Major Changes Expected for ADHD Diagnosis in the NHS transcript

The government's new review into ADHD is likely to significantly change how ADHD is diagnosed and treated in England. I'm a psychiatrist. I work a lot with ADHD. From what I've seen so far, I think this could be quite a huge deal. So, I wanted to let you all know about it. In this video, I'm going to share the facts we know so far. I'm also going to share three potential problems I see with how the government is going to implement this and then we'll discuss what's likely to happen next.

So, these are the facts we know so far. This was reported in a Guardian article which came out on Thursday. Initially, it was reported in The Times. What we know is the government commissioned an independent review into how ADHD is assessed and treated in England. It's being led by Professor Peter Fonagy, someone we've actually had on our podcast in the past. They're expected to publish their report this coming week.

And the report is apparently going to take what it calls a needs-based approach to ADHD support. So, under this proposal, people with ADHD symptoms aren't automatically going to be referred for formal diagnosis. Instead, people with ADHD symptoms are going to be triaged according to need, according to, for example, how well they function at school, at work, at home, the coexistence of other mental health difficulties, risk, like risk of self-harm, things like that.

Uh people who are judged to have a higher need are going to get assessed and treated. People judged to have a lower need are going to be offered support in lieu of an assessment and medication-based treatment. They may be offered support like flexible adjustments for work, for school, quiet spaces, various things like that. I imagine non-medication strategies for ADHD, perhaps psychological interventions, I'm not sure.

Uh the motivation for these proposed changes is largely because of the enormous amount of people on ADHD waiting list. So, there's something like 800,000 people in England on a waiting list for an ADHD assessment. And our general concerns, I think concerns we all share, about the cost of untreated ADHD. The NHS task force on ADHD estimates that the cost of undiagnosed untreated ADHD is likely to be something like 17 billion pounds.

I'm not really sure how they arrived at that number, but that's the number that they have. There are a lot of critics to these proposed changes. So, ADHD UK, the National Autistic Society, they say this essentially amounts to the rationing of health care, you know, the rationing of diagnosis or treatment. And fundamentally, this is something that's going to create inequality. Others would argue that support shouldn't necessarily require a formal assessment and medication-based treatment.

If someone can get support quickly rather than remaining on a waiting list for years, then they should get access to that support. I should point out, for now, this is not yet confirmed government policy. Just hearing about it for the first time, I do have a few issues with how this is going to work. I have a few questions, a few problems. I guess the first issue is they say, you know, ADHD symptoms aren't necessarily going to be diagnosed as ADHD.

But the problem is that's already the case. So, it's already the case that an ADHD diagnosis is not based on symptoms alone. To get an ADHD diagnosis, you have to meet the symptom threshold, you know, number of symptoms, inattentional and/or hyperactive. But the symptoms have to be present lifelong. They have to be pervasive. They have to be impairing in at least two areas of life, like work, school. There can't be a better explanation for these problems than ADHD.

So, the issue is that impairment and difficulty and distress is already baked into the diagnosis. So I'm not sure how they're going to be able to judge people who have symptoms but not enough impairment and decide, okay, they shouldn't have an assessment where someone else perhaps should. It really requires the assessment to do that. So that's the first problem I don't know how they're going to get around. I guess the second problem is the so-called high-functioning individuals with ADHD.

They may be high-functioning in terms of they have a job, they may be going to school, passing exams, maybe being able to carry out their responsibilities. And I see a lot of people with ADHD really across the spectrum. Some who have difficulties getting to employment, some who are able to have jobs. There's There's a whole spectrum. And what I would say is the so-called high-functioning individuals with ADHD still suffer hugely.

And many of them have tried all of the non-medication strategies and they may have flexible working arrangements, they may exercise, avoid stimulating technology, have good nutrition, you know, be doing all the right things without medication and they may still be having a really bad time. They may have a job, they may be doing great at a glance from the outside but internally often they're suffering, on the verge of burnout, on the verge of going on long-term sick leave.

So I think it's going to be tough to divide as this proposal saying the population into the high-functioning and the people who have a greater need. I think it's going to be way more complicated than they're anticipating. Of course, people who are so-called high-functioning and were deferred for an assessment, I think if they get those non-medication strategies and they're not very effective, they're likely to get worse with time and likely to need an assessment anyway.

But even in the first place, I'm not really sure how the government is going to make those decisions and how they're going to delineate between these groups of people. And is it just going to be two? Is it going to be binary like high need, low need? Seems pretty tricky to me to try and figure out. It seems like you would need an ADHD assessment to figure that out. And I guess that leads to my third issue, which is it really remains to see who is going to make these decisions and how.

Is it going to be doctors who make those decisions? Is it going to be someone else? What qualifications is that person going to have? And it's really something quite uncomfortable that we have to deal with a lot in the mental health world is aside from, you know, diagnosing and treating our patients, we also often have to decide on how funds are going to be allocated. So, for example, who gets an inpatient admission to a hospital or not?

Uh who gets a particular kind of psychotherapy or not? But this seems to represent an even further step in an uncomfortable direction where we're not even just deciding who should get a particular treatment, and this is, you know, ADHD treatment, which is relatively straightforward, like the medication-based treatment pathway is relatively straightforward, so I don't think it should be prohibitive. Um but also we're merging the allocation of resources with the actual diagnostic process.

So, we're saying we're funding restrictions means that we're not even going to allow someone to be given the particular diagnosis. We're not going to allow a mental health professional to decide that I think this person meets the criteria for this particular condition. And so, it's this merging of medical opinion with funding allocation, which to me strikes me as really uncomfortable, and I'd like to hear more details about how they plan to do that.

Ultimately, the devil is in the details. What's going to happen next is the final report is going to be published. This is going to happen next week, we've been told. Then the government is going to respond and choose, you know, which policies it's going to adopt and which not. And then it's down to the NHS and related services to see how they're going to implement government policy. So, there's still a lot of stuff that has to happen, but I think it's important whether it's you yourself who experience ADHD-like problems or a friend or a relative to really be aware of what's likely to be happening on a governmental level so you can potentially get ahead of any changes or prepare accordingly.

Once the review comes out, then we'll continue commenting on it in this channel and provide the information that could be helpful. In the meantime, if you found this video helpful, do like and subscribe and do comment, you know, what do you guys think? Is this something that you think is a step in the right direction? Do you think this is kind of a regression in government policy? Let us know in the comments here on YouTube.

If you want a deeper dive into the ADHD conversation in the UK, I published a video examining the Channel 4 documentary that just came out about ADHD, The Great ADHD Myth, and I point out what I think are some major flaws in that documentary, which should be appearing on screen right now. In the meantime, thank you so much for watching and we'll see you here next time.