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Government must get a “firmer grip” on mental health crisis, says watchdog

BMJ 2023; 380 doi: https://doi.org/10.1136/bmj.p324 (Published 09 February 2023) Cite this as: BMJ 2023;380:p324

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Why are Adult ADHD waiting lists not mentioned in NAO 2023 report?

Dear Editor,
Lifespan pathways for ADHD were part of the Five Year Forward View for Mental Health in 2017; however, this aim has been dropped without further comment by DHSC/NHS England and there is not a single reference to ADHD in the NAO report (Progress in Improving Mental Health Services in England; 9 Feb 2023). ADHD counts as a neurodiversity, but it is also a mental disorder (listed in ICD-11 and DSM-5-TR) that can be treated with prescribed medication, psychoeducation and CBT, just like other mental health conditions (1). The treatment of ADHD across the lifespan is cost-efficient and NHS pathways need to be organised accordingly. Since publication of the first NICE guideline in 2007, assessment and treatment for ADHD in adults has moved from specialist clinics into mainstream general adult psychiatry, often in shared care with GPs (2). Mental health services are “swamped” by referrals for ADHD assessment and treatment; increased pandemic demand has resulted in some of the longest waiting lists in the NHS (3). The lack of a top-down strategy for ADHD is to blame for desperate outsourcing to private sector providers, who are recruiting (or run by) NHS-trained clinicians, resulting in further staff shortages in public services. NHS commissioners (and private sector providers) deliberately misinterpret the NHS “right to choose” so that local funding has been used to grow the private sector instead of existing NHS services for Adults with ADHD (and other neurodevelopmental conditions). Politicians (cross-party) and experts in Adult ADHD demand mandated collection of NHS data on Adult ADHD referrals and waiting lists, eg in a recent House of Commons debate on Autism and ADHD Assessments on 6 Feb 2023 (4). Such data should include hidden waiting lists of patients waiting for a full assessment or/and treatment. We need integrated ADHD pathways and funding models that make best use of limited resources.

References
(1) Müller-Sedgwick U, Sedgwick-Müller JA (2020) Drugs to treat attention deficit hyperactivity disorder (ADHD). In: Haddad P, Nutt D (eds): Seminars in Clinical Psychopharmacology. 3rd edition (Royal College of Psychiatrists – College Seminars Series). Cambridge, Cambridge University Press, pp 392-432.
(2) Asherson P, Leaver L, Adamou M, Arif M, Askey G, Butler M, Cubbin S, Newlove-Delgado T, Kustow J, Lanham-Cook J, Findlay J, Maxwell J, Mason P, Read H, van Rensburg K, Müller-Sedgwick U, Sedgwick-Müller J, Skirrow C (2022) Mainstreaming adult ADHD into primary care in the UK: guidance, current practice, and best practice recommendations. BMC Psychiatry 22: 640.
(3) Guardian, 13 Jan 2023; www.theguardian.com/society/2023/jan/13/adhd-services-swamped-say-expert...
(4) https://hansard.parliament.uk/commons/2023-02-06/debates/183A24F1-C943-4...

Competing interests: Both authors are executive board members of UKAAN, the UK Adult ADHD Network and have received speaker honoraria and travel expenses for educational presentations (from BAP, Medice, seed Talks, Takeda & UKAAN). UMS is executive board member of the Neurodevelopmental Psychiatry Special Interest Group (NDPSIG) of the Royal College of Psychiatrists (RCPsych)

25 February 2023
Ulrich Müller-Sedgwick
Consultant Psychiatrist & Honorary Visiting Fellow
Jane Sedgwick-Müller
Adult Neurodevelopmental Service, Government of Jersey & Department of Psychiatry, University of Cambridge
St Helier, Jersey & London, UK