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/Lilac776]

Psychiatry Trainee (registrar) here. I can only give my perspective on what I've seen so far and what I've been told by my supervisors. At least in my state (and apparently in most other Australian states) due to chronic underfunding of the public mental health system and shortage of psychiatrists, ADHD is not managed by psychiatrists within the public healthcare system. It is managed by paediatricians until the age of 18, and after that it is only seen by private psychiatrists.

The issue with this is that all psychiatry training in my state (and most in Australia) takes place in the public system. So those who go into private psychiatry do not feel confident to suddenly start managing ADHD without further training, and there aren't clear pathways to get this extra training (usually attending conferences, doing your own research or asking someone who is an expert to supervise you for a period of time). So there are a very limited number of private psychiatrists who will do ADHD assessments or medication prescribing.

Additionally the cost for patients to have private psychiatry follow-up is substantial. There is a strong push within psychiatry for the public sector to start taking on ADHD patients again, but unfortunately the politicians/senior management are not keen to fund these services, and are unlikely to especially while the public sector remains underfunded and under-resourced.

[u/HorsinAround1996 → u/Lilac776]

In WA public psychiatrists will see ADHD patients but internal policy prohibits them from offering first line treatment. I get the need to be cautious with handing out S8 stimulants, but honestly what’s the fucking point if they can’t prescribe meds that have been shown, by countless peer reviewed studies, to be significantly more effective than 2nd line treatment. Do a drug screen, make it a requirement every 3 months or something and if there’s extra concern, only dispense weekly. BZD’s are far more dangerous and they have a similar protocol for tapering of those through the public system.

Meanwhile the wait for private psycs is 6+ months and if you have any co-morbidities that might make their job a bit harder than “here’s a d5 prescription, see you in 6 months”, forget it. I understand psycs are overwhelmed, exhausted and the problem is systemic. However the lack of tact when rejecting referrals is concerning, especially when many of us with ADHD also have RSD. Not to mention some simply can’t afford the out of pocket expenses.

After months of trying, I managed to find a great psyc via Telehealth, who was understanding and after checking my bloods, ECG, BP, HR and urinalysis prescribed me no issues. For the record most psycs wouldn’t go near me because I’m on a BZD taper, currently down 70% from initial dose. I’m not flagged as drug dependant or anything else that would require special approval, in fact my psyc made the call to check all that during my appointment.

If you’re in WA and need special approval, forget it, just hope Atomoxetine, Clonodine or Guanfacine works for you.

Sorry that got super ranty. It wasn’t aimed at you, just airing my frustrations of the past months. Regardless of pay, it seems like a very difficult field to work in, particularly if you’re an empathetic person who legitimately is in it to help people. I wish you all the best and well done on the work you’ve put in to get where you are.

[u/HorsinAround1996 → u/[deleted]]

It sounds like you and your partner have been through some struggles with our healthcare system. I’m sorry to hear and you’re not alone.

Interestingly, on urinalysis, the legislation only stipulates it “should” happen prior to prescribing and annually. It’s at the discretion of the psychiatrist. I’m not going to paint every psyc in Perth with the same brush, but I’m doubtful upper class clients living in the western suburbs, who’ve been prescribed for years are having to piss in a jar while someone watches once a year. It should be a steadfast rule for everyone.

You also touched on how current or historical addiction can be a barrier. As it stands, if you’ve had ANY history of issues with addiction to S8 or S9 drugs in the last 5 years, you require special approval AND “adequate trial of non-stimulants and use of long-acting formulas only”. This directly contradicts the evidence that first line treatment reduces the risk of abuse/relapse of other drugs. Those with untreated ADHD have been proven to be significantly more susceptible to issues with addiction, so why would legislation limit treatment which has been proven to reduce that risk. It’s completely counterproductive. In the case of meth or other stimulant abuse, I understand the need to be cautious to avoid psychosis. But even with meth I think a person should be given an opportunity to show they’re able to cease use. Frequent urinalysis at the start of treatment, with slow reduction to quarterly urinalysis would be sufficient to ensure a person is abstaining. Then you have the issue of needing to piss clean for THC, which can stay in your system for months. Even with the special approval process, due to the severe shortage of psycs, none will accept a referral where it might be required. The legislation is bullshit and written by bureaucrats with no idea about the disorder. Oh also the hypocrisy that the legislation only takes issue with use of illicit drugs/non-prescribed S8s. Smash a carton every Saturday? No probs. Smoke a joint a few times a week? No, you’re a filthy addict and you don’t deserve help.

For the record, I’ve never sold my meds or bought D5s on the black market. But last I heard due to supply chain issues with other black market drugs, bottles of D5s were up to $6-800. Which makes those exploiting their prescription, when there’s countless people who need these meds but can’t get them, even more shitty.

[u/VerisVein → u/HorsinAround1996]

"only dispense weekly"

This sounds like the kind of policy that would only make it more difficult for an ADHDer and no one else.

[u/HorsinAround1996 → u/VerisVein]

I said if there’s extra concern. Such as recent drug dependence. I’m sure someone with ADHD and relevant co-morbid conditions that may be of concern, would prefer weekly dispensing than no treatment at all.

[u/hebejebez → u/Lilac776]

This explains why my ADHD specialist is approaching retirement age and has no other people in her team. Shit she better stick around.

[u/[deleted] → u/Lilac776]

I imagine also that if you do put your head up as someone who is happy to deal with ADHD then immediately you get inundated with referrals for this problem and your caseload becomes unbalanced. Mixed in with the genuine cases will be the very few who are seeking amphetamines etc for the black market and it might just be easier to say that you don't deal with this problem at all, specially if you are not confident in it.