UK child diagnoses are rising—and so are costs. But the alternative isn’t neglect. From Tele-MANAS in India to U.S. school screening gaps, the answer is more baseline support, not more labels.
LONDON / NEW DELHI / BOSTON — August 2025.
A new Policy Exchange report has thrown petrol on a long-simmering debate: are UK schools and services over-diagnosing children with mental health and neurodevelopmental conditions—and at what cost? The think-tank estimates an annual bill of £16.6 billion tied to rising child diagnoses, expanding special-needs plans, and welfare supports. The report argues incentives inside education and benefits systems are nudging families toward labels to unlock help—overwhelming services and “medicalising normal childhood.”
The headline landed in a country where one in five 8–25-year-olds was rated as having a probable mental disorder in 2023, a level far above the pre-pandemic baseline. NHS Digital’s cohort tracking shows 20.3% of 8–16-year-olds screened “probable” last year, with older teens highest. At the same time, UK referrals for ADHD assessment hit ~20,000 in a single month this spring—up 13.5% year-over-year—underscoring demand spikes that neither clinics nor schools can easily absorb.
The Policy Exchange authors warn that the current model risks “undermining resilience” and straining already-thin provision. Critics counter that focusing on “overdiagnosis” distracts from under-provision, long waitlists, and persistent unmet need. Both things can be true at once.
What the UK Numbers Do—and Don’t—Say
- Prevalence is up: The NHS series shows a sustained post-2020 elevation in probable disorders across children and young people.
- Referrals are surging: ADHD assessment referrals have climbed sharply; an independent NHS taskforce notes high ADHD rates among NEET youth, much of it undiagnosed—a reminder that under-diagnosis carries costs too.
- System load is real: Secondary mental-health services were already supporting 6.6% of England’s population in 2023/24, before this latest demand wave.
The nuance: labeling all growth as “overdiagnosis” ignores evidence that post-pandemic distress, digital exposure, and academic pressure increased genuine need—while also acknowledging that pathway incentives can unintentionally push borderline cases toward formal labels.
“The drive to ensure every child is supported risks medicalising normal behaviour,” the report cautions.
The Global Picture: Elevated Need, Patchy Access
Worldwide, the World Health Organization estimates one in seven adolescents (10–19) lives with a mental disorder; suicide is among the top three causes of death for ages 15–29.
United States. A new survey of more than 1,000 principals finds fewer than one-third of U.S. public schools conduct mental-health screenings; many that do report they cannot meet demand. The result: high prevalence, low detection, and uneven response inside the very institutions where teens spend most of their day.
India. In parallel to UK concerns about “over-pathologising,” India is racing to expand basic access. On August 22, CBSE ordered its schools to promote the Tele-MANAS 24×7 helpline—14416 / 1800-891-4416—and integrate it into handbooks, assemblies, and parent meetings. The government says Tele-MANAS has already handled 2.38 million calls across 20 languages via 53 state and UT cells.
Europe. UNICEF’s 2025 report flags falling life satisfaction among adolescents across many high-income countries and slipping academic skills—context for rising help-seeking and service strain.
Put simply: countries are wrestling with two problems at once—too little access for many, and perverse incentives that can shape how, when, and why a diagnosis is pursued.
Where “Overdiagnosis” Meets “Undercare”
Three dynamics are driving today’s tension:
- Incentive architecture. In the UK, statutory Education, Health and Care Plans (EHCPs) unlock provision and funding. Where mainstream support is thin, families understandably pursue formal labels to secure help, inflating caseloads and wait times. The Policy Exchange proposal to change EHCP status will be controversial—but it squarely targets the incentive.
- Service throughput. Schools are expected to spot problems earlier; yet U.S. evidence shows routine screening remains the exception, not the norm. Even where screening occurs, referral networks are overloaded.
- Digital-age risk factors. Sleep disruption, social comparison, and always-on feeds amplify anxiety and depressive symptoms—fuel for real distress and higher help-seeking. (WHO frames depression, anxiety, and behavioral disorders as leading causes of adolescent illness.)
