Hansard

I thank members from across the parties who have supported my motion to enable this debate to take place. The debate is important for a number of reasons, not only to discuss the recommendations in the report by the Royal College of Psychiatrists but to mark the progress that we have made.

It is a little bit more than eight years since I first stated in the Parliament that I have attention deficit hyperactivity disorder and that I take medication for it. Then, in 2018, I held, I think, the first debate in the Parliament to discuss ADHD by itself.

We have made much progress. When I reflect on the context then and the context now, I think that it is now much easier to talk about ADHD. There is a much greater understanding and acceptance of it. Indeed, I find myself attending national health service briefings and other meetings at which I am not the only person raising the issue. Colleagues around the chamber find it equally important and raise the issues, too. That is fantastic.

However, there has also been an odd flipping of the situation. Back in 2017, there was stigma; it was difficult to speak up and the Government often found itself justifying why diagnosis and prescribing took place. Now, we have public demand for diagnosis, assessment and prescribing, and the Government is explaining why those things are not taking place. Most recently—and we need to talk about this in the debate—the Government has been explaining why diagnosis is not required.

That situation is dangerous, and we need to take care. We have to consider the scale of the problem. There are 42,000 children waiting for assessment—that is a 500 per cent increase. We also have 23,000 adults waiting for assessment—that is a 2,200 per cent increase. Unfortunately, we have had to rely on the Royal College of Psychiatrists to produce those numbers, because the Scottish Government is not producing them.

Behind those numbers is not just a cost in terms of the frustration and human misery caused by a failure to diagnose and provide support, but a real economic cost. It is estimated that undiagnosed autism spectrum disorder costs the economy £44 billion and undiagnosed ADHD £17 billion. In the prison population, 25 per cent are estimated to have ADHD against 3 to 5 per cent of the general population. There is a real cost to failure that we have to address. Indeed, there is not one single neurodevelopmental condition that is not overrepresented at least threefold in the prison population. That is why the report by the Royal College of Psychiatrists is so important—it sets out a clear plan of what we can do now in wider policy, and in clinical action and policy, to address the issue.

On the point about there being no need for a diagnosis, the report contains important recommendations—in particular, recommendations 1, 2 and 5 of the 10 that are made—on non-clinical pathways and how we can adjust approaches in education and wider public policy to help people with ADHD and autism. Those practical, reasonable adjustments do not need a diagnosis. Recommendations 9 and 10, which are about improving understanding more widely across the general population, are important, too.

However, the bulk of the recommendations in the report are on clinical pathways and access to diagnosis. Explicitly, recommendation 3 talks about increasing access to medication. I am not denying that medication is important. Let me be very clear, as I have been clear in the past: for me, as for many people, medication was the biggest single step that I could have taken to help me with my condition. Indeed, it is what many people approach me about, as they do constantly. They say that medication helps with their ability to hold down a job, maintain relationships with their family and deal with the chaos that ADHD often brings.

The report also sets out the need for new guidelines, including from the Scottish intercollegiate guidelines network, as we do not have any SIGN guidelines for ADHD. We also need new general adult psychiatric standards, and we need a four-tiered model for accessing diagnosis and support. Those are clear and practical points.

Another feature of the report is its statement that we need to tackle primary care head on. In recommendations 3 and 4, the Royal College of Psychiatrists makes it explicit that we need to bring forward a structure and a means by which general practitioners can actively participate in prescribing. We have seen changes and advances in our understanding of the condition, which is critical.

Let us talk about the other elephant in the room: shared care. The reality is that GPs across this country have stopped what was once the understood and received practice of entering into shared care on the basis of a private diagnosis. I do not think that someone should have to have a private diagnosis to get the treatment that they want, and I certainly do not want a system that relies on that, but we do need a pragmatic approach.

I have had lots of conversations about that in recent months, and GPs will say that they are not allowed to do shared care any more, but that is not true. Health boards are clear that they are not preventing it, and even the local medical committees say that the guidelines that they have produced do not prohibit it. However, health boards, GPs and local medical committees seem to be undertaking some kind of mutual blame activity, and are all pointing the finger in another direction.

We need a pragmatic approach in which it is recognised that private diagnoses are very often made by the very same people who would make an NHS diagnosis. Therefore, I am asking for that sort of practical approach with, as has been called for, the standardisation of what a good diagnosis looks like, so that we can accept diagnoses that have been made elsewhere.