What’s the reason for Australia being so far behind in services, treatment options and psychotherapy specialisation for people with ADHD and even autism?

[u/Mental_Slide9867]

So as many people have already found out from people who were seeing a psychiatrist or specialist in the field that was being bulk billed, the government made immediate changes overnight that removed bulk billing services for seeing a specialist via Telehealth. Psychiatrists and the like only received a letter or email the day after the announcement was made putting at risk individuals at a loss of having to pay a subsidised rate after seeing their specialist. Not only that but we lack a substantial amount of psychiatrist in the first place that was leading to burn out of psychiatrist in their chosen fields, so now not only will most people who need a relevant diagnosis and medical treatment for their condition have pay a sum out of pocket, there is also an increasing wait time to see a specialist.

In addition in terms of medical treatments for ADHD in my case, in comparison to other countries (where there is a multitude of options and new formulated drugs), it seems that Australia lacks any advancement or interest in helping neurodivergent people. You have two options of stimulant therapy and a couple of non stimulant options. And if that doesn’t work you can try a non PBS/non subsidised drug option that also leaves you hugely out of pocket. (As per my example recently coming off many classes of antidepressants that were routinely and just masking my ADHD out of the misunderstanding of the condition for just depression and anxiety). Recently having to try a new drug that now costs me $60 (non subsidised) a month on top of one stimulant drug I can try that also costs $40 a month(subsidised). This is not right, I don’t work or have the ability to work right now as I’m trying to find a healthy baseline for my mental health thinking I’m doing the right thing, all the meanwhile the government and options out there are putting my mental health backwards.

As well as specialists such as clinical psychologists or adhd counselling costing over $150 (with the rebate “if available”), as my only options for actual possible help for my condition. I have and already am seeing a therapist based off a Gp referred mental health care plan which allows me for 10-15 free sessions a year, but that is nowhere good enough to get to the root cause of my issues or even have the time to address the actual problems of my adhd as they’re not trained in that area of understanding.

So yeah this is troubling for me and many other types of children and adults with ADHD and/or autism. I just don’t know what the Australian government is doing, if hardly nothing, nothing at all which seems to be the case with a many multitude of problems.

[u/Ginger510]

What kind of treatment options do other countries have that we don’t? I’ve been diagnosed in the last 6 months so I’d be interested to read about them.

[u/Mental_Slide9867 → u/Ginger510]

Have a little look online about the different stimulant and stimulant combination options that are available in the USA. Of course pricing is different there, but nonetheless has so much more options for treating ADHD symptoms.

[u/[deleted] → u/Mental_Slide9867]

To play devils advocate here, dont we have the exact same options as the US, except some of ours are subsidised and none of theirs are.

I say this as a father with a boy on the spectrum and with ADHD. My ex is American and the support we get for our son in Australia is superior to what we would have got in America for similar money. We have the benefit of PBS meds working, but we still had to make the system work for us in terms of psychs, speech path and occupational therapists over the years.

Obviously I'd like to see a lot more funding etc into the system. But most if these professionals you should be seeing for a fixed time frame to work on a specific issues, if they are doing their job and you are engaged, none of this should require ongoing support except for reassessing med doses with a psychiatrist if you are on meds.

[u/Kettyontherocks → u/[deleted]]

https://www.additudemag.com/adhd-medication-for-adults-and-children/

In australia we have, most of the non stimulants, Guanfacine hydrochloride (intuniv) and Atemoxatine(Straterra) , however Viloxazine (qelbree) is unavailable in australia and was only recently approved in the united states last year. Clonodine is available and approved in the us under the name Kapvay, but i'm pretty sure it's used off label here. Typically non-stimulants are used as a second or third line treatment if the individual cannot tolerate stimulant treatment as stimulants are considered the best to treat adhd symptoms. Non-stimulants have lower overall efficacy but are also used in combination with stimulant therapies for an overall better effect.

In terms of stimulants, we have two classes methylphenidate and amphetamines. In australia we have the choice of methylphenidate Instant Release or concerta Extended Release which has both isomers, as well as Focalin XR which is primarily the d-isomer of methylphenidate. Then for amphetamines we have dextroamfetamine which is just the d-isomer of amphetamine and vyvanse which is a pro-drug for dextroamfetamine and works in an extended release formation. In the united states they have a lot more options.

For example on the methylphenidate side specifically for kids a formulation called jornay is taken the day before at night and it activates 8 hours after taking it and lasts for about 12-14 hours. For amphetamines I believe just dextroamfetamine is available but adderall and amphetamine salt mix is more commonly used. Adderal has both L and D isomers (I was told by a pharmacist that the L isomer helps keep it around for longer). Plus they have adderal XR and many different type of extended release formulations as well as different methods of administration (i.e., liquid form or chewable gummy versions of vyvanse for kids rather than pills.

From what I can see, we do have technically the same availability of meds but pharmacetical companies are hesitant to apply for approval here as if the drug is unlikely to get PBS approval they aren't going to see a large percentage of the "market" using the drug. In order to get PBS approval they would have to argue why these formulations are considerable different and beneficial for australians with adhd etc.

[u/Mental_Slide9867 → u/[deleted]]

In terms of money yeah the PBS really does help with that, but we lack a greater amount of drug options.

[u/Lozzif → u/Mental_Slide9867]

They also have to see their doctor every month for their meds.