical direction to this extraordinarily complex problem.
What the review reflects
The review reflects much of what our clinicians see every day: increasing psychological distress among children and young people, the complex overlap between mental health and neurodevelopmental difficulties, and the importance of providing support according to individual need rather than waiting for a formal diagnosis.
Importantly, the review also recognises that improving mental health requires more than better clinical services. It demands earlier intervention, collaboration across disciplines and practical solutions that extend beyond healthcare into families, schools and communities.
What our clinicians say
“The scale of the mental health crisis, including the tragically high rate of suicide among men, is beyond what medical professionals can solve alone. Good clinical care matters enormously, but so do the opportunities for people to connect, belong and find support within their communities. We need to look beyond the consulting room and help develop solutions that are accessible to everyone.”
“Children’s difficulties rarely fit neatly into a single diagnosis or specialty. Bringing professionals together around the child and family allows us to understand their needs more fully and provide genuinely joined-up care. We should use what we learn from working collaboratively to develop approaches that can benefit children beyond our own practice.”
“We welcome the review’s emphasis on prevention, early identification and understanding the whole young person. Schools cannot be expected to deliver specialist mental health care, but they need to work closely with families and healthcare professionals. Better coordination, continuity and communication can make an enormous difference, and these principles can be achievable in every healthcare setting with the right resource and philosophy.”
Dr Tara Porter, Clinical Psychologist and author of You Don’t Understand Me and Good Enough Parenting:
“The review challenges our tendency to understand young people’s distress primarily through diagnostic labels. We need to look more broadly at the environments in which they grow up and the pressures they face.
“The answers to the mental health crisis cannot come from healthcare services alone. They lie in families, schools, universities and communities, and in creating environments that value connection and compassion over comparison and competition.
“Rather than simply expanding diagnostic and treatment services, we should also be asking how we can create a society in which fewer young people need them.”
A view of returning to the UK after 35 years
“Returning to the UK after 35 years in Hong Kong, working as both a consultant obstetrician and gynaecologist and an advocate for better mental healthcare, I have been shocked by the scale of the deterioration in mental health and the pressures facing mental health services in the UK.
“This is apparent in both my NHS and private work. I am particularly concerned about the consequences of poor maternal mental health, not only for mothers themselves but for the emotional wellbeing and development of their children, and the potential for disadvantage and poor mental health to be transmitted across generations.
“Equally concerning is the deterioration in the mental health of frontline staff within the NHS. Having begun my clinical training in the NHS over 45 years ago, I have returned to a health service I barely recognise. My long absence may have spared me the ‘boiling frog’ phenomenon, where gradual deterioration becomes normalised by those experiencing it. Certainly, the cumulative changes appear stark and deeply troubling to someone returning after more than three decades.
“I worry that the unintended consequences of successive inquiries, increasing regulation and ever-growing administrative and accountability burdens, however well intentioned, have not been adequately evaluated for their impact on the wellbeing of either clinicians or patients. I think many of us working in the NHS believe we have created a system in which the very measures designed to improve patient safety and quality of care inadvertently undermine the very people and relationships on which safe, compassionate care depends.
“In May this year, Mind Hong Kong and Central Health Hong Kong announced the launch of Maternal Minds, a maternal mental health initiative with the ambition of improving mental health outcomes across generations. We are beginning by developing and piloting practical, scalable approaches to prevention and early intervention in Hong Kong and London, with the longer-term aim of developing models that can be adopted more widely.
“More than anything else, if patient care is to improve, doctors, nurses, midwives, psychologists and others working in the NHS need to have confidence in the solutions being proposed. At present, that confidence is lacking: the NHS is running on fumes and, in my very personal view, the only thing preventing its collapse is that 76 per cent of its workforce are women and, in Jane Austen’s words, we continue to hope when all hope seems lost.
“Professor Fonagy’s emphasis on understanding complexity and developing evidence-based, workable responses offers an opportunity to rebuild that trust. I hope its lessons can be applied more widely across the health service.”
Our commitment to better healthcare
Central Health London was founded with an ambition that extends beyond providing excellent private healthcare. We recognise that the time, resources and multidisciplinary expertise available to us create both an opportunity and a responsibility.
By ensuring that Central Health is reputation-led rather than profit-driven, we have created an environment for our clinicians to explore what can be achieved when the care they provide is shaped neither by financial constraints nor by the pursuit of profit, but by what they believe is best for their patients.
We all owe an enormous debt to the NHS, where most of us trained, many of us continue to work and from which we continue to learn. We believe private practice has a responsibility to repay that debt, not simply by taking on the straightforward, profitable cases, but by sharing responsibility for complex and challenging patients, helping to reduce the burden on NHS services and, wherever possible, using our different perspectives, expertise, professional networks and resources to help find solutions to problems facing the wider health service.
This philosophy has its roots in Central Health Hong Kong, where the clinicians drew on the practice’s clinical expertise, experience and resources to found Mind Hong Kong in 2016. Since then, Mind Hong Kong has grown into one of the city’s leading mental health charities, transforming access to community mental health care through public education, initiatives to reduce stigma and pioneering programmes providing free, evidence-based talking therapies to people who might otherwise be unable to access them.
We believe that the advantages of private practice should not benefit only those who can afford them. Our first responsibility will always be to provide the best possible care for our patients, but our wider ambition, as we managed to achieve in Hong Kong, is to use that experience to build charitable initiatives to make better healthcare accessible to many more people.
Excellence in caring for our own patients is our responsibility. Using what we learn to improve care for others is our wider purpose.
