The Scottish ADHD Coalition declares a ‘state of emergency’ in ADHD services across Scotland
The recent withdrawal of ADHD assessment and treatment across Scotland will lead to a significant rise in mortality, a reduction in life expectancy, and reduced quality of life in the affected cohort, and increased costs to the NHS and other publicly funded services which will outweigh the cost savings that have driven the decision. Changes to patient pathways will also severely undermine policy initiatives designed to address the drugs crisis, reduce youth offending and prison overcrowding, improve pupil behaviour and attainment in schools, eliminate child poverty, improve longevity and the mental health and wellbeing of the Scottish population, and to tackle the obesity epidemic.
In some areas of Scotland it is now no longer possible for an adult with ADHD to undergo an assessment or receive treatment despite suffering chronic impairment as a result of the condition.
Wait lists for children and young people are now measured in years rather than months with some patients reporting wait times of 8 years or longer and others being denied a service altogether.
The problem is particularly acute for families in crisis and for children and young people who enter the care system without a comprehensive assessment of needs and who are thus at risk of inappropriate placement and support in direct contravention of the stated aims of The Promise.
It is the view of the Scottish ADHD Coalition that the current crisis in ADHD provision is the result of poor workforce planning by the NHS and a failure to support or to consult clinicians in CAMHS and adult services, with the result that experienced professionals have left the NHS and can no longer be replaced because of the decline in working conditions and job satisfaction. Efforts to improve patient wellbeing have been further hampered by poor data management and an under-investment in research and these have become obstacles to service re-design.
As a result of the change in threshold levels that determine who is and who is not entitled to assessment, diagnosis and treatment, service provision has effectively been privatised and the cost burden transferred to those who can afford it and denied to those most disadvantaged in our society. It is thus inconsistent with the founding aims of the NHS and policies aimed at reducing inequalities in Scotland.
The Scottish ADHD Coalition calls upon the Scottish Ministers to intervene to restore patient pathways to assessment and treatment and to undertake a re-design of services to reduce patient wait times, improve data gathering, and to ensure that clinicians have the resources they require to provide an effective service.
Background Information
ADHD is currently under-diagnosed and under-treated in Scotland.
Around 5–7% of children and 2–4% of adults have attention-deficit hyperactivity disorder (ADHD). Individuals with ADHD commonly experience co-occurring difficulties, including mental illness and occupational or social challenges. High co-occurrence also exists with other neurodevelopmental differences. Supports throughout the lifespan can mitigate challenges. Although non-pharmacological and environmental strategies are the primary source of support for both children and adults, medication should be considered for those with persistent needs in at least one domain.
Between 2010 and 2019, prescriptions for ADHD medications increased (dispensed prescriptions +233.2%, defined daily dose +234.9%, cost +216.6%). Despite these increases, analysis indicated that in 2019, considering a 5% estimated ADHD prevalence among adolescents, 73% were not prescribed medication, increasing to 81% at a 7% estimated prevalence. Similarly, among adults with a 2% estimated prevalence, 91% were not prescribed medication, rising to 96% at a 4% estimated prevalence. Regional disparities were evident, with 41–96% of adolescents and 85–100% of adults, based on ADHD prevalence estimates, not receiving a prescription, depending on area.
There is a substantial public health cost associated with under-treatment in addition to the personal costs to families affected by ADHD.
Treatment has been shown to substantially reduce mortality, hospital admissions, traumatic brain injury, unintentional injury , fractures, and road traffic accidents .
No evidence has been presented to support the assertions being made that ‘diagnosis is unnecessary’ or that untreated individuals fare as well as those who receive treatment. There appears to be no evidence-base for the expectation that patients with non-complex ADHD will receive adequate support in the community as a substitute for treatment.
The withdrawal of treatment as an option for those at risk will inevitably lead to increased death and injury in this vulnerable population and marks a significant regression in the provision of healthcare across the nation.
Scotland appears to be the first western economy to have taken the decision to withdraw treatment for a widespread chronic treatable condition.
Bill Colley (Chair)
Lorna Redford
Alison Clink
