GPs will soon be able to diagnose and treat ADHD under new State Government reforms, slashing wait times and costs for patients. Catherine Lewis examines any downsides to the major shake-up.
Long wait times, sky-high costs, fragmented care, inconsistent prescribing of medication and a dearth of Medicare support. These are just some of the submissions from families to the ‘Senate Inquiry -Assessment and Support Services for People with Attention Deficit Hyperactivity Disorder (2023).’ Couple this with a mass exodus of almost 200 public psychiatrists due to ongoing pay and condition frustrations in NSW, sending fees for private appointments soaring, and it was clear something had to give.
Enter the biggest reform for ADHD treatment in NSW, which, from September, will see trained GPs empowered to provide ongoing prescriptions for those who are on stable doses of medication, without the need for specialist sign-off.
By 2026, select GPs who have received additional structured training will also be able to diagnose ADHD. If needed, these trained GPs will also be able to start medication, removing the stigma of a specialist diagnosis and cutting wait times, costs and ensuring a more personal touch. NSW Health Minister Ryan Park says that the option to see a highly trained and skilled GP to manage ADHD will ‘provide a timely, safe and appropriate pathway to care, while relieving pressure on in-demand specialists.’ While consultations would ideally be bulk billed, that would ‘depend on the GP and practice,’ the minister adds.
ADHD is one of the most common neurodevelopmental disorders in Australia, with almost 10% of children and 5% of adults affected, says the Royal Australian College of GPs (RACGP). Yet the condition remains stigmatised and misunderstood. Affecting behaviour and emotions, impacting academic performance and family dynamics, ADHD can be split into three types. Combined – hyperactive and inattentive characteristics; inattentive – struggling to focus and finish tasks; and hyperactive – impulsive, active and with little regard for danger.
Treatment usually involves a combination of counselling, behavioural therapies and, when deemed necessary, stimulant or non-stimulant medication. Early intervention is key to improving outcomes and learning capacity, says the Australasian ADHD Professionals Association. (AADPA). Yet long wait times for diagnoses are gatekeeping treatments as well as linked therapies often needed by those with ADHD, such as speech, physiotherapy or extra classroom support.
Treatments such as occupational therapy would no longer be delayed by a slow ADHD diagnosis
My son, Finn, flagged as having potential inattentive ADHD in Year 2, was not diagnosed or treated until Year 5, following a costly and emotional circuit of specialist waiting rooms. So, while the NSW Department of Education tells North Shore Living: “Our schools provide support to students with an identified need through a range of strategies,” that help can be light years away.
The new reforms will be rolled out in stages, focusing first on supporting child prescriptions, as per early intervention goals, followed by adult care. The push will ‘stop many children from languishing on outpatient waiting lists,’ argues NSW/ACT chair at the RACGP, Rebekah Hoffman.
The other meaty issue is cost, with a ‘comprehensive diagnostic assessment’ and creation of a treatment plan at ADHD Treatment Australia coming in at $1,180 before rebates, or $680 for an assessment and treatment plan for those who already have a psychiatrist diagnosis. Ongoing care appointments are $390, while repeat prescriptions are $98. At Sydney-based BrainX ADHD Clinic, a neurocognitive assessment for children aged eight and over is $1,460 – out of reach for many.
“Some patients have spent up to $5,000 on ADHD assessments and treatments, so this announcement will have life-changing impacts when it comes to accessing timely and affordable ADHD care for families across the state,” adds Dr Hoffman. “GPs in many parts of Australia, and around the world, are already diagnosing ADHD and prescribing medications. Our colleagues in Queensland, for example, have been safely prescribing ADHD medications since 2017.”
But are there dangers in opening up the diagnosis and treatment of this complex condition? Yes, says Elana Volanakis, a Sydney-based clinical counsellor and founder of youth-focused therapy practice, Don’t Shrink Me. “Young people are seeking out diagnoses on social media because they are faced with a system in crisis which is characterised by year-long waitlists and heavy fees,” Ms Volanakis argues. “I know many GPs who I’m sure are more than capable of taking this on, but isn’t the problem access to, cost and regulation of specialists?
“I think it’s great that people who suspect they have ADHD will potentially have a more accessible means of getting assessed, diagnosed and prescribed medication – although the quality of assessments, overprescribing and misdiagnosis might be an issue.
“We are neglecting the underlying cause of all of this: our mental health system is in turmoil.”
Dana Kay is the founder of ADHD Thrive Institute and says that there are also ‘significant concerns’ around the ‘overmedication in children’ with ADHD. “Stimulant medications are often the first line of defence that many doctors recommend, but there are several risks and side effects to consider, especially in the context of long-term use or high dosages,” she tells NL. Ms Kay, who is also a board-certified health and nutrition practitioner and author of Thriving with ADHD, says physical side effects include decreased appetite, weight loss, sleep disturbances, and increased heart rate and blood pressure. While in some cases these can be managed with dosage adjustments, they can also persist, leading to more significant health concerns. “In some families, the side effects of medication are even worse than the original symptoms,” Ms Kay adds.
Across Australia, ADHD diagnoses and medication levels have more than doubled in the last five years, from 1.4 million prescriptions given to 186,000 people in 2018, to 3.2 million prescriptions to 414,000 people in 2022, says a health department briefing from the ADHD Senate Inquiry.
The rise saw Government PBS spending on ADHD medicines including methylphenidate, (sold under brand names Ritalin and Concerta) soar from $59 million to $151 million. This has been linked to a backlog of undiagnosed cases being addressed as a result of rising awareness. “Medications can have a mental and emotional impact, with increased anxiety, irritability, or even depressive symptoms,” adds Ms Kay. “Over-reliance on medication can sometimes mask other underlying conditions or issues that may be contributing to the child’s symptoms, such as learning disabilities, anxiety disorders, or environmental stressors,” she adds, drawing on her own son’s battle with serious ADHD medication side-effects.
NSW Health Minister Ryan Park says GPs are ‘highly trained and skilled’
The Critical Psychiatry Network Australasia (CPNA) also believes that ‘expanding services to facilitate earlier diagnosis and treatment of ADHD could result in significant harm, particularly to children.’
“Diagnosing ADHD does not identify underlying problems,” CPNA wrote in its 2023 Senate Inquiry into ADHD submission. “Instead (it locates) the problem in the child’s neurobiology with a disingenuous disregard of social determinants such as poverty, housing insecurity, poor schooling and unemployment. This in turn invites biochemical interventions that modify behaviours in the short-term, but carry significant long-term risks.”
ADHD Thrive Institute’s Dana Kay tells NL that alternative treatments, which do not involve stimulant medication, can be ‘just as effective at reducing ADHD symptoms long term,’ but are ‘not always shared with parents.’ “They include dietary changes, exercise, sleep hygiene, and other natural strategies – useful for those who do not respond well to medication, experience significant side effects, or prefer non-pharmacological approaches,” she adds.
In theory, slashing wait times and cost burdens for families with children displaying initial signs of ADHD sounds positive, but in practice is no silver bullet to managing this complex condition. Refuting claims that the reforms are a band-aid solution for the shortage of psychiatrists across the state, NSW Mental Health Minister Rose Jackson says the move is instead about ‘increasing access to diagnoses and prescriptions.’ But isn’t that the crux of the potential danger of this sweeping shake-up? That diagnoses and medications become so routine, that Concerta is as commonplace as paracetamol? As Don’t Shrink Me’s Elana Volanakis says: “While accessibility is desperately needed for those seeking an ADHD diagnosis, we need to tackle the mental-health and health system head-on. We need to take a good, hard look and say, ‘No this is not good enough.’”
