ADHD care: A critical issue requiring calm, clinically led reform

In recent months, ADHD has become the most high-profile and publicly scrutinised areas of mental health. Sudden changes across several jurisdictions, intense public debate, and inconsistent and rapidly shifting prescribing arrangements have created uncertainty for clinicians and the community alike.

Major national reports have been released this month, including the AMA Public Hospital Report Card Mental Health Edition 2025 and the Productivity Commission final report- Mental Health and Suicide Prevention Agreement Review.

These Australian-based reports reflect what many of us experience daily in both Australia and Aotearoa New Zealand – a mental health system that is profoundly overstretched, with escalating demand, long waits for access, and growing pressure on already thin specialist services. ADHD is not an isolated problem: it is a symptom of a much deeper system failure.

The demand for ADHD diagnosis and treatment has risen sharply across both Australia and Aotearoa New Zealand and worldwide. New data underscore the scale of this shift. According to the AIHW, the rate of Australians dispensed ADHD medications has increased eleven-fold over the past two decades, rising from 2 per 1,000 people in 2004-05 to 22 per 1,000 in 2023-24. In 2023-24, around 592,000 people (~2% of the population) were dispensed psychostimulants or ADHD-related medications. Prescriptions for psychostimulants (ADHD agents) increased from 99 to 157 per 1,000 population between 2021-22 and 2023-24. Adult prescribing has grown most rapidly, particularly among women, where prescribing rates have increased nearly five-fold in just five years. In Aotearoa New Zealand, dispensing of ADHD medications to adults has increased ten-fold since 2006, with approximately 68,500 people (1.3% of the population) receiving ADHD-related medicines in 2023/24.

The community’s need for timely ADHD assessment and treatment is real. However, the rapid growth of brief or online-only patient assessments, rising stimulant prescribing, and inconsistent rules across jurisdictions have raised legitimate concerns among clinicians, patients, carers and families.

At the same time, many psychiatrists, paediatricians, GPs, psychologists and allied health colleagues are working tirelessly and often in extremely constrained environments to support people seeking care.

In this context, the College has prepared a new RANZCP Position Statement: Safe, Comprehensive, and Equitable ADHD Care.

Our Position Statement clearly emphasises:

1. Comprehensive assessment is essential.
   ADHD cannot be safely diagnosed using brief screening alone. Presentations often overlap with anxiety, trauma, autism, substance use, mood disorders, learning difficulties, sleep disorders and physical health issues. A thorough, developmental, biopsychosocial and culturally-informed assessment – supported by collateral information – is fundamental.
2. Structured shared care must underpin access.
   Psychiatrists and paediatricians should confirm diagnoses and comorbidities and develop treatment plans. GPs and other clinicians can manage stable cases within scope, supported by accredited training, CPD and clear escalation pathways.
3. Stimulant prescribing must be safe and clinically governed.
   Stimulants can be effective but come with known risks including misuse, dependency, sleep and appetite disruption, cardiovascular issues and psychiatric destabilisation. Diagnostic confidence is essential before prescribing.
4. Equity and access remain major concerns.
   Women, First Nations communities, culturally and linguistically diverse populations, rural communities and young people continue to face barriers to care. Commercial diagnosis-only service models undermine safety and erode trust.
5. ADHD pressures reflect a broken mental health system.
   Without meaningful investment in specialist psychiatry, multidisciplinary teams, and community-based services, the current strain will continue across all diagnostic groups and not just ADHD.
6. National leadership and data monitoring are essential.
   We are calling for a nationally coordinated system to track diagnosis patterns, prescribing trends, adverse events, service utilisation and the impact of policy reforms, to ensure care remains safe, equitable and evidence informed.

Our Position Statement reflects the contributions, concerns and expertise of many members. It has been designed to support your clinical practice, assist your advocacy conversations locally and nationally, and provide a stable, evidence-based reference point as changes continue to unfold.

The RANZCP will share the Statement with federal and state governments, peak bodies, lived-experience organisations and media. We will continue to advocate for reforms that expand access without lowering the quality or safety of care, and for national consistency to reduce confusion and fragmentation.

Thank you for your commitment to evidence-based, person-centred psychiatric practice which continues to shape the College’s advocacy and strengthen our collective voice.

Dr Astha Tomar
President