In the past two years, Ashleigh Yates has spent about $2000 on appointments and medication for Attention Deficit Hyperactivity Disorder (ADHD).
Unable to get help through the public health system, the 28-year-old sought a diagnosis and subsequent treatment through a private psychiatrist.
The Tauranga woman says being on medication has helped her focus enough to complete her university assignments and finish the housework.
But she described the process for accessing her medication as “ridiculous”.
Every month, Yates sees her doctor to get a prescription for her medication. And every two years, she must get her special authority renewed through a psychiatrist in order to keep getting her medication.
Rotorua woman Ayla-Anne Gwilliam, who was diagnosed with ADHD last year, agreed the process was “ridiculous” because ADHD was “a life-long neurodevelopmental condition”.
However, the Ministry of Health says recent changes have been made to allow for three-month electronic prescriptions for certain medicines for ADHD.
And Pharmac said it did not initially have criteria for renewing special authorities but following “lots of complaints” from paediatricians and psychiatrists, it introduced the two-year criteria.
Yates, a full-time university student and part-time social worker, was diagnosed with ADHD two years ago and has been on medication since.
“Before that I had suspicions, but I really only pursued getting a diagnosis when I started university because I was having a lot of trouble just sitting through lectures and concentrating and writing my assignments.”
Yates said the medication “slows down my thoughts enough to actually get my thoughts on to paper for my assignments”.
Her memory was better and she could finish daily tasks at home. It also helped improve her relationship with her partner, she said.
As it has been two years since her diagnosis, she has to get her special authority number renewed in order to keep getting her medication.
“It’s pretty much to say yes I’ve still got ADHD, the meds are working great, just sign your name.”
In her view, getting it renewed every two years was “ridiculous”.
“We’re thinking of moving in about two years’ time so I’ll have to go to a new psychiatrist in the new town that I move to. ADHD doesn’t go away.”
Yates already sees her doctor monthly to get the prescription.
Ayla-Anne Gwilliam said she was still seeing a private psychologist to figure out which medication worked best for her. However, she still had to see her GP for a prescription monthly.
While she understood some people could abuse this type of medication, Gwilliam said the process was “ridiculous”.
“ADHD is a life-long neurodevelopmental condition... you might be doing really well but that doesn’t mean that you’re not going to need the medication because you’re still going to have ADHD.”
ADHD New Zealand chief executive Suzanne Cookson said the purpose of the two-year special authority was to “check on people’s health”.
However, as there was a shortage of psychiatrists, the problem was getting an appointment, the cost and the inequity.
“If you’re an adult, it’s entirely private and at your own expense.”
Cookson said it was “very focused” on improving access to diagnosis and treatment for ADHD and regularly met with a cross-government group to discuss this.
A Manatū Hauora Ministry of Health spokesperson said amendments to the Misuse of Drugs Regulations 1977 were made in November to allow for longer electronic prescriptions for certain medicines for ADHD.
Previously, a prescription could be for a maximum of one month. This changed to three months, however, the person with ADHD would need to self-fund two of the three months.
The Pharmac schedule currently limits the amount of funding to one month’s supply per prescription, however, it has proposed amending it to align with the new regulations.
Consultation started last year and any changes were intended to be implemented from February. However, after discussions with the Ministry of Health, Pharmac agreed to delay any changes until a review of other controlled drug prescribing rules was completed.
The spokesperson said the change was made to increase access to medicines and reduce the number of times people with ADHD must contact a prescriber. It was proposed by specialist mental health service providers, recognising that requiring frequent prescriptions could be burdensome to people with ADHD and to health practitioner workloads.
Limits on prescribing these and other Class B controlled drugs were to reduce the risk of harm these drugs could cause if diverted or misused.
Pharmac’s chief medical officer Dr David Hughes said Pharmac had agreed to review the renewal eligibility criteria, specifically the prescriber restrictions, for funded class B medicines.
Before any changes were made, Pharmac would take clinical advice from its mental health specialist advisory committee, and obtain legal and health economic input to help assess possible impacts.
“We would also consider and ensure any changes would support wider changes in the delivery of health services to ensure equitable and safe access to treatment.”
On the renewal of a special authority application, Hughes said a GP could apply for renewal of a special authority approval if they had a written recommendation supporting the renewal from a paediatrician or psychiatrist and people did not need to visit them in person.
Hughes said it did not initially have renewal criteria for special authorities but it had “lots of complaints” from paediatricians and psychiatrists saying people were using recommendations a decade later. It then decided to introduce the two-year criteria.
Information obtained under the Official Information Act from Te Whatu Ora Health New Zealand said Te Whatu Ora Lakes did not offer specific ADHD assessments and diagnoses for people aged over 18. For those younger than 18, the priority was to treat those who had evidence of a childhood diagnosis with prior treatment and other complex issues such as intellectual disability, autism spectrum disorder, learning disability or another psychiatric diagnosis.
Te Whatu Ora Hauora a Toi Bay of Plenty does undertake ADHD assessments in those aged 18 and older. However, the Mental Health Services’ priority was to diagnose and treat those who have “severe and enduring illness” and for those in crisis with “high levels of distress and/or risk,” the information said.
What is ADHD?
ADHD is a neurodevelopmental condition caused by the slower development of the frontal lobe, specifically the prefrontal cortex. This “neurodevelopmental delay” to the prefrontal cortex makes automatically controlling and filtering attention, behaviours, and emotions harder. Other behaviours, such as restlessness, impulsivity or inattention, can also result from this delay.
ADHD in adults
- Living in the moment, becoming easily bored, leaves activities to the last minute.
- Racing mind skirts over numerous subjects. This and impatience can be a challenge when making realistic goals. Often over-commit, multi-task and get off track inhibiting the completion of projects.
- Easily distracted by noise, people walking past or email alerts.
- ADHD brains have to work much harder to control and filter attention, behaviours, and emotions commonly resulting in significant fatigue.
- Constantly tired, yet often have difficulty getting to, or staying, asleep. Headaches and allergies but succumb to food/sugar cravings, habitual nail-biting.
ADHD in children
- Lack of routine.
- Finding food they will eat, let alone that is nutritious, is the next challenge. And that is only if they sit for long enough to eat it.
- Makes friends easily but can struggle to keep them.
- Melt-downs are a common after-school occurrence. Screen-time is calming.
Source: ADHD New Zealand