ADHD treatment access a ‘postcode lottery’

A ‘postcode lottery’ is how RACGP president Dr Michael Wright describes the current access to treatment for Australians living with attention deficit hyperactivity disorder (ADHD).
 
As the world celebrates Neurodiversity Celebration Week (17–23 March), and in the lead-up to the Federal Election, Dr Wright is calling for nationally uniform regulation to give equitable access to treatment and medications for the more than one million Australians living with the common neurodevelopmental condition.
 
Many people with ADHD currently face significant barriers to assessment, diagnosis and treatment, including long wait times and often hundreds of dollars in costs.
 
‘Access to timely medical care shouldn’t be a postcode lottery,’ Dr Wright said in a media statement released today.
 
‘GPs can and should be able to do more for their patients with ADHD.’
 
In most of Australia, the assessment, diagnosis and treatment of ADHD can only be managed for an adult by a psychiatrist, and for a child by a psychiatrist or paediatrician.
 
Currently only specialist GPs in Queensland can prescribe stimulant medication for people with ADHD aged four to 18 years. And prior to its re-election earlier this month, the West Australian Labor Government pledged to pave the way for GPs to expand their scope to diagnose and prescribe medicine for ADHD.
 
RACGP Specific Interests Child and Young Persons Health Chair Dr Tim Jones said the pressure on available resources ‘seems to only be exponentially increasing’, and GPs are perfectly placed to ease the burden.
 
‘I believe passionately in the role of the GP in this space, because we have those long-term relationships and we go on journeys with people,’ Dr Jones told newsGP.
 
‘We’re really safe custodians of people’s lived experience and knowing how all those factors interplay, and in then tailoring individualised treatment.’
 
A recent newsGP poll found 34% of GPs believed ‘GP-led diagnostic pathways’ are the best approach to improving ADHD diagnosis and management, and 32% supported the idea of ‘funding to improve shared care models’.
 
Dr Jones said a combination of factors, including the mass resignation of psychiatrists from the New South Wales public health system, a ‘huge increase’ in adult diagnoses, and the attrition and burnout of existing services and doctors working in the ADHD space means ‘more and more doors’ are closing for patients. Costs and wait lists also add to the burden.
 
‘It’s putting an inequity into healthcare,’ Dr Jones said.
 
‘We know that people who are most going to suffer the consequences of ADHD are people who also face socio-economic hardship, and those are the people who are least able to access care.’
 
Dr Jones also said while the numbers of diagnoses in children are ‘pretty stable’, it is the spike in adult diagnoses that have become the ‘biggest pressure point’ for GPs.
 
‘In the adult space we’ve seen a huge increase,’ he said.
 
And although there is still no definitive explanation for the spike in adult diagnoses, Dr Jones believes the COVID-19 pandemic and its aftermath has played a major role.
 
‘There are a number of people out there experiencing some symptoms, but are generally pretty good at self-managing,’ he said.
 
‘But just the added stresses that they’re under since the pandemic, in terms of the demands they face, the social, economic and work pressures, it’s exposed some weak points.
 
‘I suspect that’s why we’re seeing an increased number of people coming forward from all walks of life.’
 
Dr Jones said in Queensland, when GPs had been allowed to take over ADHD diagnosis and treatment of children, he had expected to see a notable rise in diagnoses. It didn’t happen.
 
‘What we saw was, relative to the rest of the country, the percentage of children [in Queensland] being diagnosed with ADHD actually didn’t increase as much as the rest of the country,’ he said.
 
‘What that tells me is that those GPs who are really invested … they were scoping up to deliver all that care, including diagnosis and prescribing. No one was treating it without respect, they were doing it properly or not at all.
 
‘So that gives me hope that nationwide reform will actually enhance care in this space.’
 
Dr Wright said the RACGP’s plan for ‘accessible, affordable general practice care for all Australia’ also calls for higher patient Medicare rebates for longer consultations, which people with complex health issues like ADHD need.
 
‘This will halve out-of-pocket costs for and improve access to care for patients,’ he said.
 
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