Meeting with a Pro.

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Dr Sharon Brown is a Clinical Psychiatrist working for NHS Highland. Dr Brown has been in post for roughly 18 months, at the time of writing, having made the move from NHS Grampian in 2021. Dr Brown reached out to us, after coming across our Facebook Group, and very kindly offered to give up her own personal time to meet with us for a wee Q&A. Of course, we jumped at the chance to talk with someone working in a diagnostic and treatment role and promptly arranged a time to meet. Dr Brown was generous enough to meet with us on Valentine’s night and we spent a couple of hours discussing the past, present and future of ADHD diagnosis and treatment as it pertains to the Highlands of Scotland.

Dr Brown explored the training she, and many of her colleagues, gained whilst studying and developing their careers as Clinical Psychiatrists. She noted that neurodiversity was not something that was explored in a huge amount of depth, particularly in regard to how it was presented in and impacted on adults. Dr Brown noted that she was fortunate to share a lab with individuals researching ADHD, years ago, and this piqued her interests and offered her further insight that she may not otherwise have gained.

Dr Brown informed us that when she arrived in NHS Highland there was no specific process or system in place for the assessment and/or treatment of ADHD in the Highland. Specifically, she highlighted that each Highland area conducted the management of referrals, assessment and treatment of ADHD in their own way and, depending on where you lived in Highland, your journey could look very different. This offers some explanation as to why many of us have felt though it is a ‘postcode lottery’ when it comes to ADHD diagnosis and support.

Dr Brown explained that she became aware of a grant that was awarded to NHS Highland by the Scottish Government. This grant was provided to support the development of an ADHD pilot pathway. It is important to stress that this is not a large amount of money, however, Dr Brown and her colleagues have utilised what has become available to them and devised an ADHD pathway for people in Highland. This pathway is now in the early stages of implementation and, in order to gain access, a referral must be made through your GP to the Community Mental Health Team that is linked to your area. You can find more information regarding this pathway, including an illustrative flow chart, here.

Dr Brown has advised that this pathway will progress through a phased approach, with us currently being in Phase one. This current phase focuses on diagnosis and treatment through medication. GPs are now being provided with clear guidelines regarding information required for referral, which is anticipated to improve the quality of referrals and decrease delay due to poor referrals.

Once a referral has been received by the Community Mental Health Team that covers your area, and it has the appropriate information, you will then be sent an ‘opt in’, which is a set of documents, including questionnaires, for you to complete and return. At This stage, you may have some time to wait before you will be seen for your first appointment.

Your first appointment is likely to take place through an online video call, however, if you have difficulties with this, you can contact the team and advise that you require an in person appointment. Your first appointment is ultimately an opportunity for you to be assessed by a mental health professional, who will complete a general mental health assessment in which they gather more information about you, review the symptoms and traits you experience, and decide whether ADHD may be a likely condition, or whether other conditions may be worth exploring. You may have a number of sessions with this mental health professional before you are referred for an ADHD assessment.

If it is determined that an ADHD assessment would be required, you will then be referred to a diagnostician for assessment. Who undertakes this assessment will differ, depending on where you live in Highland. However, Dr Brown noted that there is a Nurse Practitioner working alongside her, undertaking up to 10 ADHD assessments per week, in the hopes of working through the current backlog of referrals. During your ADHD assessment, you are encouraged to bring someone along with you, who knows you well and can speak to your experience and offer their own insights and observations. You may also be asked to provide school reports, but do not worry if you no longer have these. You will be informed of the outcome of your assessment at the end of your appointment. Once diagnosed, you will then be referred for a medical assessment, to determine your suitability for medication. It might be worth consulting the information held on the previously linked page, if you have any questions regarding this process.

The focus of phase one of the pathway is to complete as many assessments as possible, in order to address the backlog of referrals. Although this means little support after diagnosis, we agreed with Dr Brown that the validation and opportunity for self acceptance, post diagnosis, means that many of us will be able to move forward from diagnosis in a meaningful way. Dr Brown also acknowledged the work we are undertaking as a service and highlighted that, due to the lack of funding and resources within the NHS, services like ours can prove useful in meeting the needs of the people who are unable to gain additional support through the NHS, at this time.

We discussed with Dr Brown the need for further support after diagnosis and the hopes for the future in regard to treatment methods. Dr Brown noted that the ADHD population in Highland is being let down by the lack of service delivery and it is evident that she shares in our frustration when it comes to what is available to adult ADHDers in terms of support and treatment. However, she highlighted that the service is being built from the ground up and it will take time (and money) to build in the services that are required.

