This article is featured in ABC News and is republished with permission.
It has been almost two years since Kaycee-Anne Mabbott was referred to a specialist for an assessment for attention deficit hyperactivity disorder (ADHD), and she is still waiting for an appointment.
The Queensland mother was told she may be able to speed up the process by following up and asking to be placed on the cancellation list, but she said she found it too hard.
"Having to make phone calls … can be really difficult especially when you can't focus on those tasks all the time," she said.
She will be able to see a specialist general practitioner from December 1, with Queensland becoming the first jurisdiction in Australia to allow GPs to diagnose ADHD in adults and prescribe treatment.
Ms Mabbott said it would make sense to be able to go and see her GP of 17 years who knows her and her family well."I think that having her on board … she will definitely be able to point me in the right direction," she said.
For many years, specialist GPs in Queensland have been able to diagnose ADHD in children aged four to 17-years-old. They will not be required to undertake specific training once that expands to include adults.
A specialist GP is a doctor who has completed three years of supervised training in a GP setting and has passed exams in an accredited general practice training program.
However, the absence of specific training has raised concerns for some health professionals.
Reforms to remove 'red tape'
Brisbane-based GP Dr Aaron Chambers said the changes would make it easier for children who have a diagnosis and treatment plan once they turn 18.
This is because they will no longer need to be referred back to a psychiatrist and seek regulatory approval to continue their treatment.
"It is great news for patients and it is really going to massively remove red tape and regulatory road blocks so they can get access to the care they need," he said.
However, Dr Chambers, who is the chair of the Royal Australian College of General Practitioners (RACGP) Queensland eduction committee, said it would not mean that "you are going to be able to call up your GP and they will just prescribe you medication".
"If you are curious as to whether you've got ADHD, and you want to get an assessment, that is a much deeper discussion," he said.
Dr Chambers said several steps would be taken, which could include seeing a psychologist and psychiatrist.
"It depends on the complexity of the condition and the skills of the GP as to whether they take over the entire management of that or they work in collaboration with a specialist colleague," he said.
"GPs are very good at knowing where their own personal scope of practice lies, and they work collaboratively with colleagues."
He said despite there not being a specific training requirement as part of the expanded remit, all GPs underwent annual professional development and were constantly updating their professional skills and knowledge.
"I think there are legitimate concerns around over diagnosis but GPs are experts in ... knowing when to get another specialist involved in order to validate a diagnosis," he said.
Different levels of training required
At a meeting in September, the country's health ministers endorsed the need for a national approach to ADHD diagnosis and prescribing practices, but currently each state and territory is taking different steps.
Last week, the NSW government said more than 2,900 patients with an existing diagnosis had filled scripts through a trained GP after changes came into effect in September.
Training programs for GPs are being rolled out in Western Australia and South Australia in diagnosing and initiating treatment, while the ACT opened expressions of interest earlier this year for a pilot program.
Australasian ADHD Professionals Association president and psychiatrist David Coghill said he was "very disappointed" that in Queensland the changes would not coincide with rolling out specific training.
"Everybody who manages a new health condition needs to be able to be trained in assessing, diagnosing and managing and supporting people with that condition," he said.
"People often need other types of support, not medication support, but psychological and therapeutic support to help them manage."
Professor Coghill said the rise in awareness of the condition had also come with "social media pressure" for people to consider whether ADHD was "contributing to challenges that they have".
"The task for people assessing ADHD is both to make sure that we recognise when someone does have ADHD … but also that we can recognise when someone's presenting with something they might think is ADHD but actually is better explained by other difficulties," he said.
He said once GPs were trained they would be able to provide good ongoing support for some cases and refer to specialists when needed.
"What's going to be important though is making the links between the GPs and the other specialists," Professor Coghill said.
Australian Psychological Society chief executive Dr Zena Burgess said while she welcomed the focus on improving support for patients, it was important the role psychologists played in the assessment, diagnosis and ongoing treatment of ADHD was not overlooked.
"We believe a collaborative model — where psychologists provide assessment, diagnosis and psychological treatment and GPs oversee medication — would provide a sustainable and effective solution," she said.
The position of the Royal Australian College of Psychiatrists is that the expanded role of GPs in diagnosing ADHD in adults needed to come with mandatory accredited training and professional development.
The group said that comprehensive assessments must reflect the "time and depth required", which is often up to one to two hours.
"This depth of assessment is essential to avoid both over-diagnosis and under-diagnosis, and ensures appropriate, safe, evidence-based treatments, including the safe prescribing of stimulant medication," their position statement read.
Diagnosis 'life-changing'
Ms Mabbott's sister and business partner Angie Casella was formally diagnosed about 18 months ago and said it had been "life-changing".
"I feel like it helped me gain control of some of the things I had lost complete control of in my life," she said.
It was a long and costly process for Ms Casella, with appointments with various specialists taking about eight months and leaving her about $1,500 out of pocket.
She said while she was supportive of the move to expand the remit of GPs, she was concerned that some patients may expect medication to be a quick fix.
"For me, I sought out a diagnosis because I had reached that crisis point, and I really felt like there was no other alternative other than to try medication," she said.
"It is not the be all and end all – it's one thing that you need to put in your toolbox."