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With over 1,000 adults facing years-long waits to be assessed for ADHD, the Health Department has been exploring several solutions to address the backlog while managing the growing demand for the service…but what exactly is being proposed?
According to the latest figures, there are 873 adults waiting for an ADHD assessment and 140 young people transitioning from children’s services – with those in the queue currently facing three-and-a-half years from referral to diagnosis.
In March, Mental Health Director Andy Weir said that the Health Department was exploring the possibility of either closing the adult ADHD diagnoses waiting list, or prioritising assessments based on the severity and impact of symptoms.
Pictured: The amount of time islanders are waiting for an ADHD assessment continues to increase each month.
Since then, however, the Health Minister pledged to explore "all possible actions" to reduce the wait time for adult ADHD diagnoses before making any decision on closing the waiting list.
In September, Deputy Tom Binet said that these actions include a focus on current resources and strategies to improve wait times without turning people away from services.
But what has actually moved forward since then?
The introduction of a pilot electronic self-assessment tool is being explored as a way to streamline the process of getting a professional ADHD diagnosis.
In September, the Health Minister explained that the tool could help “significantly reduce inappropriate referrals” by directing individuals who do not require ADHD assessments to alternative resources.
Pictured: In March, Mental Health Director Andy Weir said closing the ADHD assessment waitlist was being considered due to its excessive length.
He added that the tool could “support diagnostic assessment” by collecting relevant clinical information about the patient upfront.
Finally, the Minister said it would connect patients with “associated online resources for self-help”, offering support while they wait for a formal assessment with a psychiatrist.
Later in the month, the Mental Health Director explained that the Department is “in conversation with a potential provider” about the tool, but added “this is in very early stages.”
Earlier this week, Mr Weir confirmed there has been no update on this situation yet.
To alleviate pressure on existing services, the Health Department has explored commissioning private providers to conduct ADHD assessments – although this raises questions about how treatment will be managed for those diagnosed through this process.
Mr Weir said that a meeting was held with providers this week to discuss available options and that a decision is expected to be reached by January.
However, he explained that increasing assessments would inevitably lead to greater demand for prescriptions – a demand the current system cannot easily absorb.
He said: "There is no point just commissioning people to do assessments because. when the assessments have been done, someone needs to prescribe the medication to treat people.
“We could very easily go and buy a load of assessments. If we did that, then we're gonna have a load of people that are now saying, ‘Well, I've got ADHD, and I need prescriptions, and I need to be seen regularly?’ Who is going to do that?"
Pictured: Global shortages of ADHD drugs forced the Health Department to issue monthly rather than six-weekly prescriptions.
This bottleneck is caused by there being only one consultant psychiatrist and one junior doctor responsible for prescribing medication to around 250 islanders.
The situation has been complicated by an increased administrative burden on the limited prescribing staff due to a global shortage of ADHD medication earlier this year that forced the Health Department to issue monthly rather than six-weekly prescriptions.
The global shortage, coupled with long queues at the hospital pharmacy, has made it increasingly difficult for many to access treatment and left some worried that their designated medication would run out.
Earlier this year, Express was told that some patients had felt forced to turn to illegal drugs such as cannabis – or medication bought on the dark web – to ease their symptoms.
One way of reducing the administrative burden faced by the consultant and junior doctor in the ADHD service is by sharing the load with General Practitioners by allowing them to prescribe controlled medication.
Known as ‘shared prescribing’, this approach has also been touted as the solution to the long Hospital Pharmacy queues, which is where ADHD patients have to wait to collect their medication.
This agreement would allow GPs to take over routine prescribing of ADHD medication after an initial assessment by a specialist.
Pictured: 'Shared prescribing' would allow GPs to issue repeat prescriptions for some controlled drugs, such as ADHD medication.
This approach, common in other jurisdictions, could help free up specialist time for more assessments.
However, these plans are still under discussion, and no concrete framework has yet been established – with key barriers remaining.
Plans to add ADHD medication to the shared prescribing list were scuppered earlier this year due to ongoing national shortages, and concerns from local GPs.
It was also recently revealed in October that implementing such a system would cost the Health Insurance Fund over £800,000 annually to cover prescriptions for approximately 1,500 patients.
