A new kind of ADHD clinic is cashing in on surging demand for diagnoses — and promising salaries of more than $900,000 to recruit psychiatrists.
Since 2018, prescription rates for ADHD medications in Australia have more than doubled, in parallel with an ongoing diagnosis wave driven by a spike in public awareness.
As the need for services has grown, so have waitlists.
"A lot of psychiatrists have closed their books … because they're just overwhelmed," says Christopher Ouizeman, a director of the ADHD Foundation.
He's noticed a different kind of clinic that's emerged to take advantage of the moment.
"An individual called a clinic, and they were told there's a three- to six-month waiting list, however, if they're prepared to pay $3,000, they can get pushed to the front of the queue.
"In some cases, there's just blatant price gouging and complete exploitation," he says.
Specialists in Australia can set their own fees, and there's no cap.
But unlike in most fields of medicine, adult ADHD patients are stuck in the private sector, because the public system rarely treats the condition except in children.
As a result, patients who might otherwise choose to wait longer for affordable care are being forced to choose between fees as high as $3,000, or no care at all.
There's evidence that those dynamics are also distorting salaries.
The ABC's Schmeitgeist podcast has seen recruitment emails and text messages sent by multiple clinics to external psychiatrists, promising enormous pay.
One company offered salaries exceeding $900,000 a year.
The ABC has also seen offers of "signing bonuses" as large as $20,000.
The scramble to find a doctor
The clinics in question tend to share some key characteristics.
Typically, they only offer telehealth appointments, charge high fees, pay high salaries, and deliver a quick turnaround for patients seeking an ADHD diagnosis.
Anita Wall, a 41-year-old social worker in Melbourne living with ADHD, dealt with a clinic fitting that description last year.
At the time, she was desperate to find a new doctor quickly.
"My psychiatrist who had diagnosed me closed his books," says Anita.
Her two-year permit, a legal requirement for accessing ADHD medication, was due for a review, and Anita found herself scrambling for an appointment to avoid running out.
"[It took] months trying to find another psychiatrist who could then give me my review so that I could access my medications," she says.
Multiple clinics that Anita called had programmed their phones to automatically hang up when a person opted for ADHD services.
"I hit that number and it didn't answer, didn't ring, it just went to nothing… You couldn't even leave a message," she says.
Next, her GP referred her to a new telehealth clinic, which then insisted on doing a new diagnosis.
"I thought, 'Well, hang on a minute. That's not right. I'm not paying for a whole new diagnosis when I'm just after a review'."
She was quoted more than $1,500 for the re-diagnosis process alone.
If Anita had agreed and gone on to complete the treatment plan, the clinic would have collected almost $17,000 in Medicare contributions and out-of-pocket fees for the services of a psychiatrist, a clinical psychologist, a GP, and a dietician.
"It was disgusting … actually cashing in on people's disadvantage, which is just horrific".
"I walked away, and that's when I cried and thought it was hopeless," she says.
In the end, Anita was unmedicated for two months in 2022, because she couldn't get in to an appropriate psychiatrist in time.
"I know that's not long, but it is for somebody that relies on the medication to get up in the morning."
'I thought it was a typo'
The ADHD Foundation's Christopher Ouizeman has been monitoring the trend.
"We're seeing clinics popping up everywhere," he says.
"It's entrepreneurial individuals who have seen a market need and have sought to exploit that need … what they do is they seek to exploit the vulnerable."
"The average seems to be $1,500 to $2,500. $3,000 is certainly at the extreme, but there's a lot of people charging that."
Multiple people interviewed by the ABC had encountered fees at the upper end of that range.
"I thought it was a typo," says Yen, who reports being asked to pay $900 just to secure an appointment, about a year ahead of time.
The appointment itself would have cost more again, and Yen declined.
"$2,500 is a huge amount of money to put on something that I have no idea what it's going to mean and if it's going to be helpful," they say.
Yen still hasn't had an ADHD assessment.
Brandon* opted to pay roughly $2,300 to be assessed by a psychologist, only to learn later he'd need to repeat the process with a psychiatrist, if he wanted access to medication.
"I expected to be able to go down the path of trying some medication, because that's what I was led to believe," he says.
"I think I was in there once or twice, a couple of phone calls… I don't know where the money goes."
When the ABC last spoke to Brandon, he'd approached roughly 20 psychiatry clinics for an ADHD assessment, without any success.
"You're just in no-man's-land," he says.
High fees could influence diagnoses
This new breed of clinic is being watched closely by others in the industry.
"I don't think [these clinics] cover our profession with glory," says David Castle, Professor of Psychiatry at the University of Tasmania, who specialises in ADHD.
Castle warns that high fees have the potential to influence the relationship.
"As they say, if you have a hammer, everything looks like a nail," Castle says.
"You could fall into the trap, if you're not vigilant … of seeing everything as confirming a diagnosis.
"If you are charging a great deal of money, you also have people who almost expect a diagnosis."
Even if the process is completely objective, there are other potential risks.
