WEBVTT
00:00:00.000 --> 00:00:08.320
The government's new review into ADHD is likely to significantly change how ADHD is diagnosed and treated in England.
00:00:08.560 --> 00:00:09.759
I'm a psychiatrist.
00:00:09.919 --> 00:00:11.519
I work a lot with ADHD.
00:00:11.599 --> 00:00:15.279
From what I've seen so far, I think this could be quite a huge deal.
00:00:15.359 --> 00:00:17.359
So I wanted to let you all know about it.
00:00:17.519 --> 00:00:20.719
In this video, I'm gonna share the facts we know so far.
00:00:20.960 --> 00:00:29.519
I'm also gonna share three potential problems I see with how the government is gonna implement this, and then we'll discuss what's likely to happen next.
00:00:29.679 --> 00:00:31.679
So these are the facts we know so far.
00:00:31.839 --> 00:00:35.520
This was reported in a Guardian article which came out on Thursday.
00:00:35.679 --> 00:00:37.920
Initially, it was reported in the Times.
00:00:38.079 --> 00:00:45.280
What we know is the government commissioned an independent review into how ADHD is assessed and treated in England.
00:00:45.359 --> 00:00:50.399
It's being led by Professor Peter Fonegie, someone we've actually had on our podcast in the past.
00:00:50.640 --> 00:01:01.200
They're expected to publish their report this coming week, and the report is apparently going to take what it calls a needs-based approach to ADHD support.
00:01:01.439 --> 00:01:10.239
So, under this proposal, people with ADHD symptoms aren't automatically going to be referred for a formal diagnosis.
00:01:10.400 --> 00:01:26.000
Instead, people with ADHD symptoms are going to be triaged according to need, according to, for example, how well they function at school, at work, at home, the coexistence of other mental health difficulties, risk like risk of self-harm, things like that.
00:01:26.400 --> 00:01:31.680
People who are judged to have a higher need are going to get assessed and treated.
00:01:32.079 --> 00:01:40.480
People judged to have a lower need are going to be offered support in lieu of an assessment and medication-based treatment.
00:01:40.719 --> 00:01:47.840
They may be offered support like flexible adjustments for work, for school, quiet spaces, various things like that.
00:01:48.000 --> 00:01:53.840
I imagine non-medication strategies for ADHD, perhaps psychological interventions, I'm not sure.
00:01:54.319 --> 00:02:02.640
The motivation for these proposed changes is largely because of the enormous amount of people on ADHD waiting lists.
00:02:02.719 --> 00:02:08.879
So there's something like 800,000 people in England on a waiting list for an ADHD assessment.
00:02:09.039 --> 00:02:15.199
And our general concerns, I think concerns we all share, about the cost of untreated ADHD.
00:02:15.360 --> 00:02:25.680
The NHS Task Force on ADHD estimates that the cost of undiagnosed, untreated ADHD is likely to be something like 17 billion pounds.
00:02:25.759 --> 00:02:29.680
I'm not really sure how they arrived at that number, but that's the number that they have.
00:02:29.919 --> 00:02:32.560
There are a lot of critics to these proposed changes.
00:02:32.639 --> 00:02:42.400
So ADHD UK, the National Autistic Society, they say this essentially amounts to the rationing of healthcare, you know, the rationing of diagnosis or treatment.
00:02:42.639 --> 00:02:46.400
And fundamentally, this is something that's going to create inequality.
00:02:46.639 --> 00:02:53.520
Others would argue that support shouldn't necessarily require a formal assessment and medication-based treatment.
00:02:53.680 --> 00:03:00.159
If someone can get support quickly rather than remaining on a waiting list for years, then they should get access to that support.
00:03:00.400 --> 00:03:04.719
I should point out for now, this is not yet confirmed government policy.
00:03:04.960 --> 00:03:10.800
Just hearing about it for the first time, I do have a few issues with how this is going to work.
00:03:10.960 --> 00:03:13.120
I have a few questions, a few problems.
00:03:13.360 --> 00:03:21.680
I guess the first issue is they say, you know, ADHD symptoms aren't necessarily going to be diagnosed as ADHD.
00:03:21.840 --> 00:03:23.520
But the problem is that's already the case.
00:03:23.599 --> 00:03:29.199
So it's already the case that an ADHD diagnosis is not based on symptoms alone.
