Evaluation of the referral pathway to Irish specialist adult attention deficit hyperactivity disorder services.

Abstract

Objectives: This study aimed to evaluate the general practitioner (GP) referral pathway for adult attention deficit hyperactivity disorder (ADHD) devised by the Irish Health Service Executive's (HSE) National Clinical Programme for Adult ADHD (NCPAA). Primary objectives were to (i) quantify GP referrals to community mental health teams (CMHTs) for adult ADHD screening, (ii) measure workload on CMHTs related to screening adult ADHD referrals without comorbid mental health problems, and (iii) quantify access to adult ADHD screening through CMHTs and subsequent assessment and treatment access through specialist adult ADHD teams.

Methods: An observational cohort design was used to retrospectively analyse ADHD-related referral data collected by clinical staff across 11 Irish CMHTs, and three specialist adult ADHD teams from January to December 2023.

Results: There was high variability in adult ADHD referrals to CMHTs, ranging from 14 to 122 over one year. There was also high variability in the number of referrals seen by CMHTs, ranging from 9 to 82. From 304 referrals seen across 11 CMHTs, 25.3% required initial treatment for another mental health condition. Specialist adult ADHD teams received 3-4 times more referrals than they were able to assess during this timeframe.

Conclusions: The NCPAA has provided crucial services for adults with ADHD in Ireland. However, an increase in neurodiversity awareness and demand for services suggests that a range of referral pathways depending on complexity level may be required. Alternative models are proposed, which require allocation of resources and training through primary care, secondary mental health services and specialist teams.