When increased access to ADHD diagnosis is neither fair nor equitable
The push to involve general practitioners in identifying and treating Attention Deficit Hyperactivity Disorder (ADHD) may have unintended consequences and exacerbate existing inequalities, according to researcher Max Loomes, who urges healthcare policymakers to consider health equity when implementing new policies.
Max Loomes writes:
In recent months, state health departments have initiated efforts to enable GPs to receive specialized training in identifying and treating ADHD. This reform has been widely celebrated by those awaiting diagnosis and the Royal Australian College of General Practitioners (RACGP), the accrediting body.
Since mid-2025, Western Australia, South Australia, New South Wales, and Victoria have all announced funding for GPs who wish to undergo this training.
For individuals with ADHD, this news may offer reassurance and the belief that they will have improved access to medical and non-medical treatments for this often-debilitating condition.
However, from a public health perspective, this shift could potentially deepen inequality, where healthcare access is determined by postcodes and socioeconomic status.
Treatment Trends and ADHD
ADHD is a developmental condition characterized by difficulties with attention, hyperactivity, or both. Those diagnosed with ADHD struggle with everyday tasks such as organization and sustained focus, often experiencing restlessness or impulsivity.
Currently, ADHD is categorized under the umbrella of neurodivergence, an approach that emphasizes the strengths of individuals with this condition.
Despite this, moderate to severe ADHD can significantly impact social and emotional well-being, leading to increased rejection sensitivity and reduced emotional regulation. Untreated ADHD may also contribute to reward-seeking behaviors, potentially resulting in dangerous activities and addiction, as well as higher incarceration rates compared to those without a diagnosis and treatment.
The mental health and psychiatry fields have been in the spotlight due to a reported surge in ADHD diagnosis rates over the past few decades, coupled with the expansion of private services offering expedited diagnoses.
News media, including the Financial Review and 9 News, have argued that this new focus has led to an 'overdiagnosis' of young people. However, the increased recognition of ADHD can be attributed to the evolution of diagnostic criteria, which have shifted from gender and age biases to a more comprehensive approach.
For many, this has provided access to life-altering medications like lisdexamphetamine and dexamphetamines, significantly improving their quality of life.
For others who do not require medication, diagnosis has helped explain lifelong patterns of disorganization, task completion difficulties, forgetfulness, feelings of inadequacy and shame, anger, restlessness, and differences in behavior.
Postcode Inequality
While improved access to medical treatment is generally beneficial for health equity, the increase in GPs diagnosing ADHD might fail to address structural inequity.
A recent study has identified a growing 'postcode inequality' pattern in the prescription of psychiatric medications, including ADHD medications, on the Pharmaceutical Benefits Scheme (PBS). Wealthier areas of Australia have seen a tenfold increase in ADHD medication prescriptions, possibly due to better healthcare access for more affluent families, while lower-income families have experienced a relative reduction.
This disparity is also linked to the gradual privatization of psychiatrists within the healthcare system, exacerbated by the exodus of psychiatrists from the public health system due to perceived underpayments and the rising cost of psychiatric appointments, historically crucial for ADHD diagnosis and treatment, which can cost over $800 for an initial consultation.
Even with some GPs able to prescribe and treat ADHD, financial constraints of repeated medical visits ultimately exclude individuals with limited financial resources, allowing only those who can afford it to have their children supported.
Furthermore, with some ADHD medications in global short supply, those in regional and remote areas of Australia will face challenges in filling prescriptions due to limited pharmacy access, regardless of whether they have access to a prescribing GP.
Role of GPs and Task Sharing
The reforms allowing GPs, with appropriate training, to diagnose and treat ADHD are an example of task sharing, where healthcare actions are redistributed to other professionals to increase accessibility or address resource shortages.
Many in the sector have praised this move, given that GPs already act as gatekeepers to psychiatric care and often have long-term relationships with their clients.
However, the issue persists with postcode inequity. Instead of just affecting medication access, it also impacts GPs' work conditions, with rural or lower SES areas typically experiencing overwork, underfunding, and a higher likelihood of bulk-billing.
Doctors in these areas are less likely to find time for training, especially if they work on a pay-per-visit contract. These doctors would benefit the most from the training, but it is more likely that GPs in higher SES areas will receive the necessary capacity to undergo the training.
I urge healthcare policymakers and executives implementing these initiatives to consider a health equity approach. Under-serviced communities, both rural and metropolitan, should receive targeted funding directly, rather than being offered equally across states.
Additional support for these doctors, such as paid compensation or flexible training methods, is also essential.
Funding must be prioritized for these areas to achieve equity and prevent broader psychosocial issues, such as incarceration, drug and alcohol use, and accidental injury.
About the Author
Max Loomes is a clinical psychologist registrar, researcher, and PhD Candidate at the University of Technology Sydney. He has over eight years of experience in psychological and mental health research at institutions including the University of Sydney, UNSW, and St Vincent’s Hospital.
For more articles on health inequalities, visit Croakey's archive (https://www.croakey.org/category/public-health-and-population-health/health-inequalities/).