00:03:29.360 --> 00:03:37.039
To get an ADHD diagnosis, you have to meet the symptom threshold, you know, number of symptoms, inattentional and/or hyperactive.
00:03:37.199 --> 00:03:46.080
But the symptoms have to be present lifelong, they have to be pervasive, they have to be impairing in at least two areas of life, like work, school.
00:03:46.240 --> 00:03:50.240
There can't be a better explanation for these problems than ADHD.
00:03:50.400 --> 00:03:57.599
So the issue is that impairment and difficulty and distress is already baked into the diagnosis.
00:03:57.840 --> 00:04:08.400
So I'm not sure how they're going to be able to judge people who have symptoms but not enough impairment and decide okay, they shouldn't have an assessment whereas someone else perhaps should.
00:04:08.479 --> 00:04:11.120
It really requires the assessment to do that.
00:04:11.280 --> 00:04:12.639
So that's the first problem.
00:04:12.719 --> 00:04:14.560
I don't know how they're going to get around.
00:04:14.800 --> 00:04:29.199
I guess the second problem is the so-called high-functioning individuals with ADHD, they may be high-functioning in terms of they have a job, they may be going to school, passing exams, maybe being able to carry out their responsibilities.
00:04:29.360 --> 00:04:33.839
And I see a lot of people with ADHD really across the spectrum.
00:04:34.000 --> 00:04:38.480
Some who have difficulties getting to employment, some who are able to have jobs.
00:04:38.879 --> 00:04:40.000
There's a whole spectrum.
00:04:40.079 --> 00:05:03.279
And what I would say is the so-called high-functioning individuals with ADHD still suffer hugely, and many of them have tried all of the non-medication strategies, and they may have flexible working arrangements, they may exercise, avoid stimulating technology, have good nutrition, you know, be doing all the right things without medication, and they may still be having a really bad time.
00:05:03.439 --> 00:05:14.720
They may have a job, they may be doing great at a glance from the outside, but internally often they're suffering on the verge of burnout, on the verge of going on long-term sick leave.
00:05:15.040 --> 00:05:23.920
So I think it's going to be tough to divide, as this proposal is saying the population into the high-functioning and the people who have a greater need.
00:05:24.160 --> 00:05:28.240
I think it's going to be way more complicated than they're anticipating.
00:05:28.480 --> 00:05:42.560
Of course, people who are so-called high-functioning and who are deferred for an assessment, I think if they get those non-medication strategies and they're not very effective, they're likely to get worse with time and likely to need an assessment anyway.
00:05:42.720 --> 00:05:50.240
But even in the first place, I'm not really sure how the government is going to make those decisions and how they're going to delineate between these groups of people.
00:05:50.319 --> 00:05:51.439
And is it just going to be two?
00:05:51.519 --> 00:05:54.720
Is it going to be binary, like high need, low need?
00:05:55.199 --> 00:05:58.319
Seems pretty tricky to me to try and figure out.
00:05:58.399 --> 00:06:02.319
It seems like you would need an ADHD assessment to figure that out.
00:06:02.560 --> 00:06:09.279
And I guess that leads to my third issue, which is it really remains to see who's going to make these decisions and how.
00:06:09.439 --> 00:06:11.759
Is it going to be doctors who make those decisions?
00:06:12.000 --> 00:06:13.439
Is it going to be someone else?
00:06:13.680 --> 00:06:16.399
What qualifications is that person going to have?
00:06:16.560 --> 00:06:30.319
And it's really something quite uncomfortable that we have to deal with a lot in the mental health world is aside from you know diagnosing and treating our patients, we also often have to decide on how funds are going to be allocated.
00:06:30.399 --> 00:06:38.240
So, for example, who gets an inpatient admission to a hospital or not, uh, who gets a particular kind of psychotherapy or not.
00:06:38.560 --> 00:06:48.160
But this seems to represent an even further step in an uncomfortable direction where we're not even just deciding who should get a particular treatment.
00:06:48.319 --> 00:06:57.040
And this is, you know, ADHD treatment, which is relatively straightforward, like the medication-based treatment pathway is relatively straightforward.
00:06:57.120 --> 00:06:59.519
So I don't think it should be prohibitive.
00:06:59.759 --> 00:07:05.920
Um, but also we're merging the allocation of resources with the actual diagnostic process.
00:07:06.079 --> 00:07:14.000
So we're saying we're funding restrictions means that we're not even going to allow someone to be given a particular diagnosis.
