IT is not an issue that Jersey is alone in – overwhelming pressures on ADHD services – with long waiting times for diagnostic assessments, inability to access medication and insufficient support systems.
But the problem is not going anywhere, and the question is, will the next government commit to tackling the issue head on, and if so, what needs to be done?
Rachel Boss, the founder of the not-for-profit ADHD Jersey, says the government needs to look at the bigger picture, as it affects many aspects of people’s lives.
She said: “The NHS England Taskforce has made the same point nationally – it cannot be treated as a health issue alone – it affects education, employment, health, family and the criminal justice system.”
Importantly, she added: “Jersey does not need another report to prove there is a problem. The question now is what candidates are prepared to do about it”.
The issue raised time and time again, is that this will cost money, something that is difficult to find during times of tight budgets.
The cost of inaction
THE way in which waiting times and prescribing issues have knock-on costs to schools, families and the labour market, were laid bare in an article Ms Boss wrote.
It estimated that ADHD has a socio-economic cost of £38m per year under a conservative analysis, and one more than twice as big – £86m – when wider unmet needs are considered.
The figures, Ms Boss explained, are based on estimated cost of things such as the impact on the economy of a parent having to leave their job to support a child unable to go to school.
The direct public-systems costs were estimated to be £9.5m in the conservative model and £21.6m in the wider one, in large part towards education and special educational needs, with “smaller but material” health, social care and justice components.
In her conclusions, Ms Boss cited a wide variety of evidence, including UK data to make estimations, adding: “The analysis also demonstrated that waiting times and prescribing governance constraints are not only operational issues.
“They are foundational economic drivers because they extend periods of unmanaged impairment and displace costs onto schools, families and the labour market.”
Ms Boss said is should not fall on her or her team at ADHD Jersey to take responsibility to tackle the issues alone, as the organisation is “run on volunteers, public generosity and good will” which is “not a long-term answer”.
Health
THE “single most important action” the government could take right now, she said, is adding ADHD medication to the Island’s prescribing list and implementing GP shared prescribing.
Shared prescribing is when a primary care doctor takes on the responsibility for prescribing ADHD medication after a patient has stabilised onto a medication through secondary care.
“This one move would free up psychiatrists and specialist staff almost immediately,” she said. “At the moment, too much specialist time is being used to review and maintain prescriptions for people who are already stable, instead of assessing new patients, supporting complex cases, and helping children and adults currently stuck waiting.”
However, just a couple of months ago, GPs refused to change their position despite mounting pressures on services when the annual report for the Child and Adolescent Mental Service reignited calls for the introduction of shared prescribing.
At the time, Primary Care Body director Dr Bryony Perchard said that “diagnosis, management and long-term follow-up of neurodivergent children is the role of specialist services”, and that “GPs aren’t trained and do not have resources to deliver this care”.
In response, Ms Boss said: “This is not about asking GPs to replace specialists – it is about using specialists where they are genuinely needed: diagnosis, titration, complex cases, risk, co-occurring conditions and clinical oversight.”
There also needs to be a clear pathway from CAMHS into adult ADHD services as expected by NICE, she added, as “young people should not fall off a cliff when they turn 18”.
It is also vital young people who stop engaging aren’t removed, she added, explaining that “some teenagers refuse help at 16 or 17, then reach a level of maturity later where they understand they need medication or support” and end up back on multi-year waiting lists.
Education and SEND
SCHOOLS in Jersey are “carrying the consequences of a system that is not supporting early enough”, Ms Boss said, while “children waiting for assessments or treatment are still in classrooms every day”.
“If their needs are not understood, they are too often treated as behavioural problems, rather than children who need the right support”, she added – which has a cost.
According to her report, children without a diagnosis, and therefore unlikely to be receiving SEND support, leads to pressures arising in other parts of the education budget, for example in exclusion management, alternative provision measures and behavioral support. This, Ms Boss said, could amount to a cost of £800,000 annually in the conservative model, and £1.5m in the wider one.
She said: “ADHD support still too often depends on crisis, paperwork or diagnosis, rather than need. We need support based on need, not diagnosis.
“SENCos and teachers should not be left trying to hold together the consequences of delays elsewhere in the system. Schools must be part of the solution, but they cannot be expected to replace clinical services.”
There also needs to be “proper transition planning” for older pupils beyond the age of 16, to help them “start work, begin apprenticeships or go to university, because “they don’t stop needing support when they leave school,” she added. “This planning should include executive functioning support, study skills, reasonable adjustments, medication continuity and clear signposting into adult services.”
Social care
It is also important the next government provides better support for people with ADHD involved with social services, as “families need early help before crisis point”, said Ms Boss.
She estimated that ADHD-related social care costs between “two and five million£2 and £5m per year.
This can arise, she explained, when neurodivergent traits are misinterpreted: “A child in a melt down is not a naughty child, and a parent drowning in appointments is not a difficult parent.
“Many parents of ADHD children are neurodivergent themselves. Missed appointments, disorganisation or being overwhelmed should not automatically be treated as parental failure.
“They may be signs that the whole family needs practical, ADHD-informed support. You cannot shame an ADHD family into being organised. But you can support them early, before things reach crisis point.”
And, she said: “One of the most cost-effective interventions we are not using enough is occupational therapy in the home – helping families with routines, sensory needs, organisation, morning structures and practical daily systems.”
Employment
The next government also needs to look at how they can help support people with ADHD getting into, and staying in, employment.
Ms Boss said: “Many adults are not unable to work – they are unsupported at work.
“Unsupported ADHD can affect timekeeping, organisation, emotional regulation, workload management, burnout and job retention – but with the right understanding and reasonable adjustments, people with ADHD can be highly creative, committed and productive.”
This support she said could be achieved through ensuring employers get “practical neurodiversity training, occupational health pathways that understand ADHD and clear guidance on reasonable adjustments”.
She added that: “Supporting ADHD at work is not just the right thing to do – it protects skills, keeps people in employment and reduces pressure elsewhere in the system.
“The report estimates that indirect costs – including productivity losses and unpaid care – account for the largest share of ADHD’s economic impact in Jersey, estimated at around £28.5 million in the conservative scenario and £64.8 million in the wider scenario.”
Drugs and alcohol
There also needs to be a closer look at the link between substance misuse and ADHD – particularly among those undiagnosed, Ms Boss added.
She highlighted that this association was evidenced by a 2023 meta analysis which estimated that over a fifth of people being treated for substance-use disorder have ADHD.
“That means drug and alcohol services are likely already seeing people whose underlying ADHD has never been recognised – so drug and alcohol services should routinely screen for ADHD and other neurodevelopmental conditions,” she said.
“If we only treat the substance use and miss the underlying ADHD, we risk sending people back into the same cycle without the tools or treatment they need to recover.”
Justice system
The final area that Ms Boss said needs to be addressed is the relationship between ADHD and the criminal justice system.
Research suggests one in four prisoners have it, which she said: “Jersey’s prison costs around £84,000 per prisoner per year. Early ADHD support costs a fraction of that.
“Early screening in police custody, probation and prison would help. But the bigger answer is earlier intervention, long before someone reaches crisis or custody.
“When ADHD is missed in childhood, unsupported in school, untreated in adulthood and misunderstood by services, the consequences show up later: in mental health, unemployment, family breakdown, substance misuse and the justice system.”