We highlighted to Dr Brown the disappointment we felt regarding the focus in assessing individuals who are seeking medication and noted that some of our Dolls were not interested in medication or were concerned about pursuing medication as a treatment method, due to previous challenges with addiction. It was evident that Dr Brown felt that this was not an ideal situation. However, she did advise that, even if unsure about medication as a treatment plan, people seeking a referal should not be put off by this stipulation, rather, they should be open to the conversations around this. That way, you will not be ruled out of the assessment pathway and will also be able to have a discussion, after diagnosis, and explore your concerns. Dr Brown advised that those with addiction concerns should not be frightened and it is clear that Dr Brown feels that everyone should be supported to make an informed choice regarding medication.

Dr Brown was open to receiving feedback from us and we collected some responses from our Dolls prior to our meeting. We highlighted the lack of transparency as it relates to the assessment process, the difficulty ADHDers can have when faced with what can feel like a huge demand in providing information for referral, and also the fear and intimidation people can have when approaching GPs for a referral.

Dr Brown was disappointed to hear that the process did not appear transparent and highlighted that the resources provided to GP and held within this site, were only very recently shared and she is hopeful this will begin to increase transparency. Additionally, Dr Brown has agreed to include a flow chart in any correspondence relating to an ADHD referral and has intentions to draft a more patient friendly version (when she can find the time!).

In regard to GP referrals, Dr Brown advised that it may be preferable for those seeking a referral to request (or source through your GPs website), the clinical email address that will be assigned to the practice. She stated that it is not always necessary to have an in person or telephone appointment, particularly if that feels too difficult, and she has advised that you could consider gathering the information required for a referral and emailing it to your GP instead. You can find a list of the information required for a referral here.

If you are struggling to gather the information needed, or to complete this task, we intend to run sessions to help with this. Keep an eye on our Eventbrite, Facebook and Instagram accounts as we will announce these sessions here.

We discussed the potential time frames that people could expect to wait from referral to diagnosis. However, as expected, this is a very difficult thing to quantify, as everyone’s experiences and needs will differ greatly. We feel what is important to hold onto is the knowledge that assessment and diagnosis is currently being prioritised in Highland, and you are not being forgotten (although it can certainly feel like this at times, we know!).

We are so very grateful to Dr Brown for approaching us and taking the time to meet with us (especially on the day of love!). We truly appreciated her openness to feedback and willingness to listen and value the opinions of our Dolls. It was evident that Dr Brown and her team have a clear drive to develop a service that meets the needs of our Neurospicy community and we are hopeful that this is the beginning of positive change.

Dr Brown has stated that she would be willing to have a Q&A Session with our Dolls and we will be very excited to facilitate this in the future.

Yours Eclectically Ashley & Isla

Bionic Reading Format

Dr Sharon Brown is a Clinical Psychiatrist working for NHS Highland. Dr Brown has been in post for roughly 18 months, at the time of writing, having made the move from NHS Grampian in 2021. Dr Brown reached out to us, after coming across our Facebook Group, and very kindly offered to give up her own personal time to meet with us for a wee Q&A. Of course, we jumped at the chance to talk with someone working in a diagnostic and treatment role and promptly arranged a time to meet. Dr Brown was generous enough to meet with us on Valentine’s night and we spent a couple of hours discussing the past, present and future of ADHD diagnosis and treatment as it pertains to the Highlands of Scotland.

Dr Brown explored the training she, and many of her colleagues, gained whilst studying and developing their careers as Clinical Psychiatrists. She noted that neurodiversity was not something that was explored in a huge amount of depth, particularly in regard to how it was presented in and impacted on adults. Dr Brown noted that she was fortunate to share a lab with individuals researching ADHD, years ago, and this piqued her interests and offered her further insight that she may not otherwise have gained.

Dr Brown informed us that when she arrived in NHS Highland there was no specific process or system in place for the assessment and/or treatment of ADHD in the Highland. Specifically, she highlighted that each Highland area conducted the management of referrals, assessment and treatment of ADHD in their own way and, depending on where you lived in Highland, your journey could look very different. This offers some explanation as to why many of us have felt though it is a ‘postcode lottery’ when it comes to ADHD diagnosis and support.

Dr Brown explained that she became aware of a grant that was awarded to NHS Highland by the Scottish Government. This grant was provided to support the development of an ADHD pilot pathway. It is important to stress that this is not a large amount of money, however, Dr Brown and her colleagues have utilised what has become available to them and devised an ADHD pathway for people in Highland. This pathway is now in the early stages of implementation and, in order to gain access, a referral must be made through your GP to the Community Mental Health Team that is linked to your area. You can find more information regarding this pathway, including an illustrative flow chart, here.

Dr Brown has advised that this pathway will progress through a phased approach, with us currently being in Phase one. This current phase focuses on diagnosis and treatment through medication. GPs are now being provided with clear guidelines regarding information required for referral, which is anticipated to improve the quality of referrals and decrease delay due to poor referrals.

Once a referral has been received by the Community Mental Health Team that covers your area, and it has the appropriate information, you will then be sent an ‘opt in’, which is a set of documents, including questionnaires, for you to complete and return. At This stage, you may have some time to wait before you will be seen for your first appointment.

