NHS bodies in England are introducing new policies that require individuals with suspected attention deficit hyperactivity disorder (ADHD) or autism to wait at least two years before being assessed. This decision is being made due to rising demand for these services and financial pressures. Four NHS integrated care boards (ICBs), which oversee large areas of the country, have implemented this approach, explaining that they cannot afford the high number of assessments currently being requested. Patient advocacy groups have raised concerns that these delays could negatively impact children's academic progress, prevent people from receiving vital support, and increase the risk of suicide. ADHD UK, a prominent advocacy group, has called the two-year waiting period "heartless and dangerous." In total, 15 ICBs across England, covering 19 million people, have introduced various methods to manage the growing number of assessment requests. These include setting annual limits on the number of assessments and using "clinical prioritisation" to focus on those with the most severe symptoms. These policies come just before the release of a government-commissioned review led by Professor Peter Fonagy, which was ordered by former Health Secretary Wes Streeting. The review, which has been delayed, examines the sharp rise in mental health and neurodiversity diagnoses in recent years. It highlights concerns about the quality of assessments, the consistency of care, and potential financial incentives within the sector. The report also notes a significant increase in the prevalence of neurodiversity, with autism rates among boys rising 24-fold since 2000 and ADHD diagnoses among boys aged seven to 18 increasing 13-fold. The NHS is currently managing a large backlog of people waiting for assessments. There are 960,000 individuals waiting for ADHD assessments and 295,000 awaiting autism assessments. In response to rising costs, the West Yorkshire ICB has introduced a two-year minimum wait for ADHD and autism assessments, following a significant increase in expenses from £7 million in 2023-24 to £21 million the previous year. This policy affects 2.4 million people in areas including Leeds, Bradford, and Kirklees. Other ICBs, such as the North East and North Cumbria ICB, have set a minimum waiting time of about 78 weeks for initial assessments, while Somerset ICB has a 52-week minimum wait and Devon ICB has a lower minimum wait of 14 weeks. Kent and Medway ICB have also imposed waiting periods, and in Hampshire and the Isle of Wight, assessments are limited to those who meet specific priority criteria. Critics of the two-year waiting period argue that it is an unnecessary delay that can harm individuals' mental health and quality of life. Henry Shelford of ADHD UK described the policy as "institutionalised cruelty" and stressed the importance of timely assessments for accessing essential care. A spokesperson for Finally Seen, which tracks NHS restrictions on patient choice, said a two-year wait is like "a locked door with a date on it." The British Medical Journal reported that 17 of 36 ICBs had introduced minimum waits for non-emergency procedures, despite NHS guidelines. Mel Merritt of the National Autistic Society warned that restricting access to autism assessments denies individuals vital support, potentially leading to years of educational delays and increased crisis situations for autistic people. Sean Phillips of the Independent Healthcare Providers Network urged the NHS to allow private clinics to offer more appointments, emphasizing the impact of delayed assessments on mental health, education, work, and family life. Rebecca Gray of the NHS Alliance's mental health network acknowledged the frustration caused by long delays but noted that financial pressures and rising demand have led to "minimum waits" or the closure of some waiting lists, which she described as unsustainable for both patients and taxpayers.