An ADHD diagnosis must not mean a lifetime on benefits

That conclusion should be taken seriously. Most people seeking a diagnosis are experiencing genuine difficulties, even if misdiagnosis and overdiagnosis occur in some cases.

None of this will surprise anyone who has watched a child struggle silently through school, or a young adult struggle to enter work, without understanding why. For most people, a diagnosis is not a label sought for any advantage. It is a relief – an explanation, at last, for a difficulty that was real all along. Any serious response to this debate has to start there.

Yet our welfare system has not kept pace with this new reality. Since 2019, the number of working-age people claiming disability or incapacity benefits has risen by 62 per cent – driven increasingly by the young, for whom mental-health and neurodevelopmental conditions are now near-universal in a work-capability assessment.

For a growing number of people, the system treats mental health as if it were binary. Increasingly, this means a diagnosis functions as grounds to leave work, rather than unlocking a route to keep someone in employment. That is neither constructive nor compassionate. And with one in four people now living with a common mental-health or neurodevelopmental condition, it is not realistic either.

Decades of evidence show that good work is generally good for health. It provides income, but also structure, social connection, and purpose. It can be therapeutic for people with common health problems and help reverse some of the adverse health effects of unemployment. Of course, the work must be safe and accommodating of people’s needs. But the alternative assumption – that someone experiencing ill health is best protected by being removed from work – is often simply wrong.

This is as much a moral challenge as a fiscal one. For somebody with a severe and enduring condition, long-term financial support is indispensable. But for somebody with a common, fluctuating or treatable condition, writing them out of working life can entrench precisely the isolation, loss of confidence and lack of purpose that make recovery harder.

Nowhere is that more dangerous than among the nearly one million young people who are neither earning nor learning. Milburn has warned that ill health is fast becoming a pathway into permanent detachment: 44 per cent of NEET young people report a work-limiting health condition, while seven in ten young people entering health and disability benefits remain there a decade later. We should be extraordinarily reluctant to set a 20-year-old on that trajectory.

There is a fiscal imperative too. Hundreds of thousands of people are waiting for ADHD assessment, while rising health-related inactivity is feeding directly into a welfare bill on an increasingly unsustainable trajectory.

This is why the Tony Blair Institute has proposed an Emergency Handbrake for welfare. The principle is straightforward. Government should establish a category of “non-work-limiting conditions”, defined using robust clinical evidence, conditions typically compatible with employment. The presumption should be that diagnosis alone does not establish long-term incapacity.

That is not a blunt benefits cut. Anyone whose condition causes severe or sustained functional impairment would be able to demonstrate that and receive financial support. But for those capable of – and who would benefit from participating with appropriate support – the default offer should change: rapid access to high-quality treatment alongside employment support, skills, workplace adjustments and a route into good work.

In other words, treatment and support should be the first response to ill health wherever they can help someone remain in or return to work, rather than allowing financial support to become the end of the conversation. The welfare system should ask not just “what condition do you have?”, but “what can you do, what is stopping you doing more, and what support would change that?”

The government has an opportunity to pursue an approach that is neither punitive nor complacent: protect those who cannot work, while investing properly in the recovery and independence of those who can.

Fonagy may well conclude that Britain does not have an epidemic of false diagnoses. That should not be mistaken for an argument for the status quo. If mental ill health and neurodevelopmental conditions are now a normal part of millions of Britons’ lives, our welfare system must adapt to help people live – and work – successfully with them.

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Harriet Coombs is a Research & Policy Advisor at Tony Blair Institute.

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