ADHD care needs better regulation and fewer pills | Attention deficit hyperactivity disorder
As a UK-trained consultant psychiatrist, fully indemnified, assessed and regulated by the General Medical Council, with specialist expertise in the assessment and treatment of attention deficit hyperactivity disorder (ADHD) in adults, I read your article on the rising costs of ADHD care with concern and frustration (NHS spending on ADHD over budget by £164m as unregulated clinics explode, 12 January).
Over the past eight months, I have been going through the Care Quality Commission’s (CQC) opaque registration process to provide high quality, fully regulated ADHD assessments in an independent setting, alongside two similarly qualified colleagues. Until this process is complete, I am legally prohibited from seeing any patients.
It is therefore deeply disturbing to learn from your article that several companies have been awarded NHS ADHD contracts despite not being CQC registered. Furthermore, certain health professions fall outside the remit of the CQC and may therefore create a practice to “diagnose and treat” ADHD in the future – for example a psychologist working with a prescribing pharmacist.
I also previously worked for a large private provider which quickly expanded to offer NHS ADHD contracts. Although many clinicians were conscientious, the model was governed by contract and was narrowly focused rather than driven by patient needs or clinicians. Clinicians were put under pressure to prioritize throughput, continuity of care was fragile, and patients only discovered their clinician could be replaced overnight – an experience many found deeply upsetting.
These problems are the predictable result of excessive outsourcing of the public system to a fragmented and unevenly regulated market, while placing the greatest regulatory burden on small services run by expert psychiatrists. A high-quality ADHD assessment requires time, expertise, and continuity. Regulation should enable this – not prevent it.
Dr Vicky Cleak
Southampton
The NHS has just as much incentive as private providers to overdiagnose ADHD. This is largely due to the appeal to patients and clinicians of a quick fix using amphetamines to treat this disease. I know this because my daughter was prescribed them by an NHS clinician when her self-diagnosis was substantiated after an hour-long assessment and questionnaire.
When the amphetamines didn’t work, he increased the dose. When the symptoms worsened, he prescribed antidepressants, apparently determined to find the answer in a pill. Her request for therapy was rejected because he felt she needed to feel better through medication intervention before she could benefit from it. His symptoms subsided after a significant change in his circumstances, which at the time we all neglected to pay sufficient attention to. I can only be grateful that drug interventions have not caused long-term harm or dependence, as I suspect they have in others who have been disappointed by the emphasis on diagnostic and drug interventions for complex disorders.
Name and address provided
Aside from the Wild West of ADHD service provision, parents need to be aware of what they are getting into when seeking diagnostic referrals for their children. The effectiveness of behavioral interventions depends on their consistent application within the family; it is arguably easier to comply with medications than to commit to lasting behavior change. The only medications recommended by the NHS National Institute for Health and Care Excellence are psychostimulants or amphetamines – in layman’s terms, ‘speed’.
As generations who received free tranquilizers have discovered, the long-term health costs of a seemingly miraculous solution are enormous. The need for a non-pharmacological treatment of ADHD that restores neuroplasticity with minimal risk has never been greater.
Mona Sood
Southend-on-Sea
