ADHD – Priory expert stresses need for all assessments to follow NICE standards

Update on national shortage of medication to manage ADHD symptoms | October 2023

Please be aware that there is a national shortage in the supply of medication that helps to manage ADHD symptoms. This is due to manufacturing issues and an increase in global demand for the medication.

This shortage means we cannot prescribe medication to new patients until stocks are available. If you are currently taking medication as part of your ADHD treatment plan, please contact your prescriber for further advice.

Dr Leon Rozewicz is a consultant psychiatrist and medical director at Priory and a leading UK expert in ADHD who regularly gives talks on adult ADHD to GPs and consultants:

The recent Panorama programme on diagnosing attention deficit hyperactivity disorder (ADHD) in adults has caused much controversy. A journalist obtained video assessments from three private providers. The assessments lasted between 45 minutes and one hour and 40 minutes. All three made a diagnosis of ADHD. The journalist was then seen by an NHS specialist. The NHS consultant spent three hours with the journalist, carried out a full detailed and comprehensive assessment, and concluded he didn’t have ADHD.

This is not a scientifically meaningful study.

It would be very easy to oversimplify all this as saying: private assessments are bad and NHS assessments are good. The truth is there are some very good assessments in the private sector and some poor ones in the NHS, as well as the other way round.

Most psychiatrists working in the private sector spend two or more hours assessing a new patient with ADHD, as do most NHS psychiatrists. It is very unusual for an NHS psychiatrist to be able to spend as long as three hours assessing a new patient with ADHD. However, it is usually possible to bring a patient back for another appointment if the diagnosis is unclear (in both the private sector and in the NHS).

Some of the complexities of diagnoses were not touched on by the BBC. For example, over 80% of ADHD patients have co-existing psychiatric disorders, 70% have depression and anxiety. It is easy to misdiagnose other disorders (emotionally unstable personality disorder (EUPD), bipolar disorder, substance and alcohol misuse) as ADHD. It’s also very easy to miss other psychiatric disorders in people with ADHD. Therefore, a comprehensive psychiatric assessment is an essential part of the ADHD assessment.

It is also essential to take a detailed developmental and educational history, as ADHD is a disorder with an onset before the age of 12.

The sad reality – which Panorama glossed over - is that demand for ADHD assessments well exceeds supply. About 4% of the adult population have ADHD, while fewer than 0.5% have a diagnosis. NHS waiting lists are often longer than two years; in some parts of the UK, they are as long as five years.

So, many patients turn to private providers and some NHS commissioners contact private providers to assess NHS patients (and NHS patients can use private providers under the Right to Choose scheme).

Fortunately, ADHD symptoms respond very well to medication (methylphenidate, dexamfetamine, Concerta, Elvanse, atomoxetine). Patients also benefit from adjustments: additional time in university examinations for example, coaching, mentoring, workplace adjustments, office adjustments, working from home. The combination of medication and adjustments can transform people’s lives.

When students display ADHD in their first year at university, assessment and treatment can make a difference between getting a good degree and not getting a degree. In others, it can make the difference between keeping a well-paid job or being out of work, being promoted or losing a job.

Sadly, the Panorama programme may have undermined confidence in the private sector. This, in turn, may stop people accessing private assessments.

Private prescriptions for stimulant medication can cost around £100 per month. Once patients are on a stable dose of medication, it is usual for GPs to take over prescribing, and offer NHS prescriptions by means of a Shared Care Agreement. If trust in private assessments is undermined, then GPs may be less willing to agree to NHS prescribing. This will mean that patients may be denied potentially life-changing treatment.

It is essential therefore that all assessments (private and NHS) are carried out to the standards endorsed by NICE (National Institute for Health and Care Excellence). This will provide confidence in the diagnoses, and allow patients to obtain effective NHS and private treatments for ADHD.

ENDS

Contact: [email protected]

About Priory and MEDIAN

Priory is the UK’s leading independent provider of mental health services. We treat more than 70 conditions, including depression, anxiety, addictions and eating disorders, as well as children’s mental health, across our nationwide network of sites. We also support autistic adults and adults with a learning disability, Prader-Willi Syndrome and brain injuries, as well as older people, within our specialist residential care and supported living facilities – helping as many people as possible to live their lives.

Priory is part of the MEDIAN Group, one of Europe’s leading providers of high quality mental health and rehabilitation services. The MEDIAN Group comprises 290 facilities with 5,000 beds caring for 28,000 people in the UK, 120 facilities with 20,000 beds caring for around 250,000 patients in Germany, and 15 facilities with 2,000 beds caring for 13,000 people in Spain, with more than 29,000 employees overall.