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Previous Action

FOI request submitted to each NHS Board in Scotland, to reply on the actions undertaken in their respective geographic areas and asking eight questions:

1. Who in your organisation is the lead clinician for adult mental health services with responsibility for diagnosis and treatment of adults with ADHD?
2. Has any local service needs assessment been carried out by your NHS board for persons over the age of 18 with ADHD?
3. What arrangements are in place for young people with ADHD as they move into adult mental health services?
4. What services are in place for young people with ADHD who have made the transition to adult services?
5. Are these considered as specialist services specifically for ADHD?
6. Is there explicit mention of services for adults with ADHD (or equivalent term) in your integrated services plan(s)?
7. Are there any other plans, for the development of services for adults with ADHD?
8. Are there agreed timescales for implementation of any ADHD related aspects of these plans and if yes, what are these timescales?

Key to abbreviations used: GAP (General adult psychiatrist), MDT (Multi discipline team), S/W (Social Work), CAMHS (Child and Adolescent Mental Health Services), OT (Occupational Therapist), CMH (Community Mental Health), AMH (Adult Mental Health), CHP (Community Health Partnership).

The two classifications for Attention Deficit Hyperactivity Disorder included in the questionnaire are the Diagnostic and Standards Manual IV (DSM-IV), including the three diagnostic sub-types and the International Classification of Diseases – 10 (ICD-10). ADHD as an abbreviation relates to both classifications.

We have received all of the responses to our FoI requests, and the responses agree with the experiences of adults with ADHD across Scotland coming to us for help, all show the same picture, that there few provisions for specific diagnostic or clinical pathways for the treatment of adult ADHD in Scotland, leaving those with this often debilitating condition mainly undiagnosed, and therefore untreated.

Key findings from questionnaires:

• Only one NHS Board has completed a needs assessment for adult ADHD.
• Only one NHS Board mentions adult ADHD in their integrated services plans.
• Three NHS Boards are considering development of services for adults with ADHD.
• Eleven NHS Boards have no consideration of developing services for adults with ADHD.
• One NHS Board considers that adult ADHD alone does not meet the criteria for adult mental health services, or only as an exceptional case.

From this we conclude that services are not consistently applied across the country. Children and young people who are diagnosed with ADHD often have their care abruptly stopped once they reach the age of 18, despite medical research that many patients continue to suffer the effects of ADHD throughout their adult lives. Patients with ADHD undiagnosed in childhood have an even more difficult route to appropriate care, they are often unable to obtain a diagnosis as a result of confusion about the condition in primary care or finding that the expertise and knowledge is not available from general psychiatric practitioners.

Confirmed by our FoI requests and by the many patients who travel sometimes long distances to come to the Central Scotland Adult ADHD Support Group, from as far afield as the Highlands and Islands, Ayrshire, Glasgow, Fife, and the Scottish Borders, the only existing clinic for ADHD adults in Scotland is run by NHS Lothian.

Adults with ADHD coming to our charity for help report that GPs are often unfamiliar with the condition, fail to refer for a diagnosis and that general psychiatrists are not trained to diagnose or treat it. There is substantial scepticism about the condition from health professionals who do not have experience of assessing and advising those with ADHD about the condition. This does not give a fair chance to those wanting an objective assessment.  We have numerous case examples from our members which demonstrate that primary health care is unfamiliar/unwilling to refer adult ADHD cases to adult mental health services for assessment. We suspect that GPs often lack satisfactory guidance on criteria for making referrals for adults with ADHD. 

We believe that with improvements resulting from an integrated clinical pathway for adult ADHD and matching evidence based treatment to clinical demand, improvement in services can be delivered within existing resources leading to better outcomes and savings on longer term care of complex cases. Some of our members, who have received a clinical diagnosis for adult ADHD, have struggled for many years with the condition undiagnosed, while also drawing resources from the NHS for depression and other mental health complaints such as borderline personality disorder. Correct treatment of adult ADHD can bring about substantial changes and facilitate people taking charge of their own mental health.

Adults with previously undiagnosed ADHD, often first go to their GP with depression or anxiety issues and by not identifying and treating the underlying ADHD, the recovery of these individuals is severely hindered or prevented. There is a clear policy gap around ADHD in adults in Scotland, which we are asking the Government to address urgently. This important issue has not been considered by Government before.

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