I recently watched the episode of BBC Panorama titled “Private ADHD Clinics Exposed,” which delved into the practices of three private clinics offering ADHD assessments and treatment. As a consultant psychiatrist who works in both the NHS and the private sector, I am writing this article.

Previously, I served as the lead consultant psychiatrist of an Adult ADHD service in a central London NHS Mental Health Trust for nearly 8 years. In February 2022, I stepped down from this position to focus on expanding my private practice, which I established in 2015.

Since the inception of my private clinic, Adult ADHD has been one of our areas of expertise, and we are dedicated to providing our patients with high-quality service.

In addition to being an ADHD specialist, I am writing this article as a concerned member of the public who has friends and family members diagnosed with ADHD. Therefore, I would like to take a moment to address the concerns raised in the Panorama episode and provide you with a more balanced perspective on the overall landscape of ADHD diagnosis and treatment in the UK.

Unhelpful Focus on ADHD Clinic Types (i.e., NHS vs. Private):
The Panorama program appeared to exhibit a strong bias against private clinics, highlighting them while presenting NHS adult ADHD clinics as the superior choice. However, it is crucial to consider the broader perspective and recognise that both types of ADHD clinics have their strengths and weaknesses.

Throughout my 18 years of experience working as a psychiatrist in the UK, I have witnessed exemplary clinical care provided in both the NHS and the private sector. Conversely, I have also encountered suboptimal clinical practices in both sectors. The reporter in this episode of Panorama, along with his team, has created a binary distinction between NHS and private sector ADHD clinics that, to a large extent, exists only in their minds.

It is worth mentioning that the majority of doctors practicing in the private sector in the UK either continue to work in the NHS (as I do) or have received training and worked in the NHS in the past. Glamorising one sector while tarnishing the other serves as a distraction from the actual challenges faced by the healthcare system, which require a serious and comprehensive discussion.

Portraying ADHD services in the NHS as the Rolls Royce of services is far from reality. I don’t need to say more than waiting for 5 years to undergo an assessment in one of these services is not uncommon. It is also worth remembering that many, if not most, of the private ADHD clinics are led by experienced consultant psychiatrists who adhere to international and national guidelines, such as the NICE (National Institute for Health and Care Excellence) guidelines.

They strive to provide a high-quality service in a timely manner. For instance, in my private clinic, we have experienced consultant psychiatrists who assess and manage patients, while some NHS Adult ADHD services may have less experienced doctors and clinicians. It is important to note that a patient seeking an Adult ADHD assessment in the NHS may be seen by a supervised trainee doctor (once, I was that junior doctor) who might be conducting their first ADHD assessment.

On the other hand, if someone sees me at my private clinic, they would be assessed by a consultant psychiatrist who has led an NHS Adult ADHD team for more than 7 years and has assessed thousands of patients. It is crucial to highlight that the ADHD assessment the patient undergoes is likely to be the only comprehensive ADHD assessment they will have in their lifetime.

While I believe that Adult ADHD services in the NHS strive to deliver a high-quality service under immense pressure, it is unhelpful and unfair to generalise and tarnish the reputation of all private Adult ADHD clinics based on the actions of a few.

Assessment Approaches:
The program expressed concerns about the use of tick-box questions during the assessment, suggesting that it reflects poor quality. However, it’s crucial to understand that a thorough assessment goes beyond simply ticking boxes.

While various components and factors should be taken into account, the presence of yes/no or tick-box questions alone doesn’t indicate subpar assessment quality. As part of conducting a comprehensive assessment and understanding each patient’s unique needs, some tick-box or yes/no questionnaires could be used. However, I agree that relying solely on such questionnaires for the entire assessment and an ADHD diagnosis is unacceptable.

Addressing ADHD Stigma:
Unfortunately, the Panorama program missed an opportunity to address the wider challenges faced by ADHD services and inadvertently perpetuated ADHD stigma. ADHD is often an underdiagnosed mental health disorder, and when left untreated, it can have serious consequences on a patient’s mental and physical health, academic achievement, career progression, interpersonal relationships, family dynamics, safe driving, and involvement with the legal system, among other secondary problems.

Sensationalising certain aspects of how three private ADHD clinics conduct their business without considering the broader issues does not contribute to a constructive discussion. It is crucial to shed light on the lack of resources and funding for adult ADHD services, regardless of whether they are in private clinics or the NHS.

The Need for Improved NHS Funding:
Let’s zoom out and look at the bigger picture. We need to acknowledge and address the shortcomings in ADHD services provided by the NHS. Rather than solely focusing on private clinics, a more productive approach would involve investigating the reasons behind the limited availability and underfunding of adult ADHD services within the NHS.

This would provide valuable insights into the struggles faced by patients waiting for assessments and the challenges encountered by NHS ADHD services. This is one of the main reasons why many patients are seeking ADHD assessments and treatment in the private sector.

Properly funding ADHD services in the NHS will not only lead to better care and service for patients in these services, but it will also set a benchmark for the private sector to aspire to. When NHS services are underfunded and struggling to keep up with the demand, it opens the door to poor private service because some patients may feel they have no other option. I believe that private healthcare should be a choice, but it should not be the only choice.

Bad Journalism:
While watching this episode of Panorama, I couldn’t help but think what a shame it was that the journalists behind this episode didn’t do their homework properly. It was a lost opportunity to actually discuss the real problems facing ADHD patients, and it served as a good example of bad journalism. It would have made more sense for the reporter to be assessed by the NHS consultant psychiatrist featured in this episode, without the psychiatrist knowing they were assessing a reporter and being secretly filmed, similar to what was done during the assessments at the three private clinics.

However, I apologise for forgetting that the reporter would have had to wait around 5 years to be seen as a normal patient in the NHS ADHD clinic, and it’s understandable that they didn’t want to wait that long to complete this episode of Panorama. While some people might think it is acceptable for patients to wait 5 years for their assessment, it is a concern in itself.

Although I agree that the way these three private clinics conducted their assessments and managed the cases was inappropriate, we do not know the details of what the ‘patient’—in this case, the reporter—told them in order to reach the conclusion that he has ADHD. Faking symptoms could be a problem not only in psychiatry but in any field of medicine.

I recall one of my first experiences of shadowing a psychiatrist after I finished medical school, but before specialising in psychiatry. On that day, a patient came to the clinic, and I saw this experienced psychiatrist interview him. It seemed like they were having a chat during which the patient disclosed some symptoms they were struggling with. The psychiatrist I was shadowing changed the patient’s medication, and the appointment ended.

After the patient left, the psychiatrist asked me how I thought the interview went. I questioned how he knew that what the patient said was true since he based his treatment mainly on what the patient said. He smiled and nodded in agreement, then said that this could also happen with a GP if a patient complains of abdominal pain while faking it.

The bottom line is that doctors are human beings, and the most valuable thing we have with our patients is trust. We can’t do our work without trusting our patients, but if a patient wants to fake their symptoms, there is a high chance they might succeed in tricking their doctor.

While the Panorama program raised valid concerns about certain practices in three private ADHD clinics, it failed to present a balanced perspective and neglected the broader context of ADHD diagnosis and treatment. As professionals in the field, we are committed to delivering high-quality assessments and treatments for Adult ADHD in both the NHS and the private sector.

However, it is crucial to foster a constructive dialogue involving patient-led groups, ADHD experts, politicians, NICE, NHS commissioners, and independent organisations to holistically improve ADHD services, both within the NHS and the private sector. Together, we can strive for positive changes and better support for individuals with ADHD.