Tue Nov 7

A Senate inquiry says Australia needs a national ADHD framework to improve diagnosis and reduce costs

Written by David Coghill, Financial Markets Foundation Chair of Developmental Mental Health, The University of Melbourne

Around 800,00 Australians ^[1] live with attention-deficit hyperactivity disorder (ADHD). It is the most common mental health condition ^[2] in children aged four to 17, and around half of those with childhood ADHD continue to have significant difficulties as adults.

Without appropriate support, ADHD often has lifelong negative impacts on education and employment. The current cost of ADHD to Australia is estimated at more than A$20 billion every year ^[3].

Until recently, ADHD was very much under-recognised and under-treated in Australia. However, public awareness and acceptance of ADHD has led to a sharp increase in people seeking assessment and support and receiving treatment ^[4]. This has highlighted the significant barriers faced by those trying to access services, and there are now long wait times ^[5], rising costs and concerns about the quality of services on offer.

In response to these concerns, a Greens-chaired Senate inquiry looked at how people access ADHD diagnosis ^[6] and get support afterwards, the international evidence base, as well as practitioner training and cost. Yesterday, after more than 700 submissions and evidence from 79 witnesses at three public hearings, the inquiry delivered its findings ^[7].

Not just a mental health issue

The report makes 15 recommendations, all of which should be welcomed by Australians with ADHD and those involved in supporting them. The committee emphasises that ADHD is not just a mental health issue but a public health concern.

The committee members agreed there is a need for a government-funded national framework for ADHD, developed in consultation with people with lived experience. They supported the broad implementation of the Australian ADHD Professionals Association’s guideline ^[9] – an evidence-based roadmap for ADHD clinical practice, research and policy.

A national framework should include shared and collaborative models of care, the committee said. This would increase the range of healthcare professionals, particularly GPs and nurse practitioners, who can contribute to assessment and support services for people with ADHD.

They also found funding models should be reviewed to reduce the financial burden of ADHD highlighted by many of the lived-experience submissions ^[10].

The committee said Medicare and bulk-billing incentives should be considered to reduce out-of-pocket expenses for diagnosis and management for people on low incomes and families who have multiple members with ADHD.

On top of this, this inquiry recommended more telehealth and better access to care in rural, regional and remote areas. The government should “review the Pharmaceutical Benefits Scheme (PBS) to improve the safe and quality use of medications by people with ADHD”, the recommendations said.

While the committee clarified that National Disability Insurance Scheme (NDIS) supports can currently be accessed with ADHD as a “primary or secondary disability”, they highlighted people with ADHD find the process of making an NDIS application difficult. They recommended the NDIS improve the accessibility and quality of information around the eligibility of ADHD as a condition under NDIS.

The inquiry looked at the costs and access barriers for ADHD diagnosis. Shutterstock ^[11]

Learning from people with ADHD

The focus on improving lived experience is particularly welcome. Trying to navigate pathways to care, even as an expert in ADHD, can be challenging and at times painful in my experience.

While public awareness of ADHD has improved greatly in recent years there are still those spreading misinformation and increasing the stigma of people living with ADHD.

The committee said the Australian government should implement a neurodiversity-affirming public health campaign. This could shift social attitudes and reduce the stigma felt so acutely ^[13] by those with ADHD.

Also welcome is the committee’s recognition we have a long way to go in addressing the gender bias experienced by girls, women, and gender-diverse people with ADHD. Our understanding of ADHD in the context of First Nations and culturally and linguistically diverse communities was also acknowledged as lacking. The committee said this could lead to misdiagnosis or inappropriate treatment ^[14].

ADHD impacts on the whole of peoples’ lives. The committee recommended improving training across settings from workplaces to schools and universities and institutional settings including out-of-home care and correctional facilities – both places where people with ADHD are over-represented.

A first step

The committee recommends ^[16]

all levels of government consider investing in the implementation of the Australian ADHD Professionals Association’s Australian evidence-based clinical practice guideline for ADHD.

Further investment will be needed to ensure the guideline is used properly to promote more holistic care with broader access to key supports. The committee’s final recommendations call for better funding for ADHD disability and advocacy organisations to provide advice and support helplines, legal aid, financial counselling and assistance. Finally, the committee recommends funds for further research to better understand the neurodevelopmental condition, how it affects brain function and the stigma it can carry.

The inquiry’s recommendations will now be tabled in federal parliament, with government to respond within three months.

Making this work is going to be a big job but one that will payback in increased productivity, educational outcomes and a better quality of life for all Australians living with ADHD.