Policy Paths That Avoid False Choices
This is not a binary—neither “everything is overdiagnosed” nor “label everyone quickly.” The evidence points to blended fixes:
- Strengthen tier-one supports before diagnosis. Expand school-based universal programmes (sleep hygiene, social-emotional learning, anti-bullying), staffed by trained pastoral teams—so families don’t need a diagnosis to access help. (UK prevalence data + U.S. screening gaps show the value of front-loading.)
- Triage with stepped care. Reserve specialist pathways for complex cases; route mild-to-moderate distress to school-linked counselling, digital CBT, or peer programmes. India’s Tele-MANAS is a live example of low-barrier triage at national scale.
- Re-align incentives. If EHCPs act as a bottleneck/trigger for labels, widen base-level support and make targeted classroom adjustments accessible without a formal diagnosis. (This is the spirit—if not the letter—of Policy Exchange’s call.)
- Shorten ADHD queues—with guardrails. Clear backlogs through validated digital pre-assessments and multidisciplinary review, while resisting single-questionnaire diagnoses. NHS data show referral pressure; the ADHD Taskforce underscores the cost of missed ADHD, especially among NEET youth.
- Publish wait-time dashboards. Transparent local metrics for assessment and therapy slots reduce gaming and guide resource shifts.
- Fund school screening properly—or don’t mandate it. The U.S. experience shows screening without capacity simply exposes need schools can’t meet. Tie any expansion to staffing and referral capacity.
For Schools and Families: Practical Moves Now
Schools (UK/US/India).
- Adopt a “support-first” policy: sleep education, SEL lessons, and supervised quiet rooms during the day.
- Train every tutor in brief identification and warm-handoff protocols to internal teams or Tele-MANAS/ community providers.
- Audit your access triggers: what can pupils get without a diagnosis?
Parents.
- Track sleep and routines before seeking a clinical route; sleep loss is a common, fixable driver of mood/attention problems. (WHO)
- Ask schools about non-diagnostic supports available now (adjusted deadlines, study skills, pastoral check-ins).
- If pursuing ADHD/ASD assessment, request multidisciplinary evaluation and plan for classroom supports regardless of outcome.
Policymakers.
- Pilot non-diagnostic funding for classroom accommodations.
- Expand Tele-MANAS-style triage or regional call-centres to reduce entry barriers and normalise early help.
What to Watch Next
- Whitehall’s response to the £16.6 bn claim: whether reforms target EHCP mechanics, base-level school funding—or both.
- NHS ADHD backlog plans: if digital triage and team-based assessments can speed access without cutting corners.
- CBSE compliance: how quickly Indian schools operationalise Tele-MANAS beyond posters—e.g., assemblies, parent sessions, and teacher training.
- U.S. screening coverage: whether states tie funding to school screening and downstream capacity, avoiding a detect-but-can’t-treat trap.
The Signal in the Noise
Behind the argument over “overdiagnosis” is a simpler question: can a child in distress get timely, proportionate help without having to wear a label for life? The UK’s incentives problem, America’s screening gap, and India’s tele-health push are three views of the same system challenge. Build enough baseline support in schools and communities, and the need to chase labels falls. Starve that foundation, and families will do what any of us would: find the one door that opens—even if it says “diagnosis” on it.
Sources
- Policy Exchange, “The Cost of Child Mental Health Overdiagnosis,” August 2025.
- NHS Digital, Mental Health of Children and Young People in England 2023 – prevalence data (20.3% probable disorders in 8–16 year olds).
- NHS Digital, Provisional NHS mental health services monthly statistics 2023/24 – population coverage figures.
- NHS England, ADHD Assessment Data – April 2025 referral surge (~20,000 in one month).
- ADHD Taskforce (UK), Final Report on ADHD and NEET Youth, July 2025.
- The Times (UK), “Cost of child mental health diagnoses ‘hits £16.6bn a year’”, August 21, 2025.
- UNICEF, Report Card 2025: Child and Youth Well-Being in Rich Countries, July 2025.
- WHO, Adolescent Mental Health Fact Sheet, updated June 2025.
- Harvard Medical School / Harvard Gazette, “Public schools a weak link in efforts to protect teen mental health”, August 2025.
- Central Board of Secondary Education (CBSE), India – circular on Tele-MANAS integration, August 22, 2025.
- Ministry of Health and Family Welfare (India), Tele-MANAS status update – 2.38 million calls handled, 53 centres nationwide.
