Psychiatrists warn shortcuts in diagnosis and prescribing could do more harm than good, highlighting the need for structured, clinically informed reform.
Governments are moving so fast to overhaul ADHD care they risk compromising patient safety and diagnostic accuracy, Australian psychiatrists have warned.
In a position statement released today, the Royal Australian and New Zealand College of Psychiatrists (RANZCP) said sudden moves toward GP-led ADHD assessment and prescribing, coupled with heated public debate and inconsistent rules across jurisdictions, have created an environment where pressure for speed is beginning to eclipse the need for robust, clinically informed care.
RANZCP president Dr Astha Tomar said ADHD had become one of the most high-profile and publicly contested areas of mental health and that recent proposed changes risk becoming reactive “bandaid” solutions for a mental health system already in deep crisis.
“Sudden changes across several jurisdictions, intense public debate, and inconsistent and rapidly shifting prescribing arrangements have created uncertainty for patients, families and clinicians,” Dr Tomar said.
“ADHD is not an isolated problem. It is a symptom of a much deeper system failure.”
The college’s position statement release comes just days after Queensland health minister Tim Nicholls told the RACGP’s national conference that from 1 December, specialist GPs in the state would be able to “initiate, modify and continue to prescribe psychostimulant medication for the treatments of adults with ADHD”.
The current rules only allow GPs to prescribe psychostimulant medications to people with ADHD under the age of 17; adults with ADHD must access psychostimulant prescriptions from a specialist psychiatrist.
RACGP Queensland chair Dr Cath Hester told media at the time that the change to allow GPs to prescribe for their adult patients was “a very natural, very safe progression”.
There were no additional training requirements, she said, because many GPs already provide ADHD care to paediatric patients.
Dr Tomar said major national reports released in recent weeks including the AMA Mental Health Report Card and the Productivity Commission’s latest analysis point to a mental health system that is profoundly overstretched and unable to meet escalating community need.
“The community’s need for timely ADHD assessment and treatment is real, but so too is the need for coordinated, clinically informed reform across the broader mental health system. ADHD is exposing the fault lines in how we deliver care, reminding us that solutions must strengthen the whole system, not just one condition,” Dr Tomar said.
“The sharp rise in brief patient assessments, growing rates of self-diagnosis driven by social media, and rapidly escalating stimulant prescribing have raised legitimate concerns among clinicians, patients, carers and families.
“Reforms cannot prioritise speed over safety. When shortcuts in assessment become normalised, patients are the ones who bear the consequences.
“Without thorough evaluation, it is too easy to miss mood and anxiety disorders, trauma related symptoms, autism or other neurodevelopmental needs, and substance use issues. These factors can completely change the diagnosis, require different treatment approaches, or make stimulant use unsafe.
“Safe ADHD care depends on comprehensive, clinically informed assessments that look at the whole picture.”
According to the Australian Institute of Health and Welfare, the rate of Australians dispensed ADHD medications has increased 11-fold over the past two decades, with adult prescribing growing most rapidly, particularly among women.
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Safe prescribing required diagnostic confidence, complexity management, and ongoing monitoring, said the RANZCP.
The position statement, Safe, comprehensive, and equitable ADHD care, was developed through extensive member input, provides guidance for safe and equitable ADHD care and a roadmap for governments.
Key to the statement was the position that comprehensive assessment was essential.
“The RANZCP affirms that accurate diagnosis of ADHD requires a comprehensive psychiatric assessment,” the statement said.
“This includes a developmental and biopsychosocial-cultural history, exploration of mood, anxiety, psychotic and trauma-related symptoms, evaluation of learning difficulties and neurodevelopmental conditions; assessment of substance use and physical health contributors; and careful consideration of social determinants of health.
“Collateral information from family, teachers, or others is often essential. Functional, social, and occupational impacts must also be evaluated and integrated into a diagnostic formulation.
“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. Errors in diagnosis, whether through insufficient assessment or mislabelling, pose significant risks to individuals and to health systems.”
Improved access to psychiatric services depends on structured shared-care models across public and private health systems in which psychiatrists or paediatricians confirm diagnosis, assess comorbidities, and develop treatment plans, the statement noted.
“GPs and other clinicians should manage stable cases within their scope of practice, while complex or high-risk presentations remain under specialist oversight, with clear referral and escalation pathways,” it said.
“The RANZCP supports expanded GP roles with mandatory accredited training and CPD including modules in comprehensive psychiatric evaluations, in which ADHD assessments sit, as well as appropriate governance structures, and specialist access pathways being in place.
“Comprehensive assessments must reflect the time and depth required, often up to one-two hours, and avoid over-medicalising distress driven by environmental, educational, relational or social stressors.”
Stimulant medications should be prescribed only after a full biopsychosocial assessment and thorough discussions with patients and carers about non-drug and non-stimulant treatment options.
“While stimulant medications can be highly effective, they carry known risks, including appetite suppression, sleep disruption, cardiovascular complications, potential misuse, diversion or dependency, and exacerbation of underlying psychiatric conditions such as anxiety, mania or psychosis and related symptoms,” the statement said.
“Given the rapid rise in stimulant prescribing, initiation should occur only when diagnostic confidence is high. Specialist involvement is necessary for complex presentations, while stable cases may be managed in primary care. Mandating periodic specialist reviews for all cases, as occurs in some jurisdictions, can create unnecessary bottlenecks without demonstrable safety benefit.”
Recommendations from the position statement include:
- Harmonise national prescribing and referral pathways.
- Maintain specialist oversight for complex, comorbid or high-risk presentations.
- Expand GP roles with accredited training, CPD, and robust escalations pathways.
- Recognise that challenges in ADHD care reflect broader systemic failures. Meaningful investment is required in specialist psychiatry, multidisciplinary teams, public mental health infrastructure, including expanded community-based psychiatry clinics, and workforce growth.
- Embed lived-experience voices at all stages of reform, design, implementation and evaluation.
- Invest in a nationally coordinated system to monitor diagnosis patterns, prescribing trends, adverse events, and service utilisation, alongside the impact of recent policy and regulatory changes, to ensure ADHD care remains safe, equitable, and evidence-informed across all jurisdictions.
“Psychiatrists bring specialised expertise in navigating the complexity, comorbidity and clinical risks inherent in many ADHD presentations. The RANZCP supports care models that expand access without compromising diagnostic rigor, safety, or continuity of care,” the statement concluded.
“A nationally consistent, well-governed mental health system – anchored in comprehensive assessment, structured shared care, evidence-based practice and national data collection – is essential to meeting the needs of individuals, families, and communities across Australia and Aotearoa New Zealand.”