This week, Mr Weir said: “We're not any further forward with discussions around shared care agreement.
"At the moment, we still have a difference of view among GPs as to whether they wish to implement a shared care protocol. So more conversation is required.”
The challenges posed by staffing and medication shortages were the subject of a six-month review carried out by the Health and Social Security Scrutiny Panel, led by Deputy Louise Doublet.
In a report published earlier this week, the panel stressed the need for “immediate action” to reduce the waiting list and to expand the number of healthcare professionals authorised to prescribe medication by providing more training to ensure they feel comfortable to do so.
Pictured: The Health Scrutiny Panel, led by Deputy Louise, has carried out a review into the way ADHD medication is prescribed to adults.
This measure, the panel explained, would reduce the workload on the sole specialist consultant psychiatrist and expedite patient care.
The panel also found that the lack of shared care agreements with GPs was a key "barrier" to patients trying to get hold of appropriate treatment for ADHD.
They added that until the Shared Care Pathway protocols are agreed upon, "it is difficult to see how primary care will form part of the overall management of patients with ADHD".
The report read: "Shared Care Pathways are used successfully in Jersey, however, do not cover mental health issues.
"In the UK, they successfully cover areas such as mental health, cancer and chronic conditions such as diabetes.
"The benefits of Shared Care Pathways include patient satisfaction, efficiency and cost savings and better health outcomes."
In light of this, the panel urged the ADHD service to continue with primary care providers and to develop "alternative prescribing pathways that will alleviate the pressure on the current hospital team, and reduce the waiting list, allowing patients to access vital care and support more quickly".
In response, Mr Weir said that he "totally supports" the recommendations from the review, but added that many of the panel's proposals "are things that the service is already trying to do.”
He explained: "We've already tried to seek non-medical prescribers. We've tried to put additional doctors in. There's an ongoing discussion with primary care about shared care pathways."
Responding to the panel's call to train more healthcare professionals to prescribe ADHD medication, Mr Weir explained that training non-medical prescribers requires extensive qualifications, often involving months of study and supervision that cannot be completed locally.
Speaking to Express on Tuesday, Mr Weir said the Health Department is in the process of rolling out psychological support groups led by a consultant psychologist.
He explained these groups aim to provide interim assistance to those on the waiting list, and help diagnosed individuals manage their condition effectively.
Sessions include symptom management strategies and tailored programs for individuals with dual diagnoses or complex conditions, which will soon be advertised on the Government's website.
Mr Weir also outlined plans for further support groups, including initiatives focusing on men’s mental health, neurodiversity, and managing symptoms of serious mental illnesses like psychosis.
“We’ve been running groups like Tai Chi and pottery – not just as activities, but as spaces where people with serious mental illness can have supportive conversations,” he said.
Last month, Mr Weir explained that one of the difficulties with reducing ADHD waiting times was the need for "highly specialist skills" that are currently in demand across the globe.
"It's not all psychiatrists that will diagnose and treat ADHD – it's a specialism," he told Express.
"So we are looking for a small group of people and competing with everybody, everywhere, who want those people."
He continued: "We have to keep at it and we have to keep trying to attract people to come and do that work.
"We have to think about different people – we can't just rely on psychiatrists.
"So we are thinking about a specialist post for next year to work in that area."
And earlier this week, he confirmed that the situation remains the same.
Mr Weir said: “This is an area where there is a huge underrepresentation of available resources. Everybody is looking for ways of cracking this problem.
“So we are up against big organisations that are spending large amounts of money trying to solve this problem."
Speaking in October at Jersey's first-ever ADHD conference, Heidi Philips, a Welsh GP who founded the British Association for Neurodiversity, suggested that Jersey could benefit from the creation of a holistic neurodiversity "hub" to allow professionals to more easily identify overlapping conditions.
Sam*, an islander in their 20s who did not receive an ADHD and autism diagnosis until they were at university, told Express earlier this year that such a hub would have been "hugely beneficial".
They explained: "I have loads of other medical conditions that are common in neurodiverse people, so having a hub like this in place when I was younger would probably have helped me get autism and ADHD assessments much sooner."
*Name changed to protect anonymity.
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