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 inequalities, according to researcher Max Loomes, who urges healthcare policymakers to consider health equity when implementing new policies.
Max Loomes writes:
Over the last year, state health departments have moved to enable GPs to receive specialized training in identifying and treating ADHD. This reform has been celebrated by those awaiting diagnosis and the Royal Australian College of General Practitioners (RACGP), the accrediting body.
Since mid-2025, Western Australia, South Australia, NSW, and Victoria have all announced funding for GPs who nominate for the training.
For those with ADHD, this news may provide reassurance and the belief that they will have greater access to medical and non-medical treatment for this often-debilitating condition.
However, from a public health perspective, this shift may actually further entrench inequality, where access to healthcare is driven by postcodes and socio-economic status.
Treatment Trends
ADHD is a developmental condition where individuals struggle with attention, hyperactivity, or both. People diagnosed with ADHD have difficulty with everyday activities, like organization and sustained focus on tasks, as well as a feeling of restlessness or impulsivity.
Currently, ADHD is also categorized under neurodivergence, an approach to understanding mental health that highlights the many strengths of people with this condition.
Despite this, moderate to severe ADHD can significantly affect people's social and emotional well-being through increased rejection sensitivity and lower emotion regulation. Untreated ADHD can also lead to other concerns, including the tendency towards reward-seeking behaviors, potentially leading to dangerous activities and addiction, as well as higher levels of incarceration than for those without a diagnosis and treatment.
The spotlight on ADHD in mental health and psychiatry is due to a reported substantial increase in diagnosis rates over the past few decades, and an expansion of private services offering fast-track diagnosis.
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 is attributed to the evolution of diagnosis, shifting from diagnostic criteria biased towards young boys to a broader approach considering gender and age differences.
For many, this has given access to life-altering medications, like lisdexamphetamine and dexamphetamines, which have significantly improved their quality of life.
For others who do not require medication, it has explained lifelong patterns of disorganization, difficulties with task completion, or feelings of inadequacy and shame. It has also helped address anger, restlessness, and feelings of difference.
Postcode Inequality
While improved access to medical treatment is generally good for health equity, in this case, an increase in GPs undertaking ADHD diagnosis might fail to address structural inequity.
A recent study has identified a growing 'postcode inequality' pattern in how psychiatric medications on the pharmaceutical benefits scheme (PBS) are prescribed, including ADHD medications. In wealthier areas of Australia, medication prescriptions for ADHD have increased tenfold, possibly because more affluent families have better access to healthcare, whereas there’s been a relative reduction for lower-income families.
This difference is also attributable to the gradual privatization of psychiatrists within the healthcare system, especially given the exodus of psychiatrists from the public health system due to perceived underpayments and the ever-increasing cost of psychiatric appointments, historically essential to ADHD diagnosis and treatment, which can cost upwards of $800 for an initial consultation.
Even with some GPs able to prescribe and treat ADHD, financial constraints of visiting medical professionals repeatedly ultimately preclude people with limited financial resources, allowing only those who can afford it the means to have their child supported.
Furthermore, with some ADHD medications in short supply globally, those in regional and remote areas of Australia will find it more difficult to fill prescriptions, with limited pharmacy access, regardless of whether they have access to a prescribing GP.
Role of GPs
The reforms allowing GPs, with the appropriate training, to diagnose and treat ADHD are an example of task sharing, where actions or activities within the healthcare system are redistributed to other professionals to increase accessibility or navigate resource shortages.
Many within the sector have applauded this move, given that GPs already act as gatekeepers to psychiatric care and often have close, long-term continuation of care with many of their clients. General practitioners play an important role in trying to break down the shortage of psychiatrists and financial constraints.
However, the issue again lies with postcode inequity. Instead of this geospatial difference just affecting access to medication, it also affects GPs' work conditions, with GPs in rural or lower SES areas typically overworked, underfunded, and more likely to bulk-bill.
Doctors in these areas are less likely to find time to do the 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 be provided the capacity to do the training.
I implore healthcare policymakers and executives rolling out these initiatives to consider a health equity approach. Under-serviced communities, both rural and metropolitan, should be directly provided with this kind of targeted funding instead of it being offered equally around the states.
Additional support for these doctors should also be given, such as paid compensation or flexibility in the way in which the training is done.
Funding must be prioritized for these areas so that equity can be achieved and act as a preventative measure for 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 worked in psychological and mental health research for over eight years at several institutions, including the University of Sydney, UNSW, and St Vincent’s Hospital.
See Croakey’s archive of articles on health inequalities.