00:07:14.160 --> 00:07:21.360
We're not going to allow a mental health professional to decide that I think this person meets the criteria for this particular condition.
00:07:21.519 --> 00:07:29.519
And so it's this merging of medical opinion with funding allocation, which to me strikes me as really uncomfortable.
00:07:29.600 --> 00:07:33.120
And I'd like to hear more details about how they plan to do that.
00:07:33.360 --> 00:07:35.759
Ultimately, the devil is in the details.
00:07:36.000 --> 00:07:39.040
What's going to happen next is the final report is going to be published.
00:07:39.120 --> 00:07:41.519
This is going to happen next week, we've been told.
00:07:41.680 --> 00:07:47.439
Then the government is going to respond and choose, you know, which policies it's going to adopt and which not.
00:07:47.600 --> 00:07:54.079
And then it's down to the NHS and related services to see how they're going to implement government policy.
00:07:54.319 --> 00:07:56.879
So there's still a lot of stuff that has to happen.
00:07:57.040 --> 00:08:14.079
But I think it's important, uh, whether it's you yourself who experience ADHD-like problems or a friend or a relative to really be aware of what's likely to be happening on a governmental level so you can potentially get ahead of any changes or prepare accordingly.
00:08:14.240 --> 00:08:21.279
Once the review comes out, then we'll continue commenting on it in this channel and provide the information that could be helpful.
00:08:21.439 --> 00:08:26.560
In the meantime, if you found this video helpful, do like and subscribe and do comment.
00:08:26.639 --> 00:08:28.240
You know, what do you guys think?
00:08:28.480 --> 00:08:31.199
Is this something that you think is a step in the right direction?
00:08:31.360 --> 00:08:35.519
Do you think this is kind of a regression in government policy?
00:08:35.679 --> 00:08:37.919
Let us know in the comments here on YouTube.
00:08:38.080 --> 00:08:57.440
If you want a deeper dive into the ADHD conversation in the UK, I published a video examining the Channel 4 documentary that just came out about ADHD, the great ADHD myth, and I point out what I think are some major flaws in that documentary, which should be appearing on screen right now.
00:08:57.679 --> 00:09:01.840
In the meantime, thank you so much for watching, and we'll see you here next time.
00:00:00.000 --> 00:00:08.320
The government's new review into ADHD is likely to significantly change how ADHD is diagnosed and treated in England.
00:00:08.560 --> 00:00:09.759
I'm a psychiatrist.
00:00:09.919 --> 00:00:11.519
I work a lot with ADHD.
00:00:11.599 --> 00:00:15.279
From what I've seen so far, I think this could be quite a huge deal.
00:00:15.359 --> 00:00:17.359
So I wanted to let you all know about it.
00:00:17.519 --> 00:00:20.719
In this video, I'm gonna share the facts we know so far.
00:00:20.960 --> 00:00:29.519
I'm also gonna share three potential problems I see with how the government is gonna implement this, and then we'll discuss what's likely to happen next.
00:00:29.679 --> 00:00:31.679
So these are the facts we know so far.
00:00:31.839 --> 00:00:35.520
This was reported in a Guardian article which came out on Thursday.
00:00:35.679 --> 00:00:37.920
Initially, it was reported in the Times.
00:00:38.079 --> 00:00:45.280
What we know is the government commissioned an independent review into how ADHD is assessed and treated in England.
00:00:45.359 --> 00:00:50.399
It's being led by Professor Peter Fonegie, someone we've actually had on our podcast in the past.
00:00:50.640 --> 00:01:01.200
They're expected to publish their report this coming week, and the report is apparently going to take what it calls a needs-based approach to ADHD support.
00:01:01.439 --> 00:01:10.239
So, under this proposal, people with ADHD symptoms aren't automatically going to be referred for a formal diagnosis.
00:01:10.400 --> 00:01:26.000
Instead, people with ADHD symptoms are going to be triaged according to need, according to, for example, how well they function at school, at work, at home, the coexistence of other mental health difficulties, risk like risk of self-harm, things like that.
00:01:26.400 --> 00:01:31.680
People who are judged to have a higher need are going to get assessed and treated.
00:01:32.079 --> 00:01:40.480
People judged to have a lower need are going to be offered support in lieu of an assessment and medication-based treatment.
00:01:40.719 --> 00:01:47.840
They may be offered support like flexible adjustments for work, for school, quiet spaces, various things like that.
