The Fonagy Report-
Our Response
Our response to the Fonagy report: what it means for you and your family
If you’re looking for an assessment for your child, or for yourself, the last few weeks may have felt unsettling. There are lots of providers, the headlines are confusing, and it’s hard to know who to trust. We want to say plainly what the report means and how we work.
We welcome it. The Fonagy report says clearly that the current situation for neurodivergent people and those seeking clarity, assessment and diagnosis is not sustainable. It calls for better systems rather than small tweaks, with a serious focus on prevention of distress, wellbeing and mental health care for neurodivergent people. We’re glad this has been said so clearly.
Support should follow need. The report argues that support, adaptations and advice shouldn’t depend on first “breaking through” a diagnosis. It also doesn’t say diagnosis no longer matters, and we agree on both points. Services should respond to need, and a good diagnosis can still make sense of a person’s experience and point towards the right help. This is how we already think about our work.
A neuroaffirmative, safe space. We are a neuroaffirmative service. Whoever you are, and whatever you’re bringing, you will be met with respect and curiosity in a safe space. We see neurodivergence as a difference to be understood, not a deficit to be fixed.
What a good assessment looks like. The report says a good assessment should be accurate and comprehensive, identify what is causing difficulties and how they affect the person, and lead to a diagnosis that makes sense to them and informs real support. It should be more than a yes or no. That’s what we aim to provide. Our assessments are designed to be needs-led and, we hope, helpful in themselves. At the end you should have a coherent story that makes sense, and that points to the adaptations and support that will help.
How we guard against misdiagnosis. The report names several things that raise the risk of getting a diagnosis wrong. Here is how we approach each:
Brief assessments. Ours are not brief. We spend hours getting to know your child, or you.
No face-to-face contact. Every child assessment, and most adult assessments, includes a face-to-face element. A small number of adult ADHD assessments are online only, and only when we’re confident we can gather enough evidence that way. If we’re not, we move to in person.
Fragmented processes. Once your appointments are scheduled, they generally take place within one month. One lead clinician guides you through and brings everything together into one clear, consistent answer.
Not looking at the wider picture. For children, we speak to parents and carers and to teachers. If your child isn’t in mainstream school, we speak to tutors, alternative provision staff or sports coaches. For adults, we invite someone who knows you well to join, if you are comfortable doing that. We also welcome any previous reports.
Looking at only one thing. Our assessments are titled autism, ADHD or both, but in practice they are much broader. We consider other and additional explanations, including mental health, trauma and learning, to understand your whole experience.
We see people who are often missed. The report notes that underdiagnosis remains a risk for some groups, and that it can’t conclude overdiagnosis is happening at scale. We’re particularly experienced with people who may fall outside statutory referral criteria, who mask heavily, or whose experience of neurodivergence is largely internalised.
Your assessment is the start, not the end. The report is clear that assessment must lead to ongoing support. After your assessment, we signpost to trusted colleagues who can provide follow-up support, based on what will help you or your child. Behind the scenes, we are also working to create in-house support to follow your assessment, so that more of that help can be offered within our own service.
Regulation. The report supports tighter regulation, and we welcome that. Assessments are not yet a regulated activity, so we can’t currently register with the CQC. We’re actively preparing so that we’re ready to submit as soon as the CQC is able to accept us. We hope the CQC will be properly funded to take on this wider role, because the point of regulation is to protect the quality of assessments.
If you’re feeling unsure. We know how hard it is to choose a service when you’re already worried. If you’d like to talk through what an assessment with us involves, or have questions about the report, please get in touch. We’re always happy to talk.