The Fonagy Review and the question of what we offer while people wait

Demand for support is growing, pathways are fragmented, and too many people are left waiting for help while their lives continue around them.

For autistic people, people with ADHD and those experiencing mental health difficulties such as anxiety, the gap between recognising a need and accessing appropriate support can be particularly difficult. The Fonagy Review sets out the scale of that challenge, including the long waits for autism assessment and the lack of consistent support for many people before and after diagnosis.

There is an important question to ask alongside how we assess and diagnose people. What support can we offer now, while they are waiting, and is that support designed around their needs? At XR Therapeutics, this question sits at the heart of our work.

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Mental health and neurodevelopmental needs do not exist inseparate boxes

The review highlights the significant overlap between autism, ADHD and common mental health conditions, reinforcing the importance of understanding the whole person rather than treating each need in isolation.

Anxiety, for example, can affect someone's ability to attend school or work, navigate everyday situations, build relationships or take part in activities that matter to them. For an autistic person or someone with ADHD, conventional approaches to psychological support may not always feel accessible or relevant without appropriate adaptations.

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Why psychological therapy needs adapting for autisticpeople and people with ADHD

The review points to emerging evidence that neurodivergent people may benefit from psychological therapies adapted to their cognitive, communication and behavioural styles.

This is an important direction of travel. We should be asking how interventions can be adapted to the individual, to their experiences, preferences, strengths and challenges, so that support is meaningful and usable in real life.

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Designing with lived experience, not consulting on it

At XR Therapeutics we have worked extensively with people with mental health conditions, autistic people and people with ADHD to inform the design of our anxiety interventions.

That experience has reinforced a fundamental principle. Involving people with lived experience should be more than a consultation exercise. It should shape the intervention itself.

In practice that means considering what makes an experience feel safe and manageable, such as graded exposure in an immersive space. How people engage with different situations. What might create unnecessary barriers. And how an intervention can help someone build confidencein a way that feels relevant to them.

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Digital therapy should support in-person care, not replaceit

The review calls for a more ambitious approach to safe digital and AI-enabled tools, including the extension of regulated digital therapies within integrated care pathways.

Crucially, it also makes clear that digital approaches should preserve, rather than replace, in-person care.

We believe this is the right principle, and one we adopt at XR Therapeutics.

Immersive technology offers opportunities to deliver psychological interventions in structured, interactive environments.

For anxiety, this can provide a way for people to engage with carefully designed scenarios as part of a therapeutic process to overcome challenges, with support from a therapist. It makes therapeutic experiences more practical, engaging and adaptable, while keeping clinical expertise and the needs of the individual at the centre.

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Turning the wait into a period of active support

One of the review's most important messages is that waiting for an assessment should become an active period of support rather than a passive delay. It also argues that diagnosis and signposting alone are not an adequate response to people's ongoing needs.

We need to move beyond a system focused primarily on assessment, and ask how we can help people earlier, more effectively, and in ways that fit their lives. We need interventions that recognise the diversity of mental health and neurodevelopmental experiences, and evidence that shows whether those interventions make a meaningful difference.

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At XR Therapeutics we believe carefully designed, therapist-led immersive interventions can be part of that response, complementing existing care, supporting clinical practice and giving people additional ways to engage with psychological therapy.