00:01:48.000 --> 00:01:53.840
I imagine non-medication strategies for ADHD, perhaps psychological interventions, I'm not sure.
00:01:54.319 --> 00:02:02.640
The motivation for these proposed changes is largely because of the enormous amount of people on ADHD waiting lists.
00:02:02.719 --> 00:02:08.879
So there's something like 800,000 people in England on a waiting list for an ADHD assessment.
00:02:09.039 --> 00:02:15.199
And our general concerns, I think concerns we all share, about the cost of untreated ADHD.
00:02:15.360 --> 00:02:25.680
The NHS Task Force on ADHD estimates that the cost of undiagnosed, untreated ADHD is likely to be something like 17 billion pounds.
00:02:25.759 --> 00:02:29.680
I'm not really sure how they arrived at that number, but that's the number that they have.
00:02:29.919 --> 00:02:32.560
There are a lot of critics to these proposed changes.
00:02:32.639 --> 00:02:42.400
So ADHD UK, the National Autistic Society, they say this essentially amounts to the rationing of healthcare, you know, the rationing of diagnosis or treatment.
00:02:42.639 --> 00:02:46.400
And fundamentally, this is something that's going to create inequality.
00:02:46.639 --> 00:02:53.520
Others would argue that support shouldn't necessarily require a formal assessment and medication-based treatment.
00:02:53.680 --> 00:03:00.159
If someone can get support quickly rather than remaining on a waiting list for years, then they should get access to that support.
00:03:00.400 --> 00:03:04.719
I should point out for now, this is not yet confirmed government policy.
00:03:04.960 --> 00:03:10.800
Just hearing about it for the first time, I do have a few issues with how this is going to work.
00:03:10.960 --> 00:03:13.120
I have a few questions, a few problems.
00:03:13.360 --> 00:03:21.680
I guess the first issue is they say, you know, ADHD symptoms aren't necessarily going to be diagnosed as ADHD.
00:03:21.840 --> 00:03:23.520
But the problem is that's already the case.
00:03:23.599 --> 00:03:29.199
So it's already the case that an ADHD diagnosis is not based on symptoms alone.
00:03:29.360 --> 00:03:37.039
To get an ADHD diagnosis, you have to meet the symptom threshold, you know, number of symptoms, inattentional and/or hyperactive.
00:03:37.199 --> 00:03:46.080
But the symptoms have to be present lifelong, they have to be pervasive, they have to be impairing in at least two areas of life, like work, school.
00:03:46.240 --> 00:03:50.240
There can't be a better explanation for these problems than ADHD.
00:03:50.400 --> 00:03:57.599
So the issue is that impairment and difficulty and distress is already baked into the diagnosis.
00:03:57.840 --> 00:04:08.400
So I'm not sure how they're going to be able to judge people who have symptoms but not enough impairment and decide okay, they shouldn't have an assessment whereas someone else perhaps should.
00:04:08.479 --> 00:04:11.120
It really requires the assessment to do that.
00:04:11.280 --> 00:04:12.639
So that's the first problem.
00:04:12.719 --> 00:04:14.560
I don't know how they're going to get around.
00:04:14.800 --> 00:04:29.199
I guess the second problem is the so-called high-functioning individuals with ADHD, they may be high-functioning in terms of they have a job, they may be going to school, passing exams, maybe being able to carry out their responsibilities.
00:04:29.360 --> 00:04:33.839
And I see a lot of people with ADHD really across the spectrum.
00:04:34.000 --> 00:04:38.480
Some who have difficulties getting to employment, some who are able to have jobs.
00:04:38.879 --> 00:04:40.000
There's a whole spectrum.
00:04:40.079 --> 00:05:03.279
And what I would say is the so-called high-functioning individuals with ADHD still suffer hugely, and many of them have tried all of the non-medication strategies, and they may have flexible working arrangements, they may exercise, avoid stimulating technology, have good nutrition, you know, be doing all the right things without medication, and they may still be having a really bad time.
00:05:03.439 --> 00:05:14.720
They may have a job, they may be doing great at a glance from the outside, but internally often they're suffering on the verge of burnout, on the verge of going on long-term sick leave.
00:05:15.040 --> 00:05:23.920
So I think it's going to be tough to divide, as this proposal is saying the population into the high-functioning and the people who have a greater need.
00:05:24.160 --> 00:05:28.240
I think it's going to be way more complicated than they're anticipating.
