A new era of mental health provision for young people
Shire looks at how the government's green paper on children and young people's mental health can help improve outcomes for patients with ADHD
The green paper on children and young people’s mental health provision1 outlined ambitious plans to ensure young people get the help they need with their mental health, when they need it. It follows an increased focus on mental health policy, with the Prime Minister identifying mental health as a key priority, the establishment of the Five Year Forward View for Mental Health, and now a dedicated mental health workstream within the NHS 10 Year Plan.
This is a welcome shift. A first step in reviewing mental health provision should be to assess conditions that have been historically under prioritised. Attention Deficit Hyperactivity Disorder (ADHD) is a condition which has a significant impact on individuals, the education service and beyond, but as Jo Platt MP, the Chair of the All-Party Group on ADHD has argued, healthcare provision remains “unresponsive to a condition that affects so much of the population”2. Without proper treatment, 39% of children with ADHD are excluded from school3 and the negative impacts can continue into adulthood. There is evidence which suggests that there are disproportionally more individuals with ADHD within the criminal justice system4; and those with ADHD are twice as likely not to take up full-time employment5. Undiagnosed ADHD costs the UK billions every year6.
Ensuring mental health policies are alert to the treatment and diagnosis of ADHD has additional importance given that 2/3 of children with ADHD have a linked psychiatric disorder7. As a company, Shire has over 20 years’ experience in ADHD and we are committed to improving outcomes for patients with ADHD. We see the green paper proposals as an exciting way to achieve this goal.
The introduction of Designated Senior Leads and Mental Health Support Teams is an important step towards better identification, diagnosis and treatment of mental health conditions. This is particularly evident for ADHD. Despite each class including, on average, one child with ADHD8, 74% of teachers think ADHD is not well understood and 22% would not know how to refer a child they believed to have ADHD9.
The commitment to four week waiting times and the continued roll-out of Mental Health First Aid training in schools is crucial to ensure conditions are identified quickly and managed effectively. Evidence published by the Health Service Journal showed that in just one county council, up to 800 children have been waiting for nearly two years for assessments for autistic spectrum conditions and attention deficit/hyperactivity disorder10. Sadly this case is not atypical, with evidence showing delays for ADHD diagnosis are very common11. As such, the renewed commitment to four week waiting times is particularly welcome for the ADHD community, where a focus on early diagnosis is clearly required.
Crucially, enhanced data collection is required to ensure that each policy intervention is evidence-based, and the impact is measurable over time. There is currently no official dataset on the number of children and young people with ADHD, restricting the NHS’ ability to plan adequately. In May this year, Minister for Mental Health and Inequalities Jackie Doyle-Price MP, committed to exploring what data can be collected12 and this should remain a priority.
The green paper has the potential to usher in a new era of mental health provision and, for young people with ADHD, the Government’s proposals could prove truly life-changing. Properly implemented, the recommendations could help those currently predetermined to a life more likely to include depression13, substance abuse and poorer relationships with family and friends14.
ADHD fits within these welcome proposals and should be considered a priority as policy-makers take these proposals forward. The cost of failing to do so is too high.
Preparation date, October 2018
1 Department of Health and Department for Education (2017). Transforming Children and Young People’s Mental Health Provision: a Green Paper. [Online]. London, Department of Health and Department for Education. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploa... [Accessed September 2018].
2 Hansard (2018), ‘ADHD Diagnosis and Treatment’, HC Deb, vol. 641, col. 107WH, 15 May 2018. [Online]. Available at: http://bit.ly/2O4dPux. [Accessed: September 2018].
3 O’Regan F. (2009), ‘Persistent disruptive behaviour and exclusion’, ADHD in Practice, 1(1): 8-11
4 Young, S.J et al. (2011), ‘The identification and management of ADHD offenders within the criminal justice system: a consensus statement from the UK Adult ADHD Network and criminal justice agencies’, BMC Psychiatry, 11 (32).
5 Biederman J and Faraone S. (2006), ‘The effects of attention-deficit/hyperactivity disorder on employment and household income’, Med Gen Med, 8(3): 12.
6 Demos and Shire (2018), Your Attention Please. London: Demos.
7 Masi L and Gignac M. (2015), ‘ADHD and Comorbid Disorders in Childhood Psychiatric Problems, Medical Problems, Learning Disorders and Developmental Coordination Disorder’, Clinical Psychiatry, 1(5): 1-9.
8 Royal College of Psychiatrists (Under Review 2018), Attention Deficit Hyperactivity Disorder in Adults. [Online]. London: RCP. Available from: http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/adhdinadults.aspx. [Accessed September 2018].
9 ComRes (2017), Shire ADHD at School Survey. [Online]. London: ComRes. Available at: http://www.comresglobal.com/polls/shire-adhd-at-school-survey/ [Accessed September 2018].
10 Moore A. (2018), ‘Hundreds of children waiting years for ADHD assessments’, Health Service Journal, 21 March 2018. [Online]. Available from: https://www.hsj.co.uk/nhs-south-kent-coast-ccg/hundreds-of-children-wait... [Accessed September 2018].
11 Born to be ADHD (2017), A Lifetime Lost, or a Lifetime Saved. [Online]. London, Born to be ADHD. Available at: https://www.borntobeadhd.co.uk/wp-content/uploads/2017/09/A-Lifetime-Los... [Accessed October 2018]
12 Hansard (2018), ‘ADHD Diagnosis and Treatment’, HC Deb, vol. 641, col. 109WH, 15 May 2018. [Online]. Available at: http://bit.ly/2prgeoY. [Accessed September 2018].
13 Pitts M. et al. (2015), ‘Impairments, Diagnosis and Treatments Associated with of Attention Deficit Hyperactivity Disorder (ADHD) in UK Adults: Results from the Lifetime Impairment Survey’, Archives of Psychiatric Nursing, 29(1): 56-63.
14 Masi L and Gignac M. (2015), ‘ADHD and Comorbid Disorders in Childhood Psychiatric Problems, Medical Problems, Learning Disorders and Developmental Coordination Disorder’, Clinical Psychiatry, 1(5): 1-9.