RCOT: Success should be measured by participation, not diagnoses

Success should be measured by whether people can participate in everyday life, not by diagnoses or waiting-list targets, according to the independent review led by Professor Peter Fonagy.

The review calls for a fundamental shift in how support is provided for people experiencing mental health difficulties, ADHD and autism. It argues that people should be able to access support based on their needs and the impact on their daily lives, rather than waiting for a diagnosis before help is available.

Occupational therapists already work in this way, focusing on participation, practical solutions and the outcomes that matter most to people.

RCOT is calling for greater investment in occupational therapists across schools, community services, workplace support services and mental health teams so people can access practical support earlier. Support should be based on what people need to participate in everyday life, not simply where they are in their diagnostic journey.

Karin Orman, RCOT, Director of Practice, Innovation and Advocacy at RCOT, said:

‘One of the most significant conclusions of this review is that success should be measured not by diagnoses or waiting-list targets, but by whether people can participate in education, employment, relationships and community life.

People rarely experience challenges in neat, separate boxes. Mental health difficulties, ADHD, autism and wider life circumstances often overlap, yet support is still too often organised around individual diagnoses.

What matters most is the impact these challenges have on daily life and what support could make a difference today. Occupational therapists look at the whole picture, focusing on participation, practical solutions and the outcomes that matter most to people.

We need a system that delivers timely assessment and treatment where needed, while ensuring people can access support based on need, not simply where they are in their diagnostic journey.’

Emma, whose 19-year-old daughter Anna has a traumatic brain injury, autism and ADHD, says her family spent years navigating assessments, diagnoses and support systems, but struggled to access the practical help Anna needed.  Emma said:

‘After years of fighting for assessments and diagnoses, we were told what support Anna needed, but very little practical help ever followed. The biggest challenge wasn't getting a diagnosis, it was getting the support she needed to take part in education and everyday life.’