00:05:28.480 --> 00:05:42.560
Of course, people who are so-called high-functioning and who are deferred for an assessment, I think if they get those non-medication strategies and they're not very effective, they're likely to get worse with time and likely to need an assessment anyway.
00:05:42.720 --> 00:05:50.240
But even in the first place, I'm not really sure how the government is going to make those decisions and how they're going to delineate between these groups of people.
00:05:50.319 --> 00:05:51.439
And is it just going to be two?
00:05:51.519 --> 00:05:54.720
Is it going to be binary, like high need, low need?
00:05:55.199 --> 00:05:58.319
Seems pretty tricky to me to try and figure out.
00:05:58.399 --> 00:06:02.319
It seems like you would need an ADHD assessment to figure that out.
00:06:02.560 --> 00:06:09.279
And I guess that leads to my third issue, which is it really remains to see who's going to make these decisions and how.
00:06:09.439 --> 00:06:11.759
Is it going to be doctors who make those decisions?
00:06:12.000 --> 00:06:13.439
Is it going to be someone else?
00:06:13.680 --> 00:06:16.399
What qualifications is that person going to have?
00:06:16.560 --> 00:06:30.319
And it's really something quite uncomfortable that we have to deal with a lot in the mental health world is aside from you know diagnosing and treating our patients, we also often have to decide on how funds are going to be allocated.
00:06:30.399 --> 00:06:38.240
So, for example, who gets an inpatient admission to a hospital or not, uh, who gets a particular kind of psychotherapy or not.
00:06:38.560 --> 00:06:48.160
But this seems to represent an even further step in an uncomfortable direction where we're not even just deciding who should get a particular treatment.
00:06:48.319 --> 00:06:57.040
And this is, you know, ADHD treatment, which is relatively straightforward, like the medication-based treatment pathway is relatively straightforward.
00:06:57.120 --> 00:06:59.519
So I don't think it should be prohibitive.
00:06:59.759 --> 00:07:05.920
Um, but also we're merging the allocation of resources with the actual diagnostic process.
00:07:06.079 --> 00:07:14.000
So we're saying we're funding restrictions means that we're not even going to allow someone to be given a particular diagnosis.
00:07:14.160 --> 00:07:21.360
We're not going to allow a mental health professional to decide that I think this person meets the criteria for this particular condition.
00:07:21.519 --> 00:07:29.519
And so it's this merging of medical opinion with funding allocation, which to me strikes me as really uncomfortable.
00:07:29.600 --> 00:07:33.120
And I'd like to hear more details about how they plan to do that.
00:07:33.360 --> 00:07:35.759
Ultimately, the devil is in the details.
00:07:36.000 --> 00:07:39.040
What's going to happen next is the final report is going to be published.
00:07:39.120 --> 00:07:41.519
This is going to happen next week, we've been told.
00:07:41.680 --> 00:07:47.439
Then the government is going to respond and choose, you know, which policies it's going to adopt and which not.
00:07:47.600 --> 00:07:54.079
And then it's down to the NHS and related services to see how they're going to implement government policy.
00:07:54.319 --> 00:07:56.879
So there's still a lot of stuff that has to happen.
00:07:57.040 --> 00:08:14.079
But I think it's important, uh, whether it's you yourself who experience ADHD-like problems or a friend or a relative to really be aware of what's likely to be happening on a governmental level so you can potentially get ahead of any changes or prepare accordingly.
00:08:14.240 --> 00:08:21.279
Once the review comes out, then we'll continue commenting on it in this channel and provide the information that could be helpful.
00:08:21.439 --> 00:08:26.560
In the meantime, if you found this video helpful, do like and subscribe and do comment.
00:08:26.639 --> 00:08:28.240
You know, what do you guys think?
00:08:28.480 --> 00:08:31.199
Is this something that you think is a step in the right direction?
00:08:31.360 --> 00:08:35.519
Do you think this is kind of a regression in government policy?
00:08:35.679 --> 00:08:37.919
Let us know in the comments here on YouTube.
00:08:38.080 --> 00:08:57.440
If you want a deeper dive into the ADHD conversation in the UK, I published a video examining the Channel 4 documentary that just came out about ADHD, the great ADHD myth, and I point out what I think are some major flaws in that documentary, which should be appearing on screen right now.
00:08:57.679 --> 00:09:01.840
In the meantime, thank you so much for watching, and we'll see you here next time.
