THERE ARE CURRENTLY no psychiatrists in private practice to assess, treat, and prescribe medicine for children with ADHD, amid a surge in demand last year for ADHD supports.
Ken Kilbride of ADHD Ireland told The Journal that there had been two or three private-practice psychiatrists for children with ADHD up until two years ago, but that they left the industry due to the overwhelming demand for their services.
Children with ADHD could be waiting up to two years to be seen in the public system, and Kilbride said that there is a ‘postcode lottery’ in terms of the resources available to help people seeking to be diagnosed.
ADHD is a common neuro-developmental disorder. There are three core symptoms: inattention, hyperactivity and impulsivity. Around 5% of children are estimated to have ADHD, and around 3% of adults will have symptoms, with 1.5% of the adult population having at least two of the three core symptoms.
“So what happened with the other 2%? Those people have symptoms but are managing it,” Kilbride says, adding that ‘attention deficit’ disorder is a misnomer, as it is more of an inability to retain focus than a deficit.
“Your attention is all over the place because you’re focusing on too many things at the one time, and you’re constantly disappearing down rabbit holes.”
He said that although ADHD services had been primarily focused on children several years ago, there has been an increase in demand in recent years for services and information for adults who think they may have ADHD – with half of all their queries now about adult supports.
“One of the difficulties is that there is no psychiatrist in private practice dealing with ADHD with children,” he said.
“The Child and Adolescent Mental Health Services (CAMHS) are understaffed, and they operate on the basis of priority. So if they are seeing a child who is self-harming, the child with ADHD might be waiting a year and a half, two years before they are seen.
“They can be seen privately by a psychologist, but if the child needs medication they need a psychiatrist.”
There were two or three child ADHD psychiatrists two years ago, but they were overwhelmed by the numbers coming to them. And it’s not like you treat a person once and it’s done. with medical reviews you get so many people coming back. One of the former psychiatrists said to me ‘I got to the stage that I needed to stop taking new referrals’.
This week, the Irish Independent reported that a doctor linked with the CAMHS unit in south Kerry is alleged to have made diagnoses of ADHD without proper assessment, and that this junior doctor had no previous CAMHS experience.
Kilbride said that ADHD Ireland is currently “drowning” in calls to their service of adults and parents looking for assessments and advice on ADHD.
“The phone line has exploded,” Kilbride said.
While last year ADHD Ireland received 3,000 calls, which averages at around six calls a week, in the months between September and Christmas they were getting around 100 calls a week – “double of what we did last year”.
He said that 80-90% of calls were people who thought they might have ADHD and looking to get assessed. Five years ago, the charity was primarily child-focused, whereas now it’s 50-50 between adults and children.
“We have got funding from the HSE, and it has increased to allowed us to employ more staff, which allows us to create much more awareness of the condition.
“We have two full-time staff and four part-time, but we’re stuck to the walls and drowning in calls.”
To get assessed through the public healthcare system, you go to your GP and tell them that you think you may have ADHD. They should refer you to your local community mental health service for assessment.
But Kilbride says this is where it becomes “a postcode lottery”.
In CHO9 (north Dublin) or CHO1 (Louth, Meath and the North West) there’s nowhere to refer you for an ADHD assessment with the HSE. There isn’t a specific ADHD clinic, but psychologists and psychiatrists can assess you and if you need medication, psychiatrists can manage that.
To get assessed privately, it costs around €650, but after that there is also the possibility of medication and review appointments. “It’s not a cheap condition,” Kilbride said.
In a statement to The Journal, the HSE said that young people with ADHD can be referred by their GP to services at primary care level or specialist mental health services.
“Many young people with mild to moderate mental health difficulties can be treated at primary care level and make progress without needing to access specialist mental health services. Primary Care services include GPs, Jigsaw and other NGO service providers, Primary Care Psychology services and counselling in Primary Care (CIPC) which is available to those over 18.
CAMHS is a specialist clinical service for people under 18 with moderate to severe mental health difficulties. It is not for everyone; only a small percentage (approx. 2%) of the population would require access to this service.
There are 73 CAMHS Community Mental Health Teams nationwide.
“Every effort is made to prioritise urgent referrals so that young people with high risk presentations are seen as soon as possible and this is often within 24 to 48 hours. This may impact on wait times for cases that are considered, by a clinician, to be less severe.
“As of the end of November 2021, 75.3% of referrals accepted by child and adolescent community teams nationally were offered an appointment within 12 weeks against a target of 78%.
Nationally, 93.8% of urgent referrals to CAMHS were responded to within three working days, above the 90% target. 95.8% of accepted referrals/ re-referrals offered first appointment and seen within 12 months.
The HSE set out its aims for providing services and treatments for adults with ADHD in its ‘model for care’ document launched in January last year.
The plan is for 11 adult ADHD clinics to be set up to provide assessment and treatment, with each clinic consisting of a consultant psychiatrist, a senior psychologist, a senior occupational therapist, CNSMH (nursing staff) and an administrator.
The HSE said in a statement that funding is in place for three teams in CHO1 (Louth, Meath and the North West), CHO3 (Limerick, Clare and north Tipperary) and CHO6 (Dublin south east).
Additional funding for 2022 will provide a further 3.5 adult ADHD teams in CHO4 (the Cork and Kerry area), CHO7 and CHO8 (Dublin west and Leinster counties).
The National Clinical Programme is also working with ADHD Ireland and UCD School of Psychology on a patient app to provide specific information for adults who have ADHD or think they may have ADHD.
It is expected to be available from the end of the first quarter of 2022.
If you need further information, you can also call the ADHD helpline on 01 874 8349, from Monday-Friday from 9am to 5.30pm. Other resources include:
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