"I don't think that [telehealth] is the best way to do an initial assessment," he says.
"It doesn't mean that it's not valid, but on a screen … you don't get the same human interaction."
Thorough checks reduce the risk that something important, such as a comorbid condition, will be missed.
"You need to exclude other psychiatric disorders, because you can get into misdiagnosis," he says.
"Some of the treatments, stimulants in particular, can be quite dangerous in people with severe mood disorders, severe anxiety disorders and psychotic disorders, and that all needs to be weighed up."
Castle also points out that clinics such as these are meeting a need, and some people are willing to pay. Overall though, he describes the current situation as "a failing", and says regulating fees might help solve the access crisis.
"Building in a cap on the extra amount that you're allowed to charge, I think, would go a long way towards resolving all this," he says.
"But that will never happen because once people have been used to making a certain amount of money, they're not going to give that up very easily."
Another proposal is to train GPs so they can share the growing ADHD caseload.
ADHD psychiatrist Dr Dianne Grocott ultimately wants to see a subset of credentialed GPs empowered to initiate permits for stimulants.
"If we can get ADHD back into primary care, into the hands of trained GPs, [this] will be a blip in history," she says.
The rules as to who can prescribe Schedule 8 stimulants have traditionally been a controversial topic, but an ongoing Senate inquiry into ADHD is actively considering the question of access to medication.
It's due to report back in September.
What's causing the ADHD wave?
The demand for ADHD services doesn't seem to be slowing down.
Psychiatrists say most of their new patients, especially young women, develop their first suspicions after seeing social media content that's geared for a neurodivergent audience.
That's given rise to two warring narratives seeking to explain this spike.
One side of the debate sees this wave of interest as an out-of-hand TikTok trend, fuelled by a search for identity, attention and meds, or all three.
The other side sees it as the natural consequence of an overdue improvement in the public's understanding of ADHD.
If you boil the argument down, it's a case of overdiagnosis vs catch-up.
The ABC has also been investigating the origins of this wave by looking at both sides of that fight.
"Nobody is watching a 15-second TikTok and being like, 'welp, that's solved, I've got the ADHD'," says Cate Osborn, a popular ADHD educator on TikTok.
Cate posts on multiple platforms under the name Catieosaurus, where the bulk of her audience is women who've had an adult ADHD diagnosis.
"It's such an honour to get emails from people saying that my video was the reason why they ultimately went to go get a diagnosis," says Cate.
She's a proponent of the "catch-up" theory.
"There were so many voices being left out of the conversation … older adults, especially people of colour, trans people," says Cate.
"Then all of a sudden social media happens … And so for 10 years, we've had a place where members of this community can come and they can talk about their own experience.
"And then we start to say, OK, well, if these people are being systematically left out, if there is a bias in the research, what else is getting missed?"
The answer to that question is still emerging. For example, until a decade ago, psychiatry's diagnostic manual, the DSM, ruled out the possibility of a person having both ADHD and an autism spectrum disorder.
Now, the overlap is thought to be at least 20 to 30 per cent.
Is it 'cool' to have ADHD?
At the heart of the counterargument is the claim that there's a social and emotional incentive that's attached to an ADHD self-diagnosis online.
"Suddenly the conversation around ADHD became all at once very normalised, but also very flippant," says Professor Crystal Abidin, a digital anthropologist who studies internet micro-communities, such as the ADHD community on TikTok.
"Anyone and everyone could have a say if they identified with any element of the behaviour on ADHDTok".
Abidin says there is a culture of generosity in some of these online communities, but at the same time, often the usual social hierarchies are inverted.
"ADHDTok … is plagued in this culture where attention and visibility is assigned to people on the basis of competitive one-downmanship," she says.
It's a pattern she says is repeated across social media platforms, where people compete on "who is worse off".
"People who felt that they were at the intersection of multiple marginalities, multiple disabilities or multiple disadvantages somehow emerged as the most authoritative voice."
Put simply, there are corners of the internet where having ADHD, or saying you have it, is a precondition for full acceptance and participation.
On top of that, Abidin points to the way an ADHD diagnosis can seem to promise meaningful solutions to some of life's most intractable problems
"These types of memes that make us self-diagnose can sometimes be a way for us to self-soothe or individualise a lot of the challenges we are facing as a society," she says.
She describes it as the thought that "maybe I have an illness or a condition, maybe that's why I'm not fitting in to 'mainstream society' ".
Whether those incentives are powerful enough to meaningfully drive the enormous increase in people seeking ADHD assessments is less clear.
Cate Osborn knows not everyone who diagnoses themselves with ADHD online will get it right, but she doesn't see it as a problem.
"What we're really saying is more people are asking for help," Osborn says.
"Sometimes those people are right … but sometimes they might be dealing with … depression and anxiety and, you know, PTSD or something like that.
"Learning through social media, learning through independent research is just allowing you the opportunity to really focus on yourself."
The question is what happens when inaccurate self-diagnosis meets the clinics where, as Castle puts it, hammers see nothing but nails.
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