Member Article

The ADHD Foundation urges the NHS to review its spending in order to improve the lives

Dr Tony Lloyd of ADHD Foundation is urging NHS trusts and NHS CCG Commissioners to review its spending on child and adolescent mental health in order to vastly improve the lives and reduce the distress of young people and their families who have been newly diagnosed with Attention Deficit Hyperactive Disorder (ADHD) to reduce the risk and cost of them developing related mental health problems such as anxiety, depression, self harm and suicide.

In 2013, the Care Quality Commission (CQC) reported that the number of prescriptions for drugs used to treat ADHD doubled in England in the past six years. As a result, it warned medical professionals to monitor use of methylphenidate medication. The National Institute for Health and Care Excellence (NICE) guidelines state that treatment should be multi-modal and include psycho-social skills-based training and CBT as a first line of treatment before medication is considered.

Although NICE recommends that medication should only be prescribed for ADHD for those with the most severe form of the condition, The ADHD Foundation has seen evidence that suggests that access to multi-modal support and training for those living with ADHD is very limited in many parts of the UK. (Evidence obtained from a FOI request by ADHD Foundation and Young Minds in Feb 2012). The ADHD Foundation supports over 250 families per year and more than 500 individual children across Merseyside and Warrington. The charity’s services reduce the risks of children developing other related mental health problems, saving the NHS considerable money through reduced dependency upon NHS clinicians and medication.

An escalation in the number of children with mental health problems and an increase in children being diagnosed with neurodisabilities such as ADHD is stretching NHS resources to the limit. A growing number of young people are having to wait for up to two years for an ADHD or ASD diagnosis and even then when they have been diagnosed, they are struggling to access post diagnostic support.

Merseyside, Liverpool and Sefton CCGs in particular are pioneering in commissioning charities such as The ADHD Foundation to help plug the gap in services to deliver evidence based support as soon as children have been diagnosed. The ADHD Foundation multi-modal model costs the equivalent of one year of medication and dispensing costs. Dr. Lloyd states that medication is often a very effective form a treatment and for children with severe ADHD, it is a vital part of any treatment pathway to help the child cope – especially in school. He goes on state however, that even when medication is necessary, these children still need to learn the skills to self-manage their neurodisabilities so they can develop the necessary life skills that will enable them to become more independent and achieve their potential. What is more, as many as 80 per cent of teenagers cease to be compliant to with medication by the age of 15, so without an educative approach to their condition as well, they simply will not have the skills and knowledge to learn how to manage their ADHD. This is particularly important at a time in their lives when they are taking important GCSE exams and transitioning into adult health services.

Dr Tony Lloyd, CEO of The ADHD Foundation, said:

“This huge shortfall in support and training means that the outcomes for children with ADHD and Autistic Spectrum Disorder (ASD) are extremely alarming, with almost half suffering from long-term mental health problems, such as anxiety and depression. Data published recently also shows an increase of 41 per cent in the number of children presenting at accident and emergency departments after self harming. Other research suggests that as many as 1 in 5 of those with ADHD will attempt suicide at some point in their lives.

“However, despite acknowledging that if the right support is given at the earliest opportunity when they first start school, children are likely to become more resilient, less dependent on health services and enabled to learn how to self-manage their neurodisability so they achieve their full potential. However, the NHS is still not providing the NICE recommended post-diagnostic services which are so desperately needed in most parts of the country.

“A review of NHS spending on child and adolescent mental health needs to address this issue urgently, particularly in light of the ongoing costs to the NHS trusts as these children transition into young adulthood. Money simply isn’t an excuse for lack of support from specially trained mental health workers and counsellors, as one year of psycho-educative and cognitive behavioural therapy (CBT)-based support for a child and their family costs approximately £750 - the same as it costs the NHS to purchase and dispense a years worth of ADHD medications such as Ritalin.”

Dr Tony Lloyd continued:

“Even pharmaceutical companies, which manufacture ADHD medications, state quite clearly that medication should not be used in isolation, and many NHS trusts are still failing to implement NICE guidelines.

“Although medication can be very effective, it does not teach young people about how to take a strength-based approach to their mental health. This means that they run a far greater risk of developing associated mental health problem and are much less likely to achieve their potential at school and go on to gain meaningful employment.

“Across Merseyside we are funded by NHS, Big Lottery Fund, BBC Children in Need, Comic Relief and Lloyds Bank to provide early intervention and the right support to alleviate a great deal of suffering for these children and their parents - but we can also prove that our outcomes save substantial amounts of money for the NHS.”

Dr Simon Bowers, GP and Clinical Vice-Chair and Children’s Lead at Liverpool CCG, said:

“The NICE guidance is clear, but only a few areas, such as Liverpool and Leicester, currently offer a pathway that includes such holistic interventions, offered in many cases by local and national charities or other non-NHS organisations. Even in these areas, however, waiting times for assessments or support can be measured in fractions of years, as embattled community paediatricians find themselves morphing into neurodevelopmental specialists by default, with endless follow-ups of stable children on medication.

“The problem isn’t going to go away, as numbers continue to increase. In Liverpool last year, new diagnoses rose by 100%, with hospital and voluntary services struggling to keep up with demand. Even in a relatively well resourced pathway, services are running to stand still—to the point where we consider a four month wait for assessment to be a great achievement. Elsewhere in the country, the picture is far worse.

“Having an accessible, holistic ADHD pathway is a fine example of “invest to save” and is easily sellable to clinicians, as they are precisely the people frustrated by current waiting times and poor patient experience. Every penny counts in the new world, but the successful commissioners will be the ones that see the wider benefits of what they commission.

“Outcomes from a functional ADHD pathway may not be directly measured in health terms but in educational, welfare state, criminal justice, and economic terms. Health commissioners have been justifiably obsessed by the cost of medicines, but they must see the benefits of their spending in the context of outcomes for the patient. Unfortunately, that often takes years to realise, and we’re not great at tracking it. And it’s wrong to use psycho-educative interventions as an alternative to medicines in all children; a successful ADHD pathway will have appropriate access to assessments for both.”

The ADHD Foundation, a CAMHS funded charity, provides a range of services to children and families living with ADHD after they have been diagnosed with the condition such as Cognitive Behavioural Therapy, Skills based psycho social training to self manage health for both children and their parents, mindfulness based stress relief and solution focused counselling . This is very rare in the UK with only one other organisation in Leicester offering this approach to supporting those living with ADHD.

This was posted in Bdaily's Members' News section by Chris Lowe .