A shortage of services for attention deficit hyperactivity disorder (ADHD) in adults has resulted in some patients being unable to access care, the HSE has conceded.
The problem is particularly acute when adolescent patients with an ADHD diagnosis – and who are on medication – are required to transfer from HSE child and adolescent mental health services (CAMHS) to adult services at 18 years of age.
“In areas without an adult ADHD service, CAMHS ADHD patients needing to transition to an adult service may not be accepted, although there is some variability around the country,” a HSE spokesperson told the Medical Independent (MI).
All CAMHS transfers are accepted where established adult ADHD services exist, said the spokesperson. CAMHS begins planning transfers “one year in advance”.
“One of the main challenges is that general adult psychiatrists who train in Ireland are not required by the approved training body to have ADHD assessment and diagnosis as a competency to achieve specialist accreditation in psychiatry,” the spokesperson continued.
There are an estimated 120,000 adults likely to have ADHD in Ireland. “This number exceeds the capacity of the established adult ADHD services,” said the spokesperson.
They added that the HSE “regrets” any difficulties that people experience in accessing services.
“We are acutely conscious of how this impacts people and their families. We aim to provide the right care in the right place at the right time, but must acknowledge that the growing demand for services can outstrip resources and capacity.”
Prior to 2018, there were no adult ADHD services in the HSE. In 2021, the HSE launched a national clinical programme and model of care for ADHD in adults. This model included plans to establish 11 adult ADHD teams nationwide.
Seven adult teams are currently in place and a further four have received funding from the Department of Health. These four teams are at varying stages of development.
Dr Tadhg Crowley, Chair of the IMO GP committee, told MI the lack of care available for some patients was a “major problem”.
“We certainly see it down here as an issue,” he added.
Dr Crowley is based in Kilkenny, where an adult ADHD team has yet to be established.
He referenced the Medical Council’s Guide to Professional Conduct and Ethics for Registered Medical Practitioners.
The document outlines that when transferring the care of a patient, a doctor must ensure another doctor is available to take responsibility for their care.
He noted that in some areas there is no adult service to which CAMHS can transfer the patient when they reach 18 years.
“So I think there is a bit of work to be done in terms of determining who is responsible here,” he said. “In some departments of psychiatry, they feel that they are not qualified in treating ADHD. They have made a decision that they are not fully competent to treat people with ADHD. What happens then is the patient is told they are being transferred [from CAMHS], they’re not being accepted [into an adult service], and the patient is left without someone to treat them. So they tend to come back to their GP.”
Dr Crowley also said there is an issue with transcribing medication for patients with ADHD and associated insurance cover.
A medico-legal article, in the previous edition of MI, provided advice for GPs on safe prescribing for adult patients with ADHD following discharge.
In the article, Dr Ben White, Medical Protection, wrote that if GPs feel patients are being put at risk – due to the lack of specialist services, or where they feel they are being asked to prescribe inappropriately – then it may be necessary to consider raising concerns in line with local policy and Medical Council guidance.
Meanwhile, issues relating to waiting lists and access to services in the south-west were noted in meeting minutes of the ADHD in adults national clinical programme oversight implementation group in September 2024.
The minutes also revealed that some GPs in parts of Dublin were refusing to handle prescriptions for patients transferring from CAMHS to adult services. This was having a “negative impact on caseload”.
A meeting in November 2024 heard that in the same areas, the “majority of local GPs decline to continue prescribing (CAMHS transfers)”, according to records released through Freedom of Information law.
According to the HSE, the mental health clinical programmes office and ADHD Ireland have drafted a proposal to expand capacity for adults “by developing a primary care component to work in an integrated manner with the existing adult ADHD services”.
“This proposal is currently being considered by the HSE and ADHD Ireland as an early intervention solution to address the scale of demand in this area.”
The HSE funds ADHD Ireland to provide support and information for young people and adults, as well as carers and families.
The Adult ADHD App provides information for adults who have ADHD or think they may have the condition. It was developed by the HSE in partnership with ADHD Ireland and the University College Dublin School of Psychology.
The app provides self-care and signposting information and is available to download from the Apple and Google app stores.
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