Beyond the silo: Single-disorder ADHD clinics and the case for more integrated care
Soumitra Das, Seshadri Sekhar ChatterjeeObjective
The rapid growth of ADHD assessment and prescribing in Australia reflects a gap between demand and service availability. Workforce shortages, restrictive stimulant regulations and limited adult ADHD care within public mental health services have contributed to this gap. ADHD-focused clinics have emerged in response. Using two de-identified clinical scenarios, this paper examines the drivers of this model and its potential harms.
Conclusion
Focused clinics can improve access and provide expertise. However, a narrow scope and fee-for-service model may also encourage transactional and fragmented care. We describe this risk as organisational iatrogenesis. Potential harms include incomplete formulation, uncoordinated prescribing and missed psychiatric, neurodevelopmental or neurocognitive comorbidity. Broader concerns include inequity, cost, discontinuity of care and erosion of generalist skills. The solution is not to restrict focused practice, but to integrate it more effectively with mainstream care. Priorities include nationally consistent prescribing rules, stronger shared-care arrangements with general practitioners, greater adult ADHD capacity within public services and clearer standards for scope-restricted practice. These issues are also relevant to other single-disorder models of psychiatric care.