Oct 5, 2026 · Comments ↓

Last updated on Oct 5, 2026

Needs, not labels: help at work shouldn't wait for a diagnosis

A government panel says support at work should be needs-led, not dependent on a diagnosis. It's right. Here's why the label became the gate, and what to watch.

On 2 October the government published the final report of its Expert Academic Panel on Neurodiversity. Its executive summary says something I’ve been saying for years: support at work should be “needs-led, not dependent on a diagnosis”.

That’s the whole argument, really. Everyone deserves to have their needs met. There are plenty of people without a diagnosis struggling, and plenty of people with one struggling too. The label doesn’t tell you much about either.

How a diagnosis became the gate to help

The panel, chaired by Professor Amanda Kirby, is blunt about how things work now. Workplace adjustments “are often only provided to those who fit and can obtain a specific diagnosis.” And: “Current approaches that require specific diagnosis further widen the gap: individuals with recognised conditions and clearer diagnostic pathways are more likely to access support, while many others miss out altogether.”

The government’s other big review in this area, led by Professor Peter Fonagy, said the same thing in its interim report in March. Diagnosis works “not only as a clinical classification but also as a gateway to resources, adjustments and formal recognition,” especially in education and employment, “where documentary evidence of a diagnosis is often required before support can be provided.”

So if you want help, you need the label first.

What happens when the label is the only door

The psychiatrist Awais Aftab wrote about this recently in Rethinking Psychiatric “Overdiagnosis”. His argument is that clinicians stretch diagnoses to cover people who are genuinely struggling, because the official categories are “too narrow (not too broad, contrary to popular perception)” and because of “institutional dependence on specified diagnoses.”

I read that and thought: then the problem isn’t the width of the manual. It’s the gatekeeping. If a label is the only way through the door, people will be stretched to fit through it. Stop making help depend on the label, and there’s nothing to stretch for.

People don’t come in boxes

I’ve never understood why we need labels like cans of soup. Over a lifetime of poor mental health I’ve been given ten diagnostic labels. That doesn’t make me ten cans of soup. I didn’t know about nearly half of them until I got a copy of my psychiatric records.

So what exactly is that meant to tell me? And whether it’s one label or ten, what is it telling you?

The checklists have too many crossovers, and counting symptoms against a timeline doesn’t describe a person.

Take depression. To meet the main criterion you need five or more of nine listed symptoms over the same two weeks, and one of them has to be low mood or loss of interest. Do the sums and two people can get the same diagnosis while sharing just one symptom.

Researchers have found the same thing. A 2019 University of Liverpool study, Heterogeneity in psychiatric diagnostic classification, went through five chapters of the diagnostic manual. It found that criteria and difficulties recurring across lots of different diagnoses “undermine the model of discrete categories of disorder.” The neurodiversity panel says something similar: “current diagnostic categories do not accurately reflect how differences in brain function present.”

Needs-led support already exists

This isn’t a utopian idea. We already have it in places.

The Equality Act 2010 defines disability by its effect: an impairment that has “a substantial and long-term adverse effect” on someone’s ability to carry out normal day-to-day activities. No diagnosis is named. Acas puts it plainly: “A worker does not need a diagnosis to be considered disabled under the Equality Act 2010.”

In Scotland, the Additional Support for Learning Act 2004 gives a child support where, “for whatever reason,” they need it to benefit from school. For whatever reason. That’s a needs-led law, and it’s been on the books for over twenty years.

And the British Psychological Society’s Power Threat Meaning Framework, from Lucy Johnstone and Mary Boyle, sets out “a conceptual alternative to the diagnostic model”. Instead of asking what’s wrong with someone, it asks what has happened to them.

Why labels hang on

Diagnoses don’t only exist because of gatekeeping. They’re tied to funding, to legal entitlements and to research. Some people find real relief in a diagnosis, and a community that comes with it, and I’d never tell anyone that relief isn’t real.

Even the Power Threat Meaning Framework’s authors accept that, for now, diagnoses “will still be required for people to access services, benefits and so on,” and that “these rights must be protected.”

None of that needs the label to be the price of help, though. You can keep the diagnosis for the people who want it, and still give support to everyone who needs it.

Watch what “needs-led” gets used for

The government’s response says it supports the panel’s “key recommendation that neuro-inclusion in the workplace be needs-led.” Good.

But read the rest of the response. It says “a diagnosis should not lead to someone being signed off, written off, or left without the hope of work,” and closes on making sure a diagnosis “does not lead to wasted talent and a life on benefits.”

Needs-led is right. The question is which way it gets used. Needs-led should mean more people get help, with or without a label. It shouldn’t become the reason to take help away from people who have a diagnosis and still need the support it opened up.

What this means if you manage people

You don’t need a label to make an adjustment. You never did.

I know the worry. Ask people what they need and they’ll want everything. That isn’t what needs-led means.

It means sitting down as equals and talking about what would help. Whoever is having that conversation will have needed something themselves at some point. Maybe it was a change of hours, time off when someone at home was ill, or some slack after a hard year. Then work out together how you can support them with it, within what’s doable.

That’s what we teach mental health first aiders: notice, ask, listen, respond to what the person needs. Nobody on our courses learns to diagnose, and nobody needs to.

Most of what people bring into work isn’t a diagnosis anyway. And as a former president of the Royal College of Psychiatrists said recently, most patients can live with their symptoms if they have a job, money, a home and relationships.

Help shouldn’t have to wait for a label. Talk to people as equals about what they need, and work out together what you can do.

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