Concern GPs not ready for 'neurodiversity tsunami' after law change

• From 1 February, specialist GPs can diagnose adult ADHD and prescribe stimulant medicines
• Patients under 18 can now be diagnosed and treated by nurse practitioners working in paediatric services and child and adolescent mental health services
• Psychiatrists and paediatricians will continue to prescribe as previously
• Costs to patients will vary
• No government funding for training health

GPs and nurse prescribers will be able to diagnose attention deficit/hyperactivity disorder (ADHD) in adults from next week (1 February) - but they will not be funded for it.

Those working in the sector are warning it will not be as simple - or as cheap - as booking a 15-minute appointment, and it will take time for services to scale up to cope with the backlog of demand.

Tauranga entrepreneur Freddie Bennett was not diagnosed with ADHD until his mid-30s.

• Do you have an ADHD story? Get in touch at iwitness@rnz.co.nz

"I spent my life thinking I was broken. I found myself stressed, depressed, addicted, really unfit, [with] really bad mental health issues, attempts to take my life and everything - and then once I got my diagnosis I finally found the answers.

"I found if I really leaned into my neurodiversity, then I could discover my strengths."

Harnessing those strengths has allowed him to cross the Sahara Desert on foot, run across the Arctic to the North Pole and win a place in the Guinness Book of Records for the fastest marathon while dressed as a fisherman in gumboots, waterproofs and carrying a tackle box (four hours and 37 minutes) and build a successful career as a business coach.

Initially diagnosed with ADHD by a psychologist, Bennett then had to go to a private psychiatrist to be assessed and prescribed medication.

Wider prescribing rights - but at what cost?

Since GPs were stripped of their authority to prescribe stimulants in 1999 (due to concerns the drugs could be abused), only paediatricians and psychiatrists have been permitted to diagnose ADHD and prescribe drugs.

College of GPs president Luke Bradford said the lack of capacity in the public system has forced adult patients to go private.

"We've got people doing telehealth consults for people they've never seen, and then not following through on the treatment and just handing them back to the GP to initiate, titrate (adjust the dose) and manage without having actually done the work in the first place.

"So it was not best service for patients, it was becoming overly expensive and overly commercialised."

The decision to widen prescribing rules was signed off by Pharmac and Medsafe last year, with cross-party support from MPs wanting to see faster access to assessments and treatment.

Under the new rules, there are no government requirements for accreditation for GPs and nurse practitioners wishing to provide ADHD services - and no additional government funding for training - but they are expected to do so.

Professional bodies have developed training packages, with about 600 GPs registering for a recent series of eight online seminars.

Bradford said however not every GP would have the capacity to offer ADHD assessments, which did not fit into the usual 15-minute appointment slot. A complete assessment took at least 90 minutes, possibly over several sessions, plus extensive questionnaires.

"What we're expecting is that instead of psychiatrists charging up to $2000 in some cases, we'll see much more reasonable rates, but acknowledging that one-and-a-half hours of GP time is going to be in the hundreds of dollars."

Diagnosis just the beginning - advocates

ADHD New Zealand is advocating for increased access to publicly-funded diagnosis and treatment.

Spokesperson Sarah Hogan said diagnosis was "just the first step" - and there were currently no specific services in the public system for people with ADHD.

"But for a lot of people their mental health needs are as a result of having lived with ADHD undiagnosed and untreated and all the spinoff effects of that life and the health consequences of that."

Psychotherapist Tami Harris from Acorn Neurodiversity, a not-for-profit organisation providing multidisciplinary support for children with ADHD, said while the public system accepted referrals for children, there was "a very high bar".

"Usually terrible things need to have happened. And so what we see is people not getting a diagnosis and just being called 'naughty' or 'bad', then that affects their feelings about themselves and they may be more likely to get into addictions or offending behaviours or not be able to learn at school, and then their future potential is really diminished."

The fact that GPs would have to charge for adult assessments meant those barriers would remain, she said.

"It's still not an accessible service, it still doesn't address the equity problems in terms of getting a diagnosis. So it's really frustrating in terms of how it's been done.

"It will help down the road in terms of getting it sorted, but it's not going to be what people expect on 1 February."

Parents' struggle

For Freddie Bennett's son, who is now 11, it took two years to get diagnosed through the public system.

"As a parent I found it really overwhelming and really confusing because I felt my son was having to put his life on hold, and I saw this boy who was creative, talented, energetic, charismatic but he was suffering because he wasn't getting the help he needed, and we as parents weren't getting the answers we needed."

As a result of his family's experience, Bennett and his wife (developmental paediatrician Dr Sarah Moll) set up an ADHD clinic in Tauranga, Bay Paediatrics.

Many families were asking why it was now easier for adults to get support, while their children were stuck on waiting lists or fragmented care pathways, Bennett said.

"The communications around the change have been really poor, as well. A lot of parents think that on 1 February their GP will be able to assess their child, and that's just not true."

Furthermore, he was sceptical that stretched and overworked GPs would be able to provide the wraparound support needed.

"I think they're facing a neurodiversity tsunami. They're doing their best to hold back the tide, but it's an impossible job."

Meanwhile, those who are diagnosed with ADHD may struggle to get medication.

The new rules were initially slated to come into effect in July 2025, but delayed due to concerns about supply problems for ADHD medication.

Pharmac said shortages were expected to continue throughout this year.

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