Your first appointment is likely to take place through an online video call, however, if you have difficulties with this, you can contact the team and advise that you require an in person appointment. Your first appointment is ultimately an opportunity for you to be assessed by a mental health professional, who will complete a general mental health assessment in which they gather more information about you, review the symptoms and traits you experience, and decide whether ADHD may be a likely condition, or whether other conditions may be worth exploring. You may have a number of sessions with this mental health professional before you are referred for an ADHD assessment.

If it is determined that an ADHD assessment would be required, you will then be referred to a diagnostician for assessment. Who undertakes this assessment will differ, depending on where you live in Highland. However, Dr Brown noted that there is a Nurse Practitioner working alongside her, undertaking up to 10 ADHD assessments per week, in the hopes of working through the current backlog of referrals. During your ADHD assessment, you are encouraged to bring someone along with you, who knows you well and can speak to your experience and offer their own insights and observations. You may also be asked to provide school reports, but do not worry if you no longer have these. You will be informed of the outcome of your assessment at the end of your appointment. Once diagnosed, you will then be referred for a medical assessment, to determine your suitability for medication. It might be worth consulting the information held on the previously linked page, if you have any questions regarding this process.

The focus of phase one of the pathway is to complete as many assessments as possible, in order to address the backlog of referrals. Although this means little support after diagnosis, we agreed with Dr Brown that the validation and opportunity for self acceptance, post diagnosis, means that many of us will be able to move forward from diagnosis in a meaningful way. Dr Brown also acknowledged the work we are undertaking as a service and highlighted that, due to the lack of funding and resources within the NHS, services like ours can prove useful in meeting the needs of the people who are unable to gain additional support through the NHS, at this time.

We discussed with Dr Brown the need for further support after diagnosis and the hopes for the future in regard to treatment methods. Dr Brown noted that the ADHD population in Highland is being let down by the lack of service delivery and it is evident that she shares in our frustration when it comes to what is available to adult ADHDers in terms of support and treatment. However, she highlighted that the service is being built from the ground up and it will take time (and money) to build in the services that are required.

We highlighted to Dr Brown the disappointment we felt regarding the focus in assessing individuals who are seeking medication and noted that some of our Dolls were not interested in medication or were concerned about pursuing medication as a treatment method, due to previous challenges with addiction. It was evident that Dr Brown felt that this was not an ideal situation. However, she did advise that, even if unsure about medication as a treatment plan, people seeking a referal should not be put off by this stipulation, rather, they should be open to the conversations around this. That way, you will not be ruled out of the assessment pathway and will also be able to have a discussion, after diagnosis, and explore your concerns. Dr Brown advised that those with addiction concerns should not be frightened and it is clear that Dr Brown feels that everyone should be supported to make an informed choice regarding medication.

Dr Brown was open to receiving feedback from us and we collected some responses from our Dolls prior to our meeting. We highlighted the lack of transparency as it relates to the assessment process, the difficulty ADHDers can have when faced with what can feel like a huge demand in providing information for referral, and also the fear and intimidation people can have when approaching GPs for a referral.

Dr Brown was disappointed to hear that the process did not appear transparent and highlighted that the resources provided to GP and held within this site, were only very recently shared and she is hopeful this will begin to increase transparency. Additionally, Dr Brown has agreed to include a flow chart in any correspondence relating to an ADHD referral and has intentions to draft a more patient friendly version (when she can find the time!).

In regard to GP referrals, Dr Brown advised that it may be preferable for those seeking a referral to request (or source through your GPs website), the clinical email address that will be assigned to the practice. She stated that it is not always necessary to have an in person or telephone appointment, particularly if that feels too difficult, and she has advised that you could consider gathering the information required for a referral and emailing it to your GP instead. You can find a list of the information required for a referral here.

If you are struggling to gather the information needed, or to complete this task, we intend to run sessions to help with this. Keep an eye on our Eventbrite, Facebook and Instagram accounts as we will announce these sessions here.

We discussed the potential time frames that people could expect to wait from referral to diagnosis. However, as expected, this is a very difficult thing to quantify, as everyone’s experiences and needs will differ greatly. We feel what is important to hold onto is the knowledge that assessment and diagnosis is currently being prioritised in Highland, and you are not being forgotten (although it can certainly feel like this at times, we know!).

We are so very grateful to Dr Brown for approaching us and taking the time to meet with us (especially on the day of love!). We truly appreciated her openness to feedback and willingness to listen and value the opinions of our Dolls. It was evident that Dr Brown and her team have a clear drive to develop a service that meets the needs of our Neurospicy community and we are hopeful that this is the beginning of positive change.

Dr Brown has stated that she would be willing to have a Q&A Session with our Dolls and we will be very excited to facilitate this in the future.

Yours Eclectically
Ashley & Isla