Harley Mind care Psychiatrists
child/Adolescent ADHD

No	Description
1	Many GPs currently show hesitancy in accepting shared care agreements, even those involving patients referred under the NHS Right to Choose scheme. This often highlights a disparity in accepting follow-up and aftercare arrangements between private entities' physical and mental health services.
2	I would advise anyone considering private assessments to discuss these possibilities with their GP beforehand. This ensures that you are fully informed about potential outcomes regarding shared care arrangements.
3	Many GPs currently show hesitancy in accepting shared care agreements, even those involving patients referred under the NHS Right to Choose scheme. This often highlights a disparity in accepting follow-up and aftercare arrangements between private entities' physical and mental health services.

No	Description
1	Please visit our website at www.harleymindcare.com
2	Select Book an Appointment.
3	Choose ADHD Consultation.
4	Select Child/Adolescent ADHD Assessment – Virtual.
5	Click Next.
6	Choose a Dr from the list of available doctors.
7	Select a date and time that works for you.
8	Complete the payment process.

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What is a Psychiatrist?

A psychiatrist is a medical doctor who specialises in the diagnosis, treatment, and prevention of mental illnesses. Psychiatrists have completed medical school and additional training in psychiatry. They can prescribe medication, conduct physical examinations, and order lab tests. What Can Psychiatrists Do?

• Diagnose mental health conditions.
• Prescribe medications.
• Provide psychotherapy (though not all do).
• Conduct physical exams and order tests.

What Psychiatrists Cannot Do:

• Provide long-term psychotherapy sessions in the same depth as psychologists or psychotherapists, due to their primary focus on medical aspects.

What is a Psychologist?

A psychologist is a professional who studies the mind and behaviour. They often hold a doctoral degree (PhD or PsyD) in psychology. Psychologists are trained in psychological testing, assessment, and therapy. What Can Psychologists Do?

• Conduct psychological assessments and tests.
• Provide psychotherapy (cognitive-behavioral therapy, psychoanalysis, etc.).
• Develop treatment plans for mental health issues.
• Conduct research and teach at academic institutions.

What Psychologists Cannot Do:

• Prescribe medication (except in a few jurisdictions with additional training and licensure).
• Perform medical exams or order medical tests.

What is a Psychotherapist?

A psychotherapist is a general term for professionals trained to treat mental health issues through therapy. This term can include psychiatrists, psychologists, social workers, counsellors, and other trained professionals. The specific qualifications can vary widely. What Can Psychotherapists Do?

• Provide various forms of psychotherapy (talk therapy, cognitive therapy, etc.).
• Help clients understand and manage mental health conditions.
• Work in various settings, including private practices, hospitals, and community centres.

What Psychotherapists Cannot Do:

• Prescribe medication (unless they are also psychiatrists).
• Perform medical exams or order lab tests (unless they have additional medical training).

Comparing Roles: What Each Can and Cannot Do

Prescribing Medication:

• Psychiatrists: Yes
• Psychologists: No (except in special cases)
• Psychotherapists: No

Conducting Therapy:

• Psychiatrists: Yes, but often limited
• Psychologists: Yes, extensively
• Psychotherapists: Yes, extensively

Performing Medical Exams:

• Psychiatrists: Yes
• Psychologists: No
• Psychotherapists: No

Conducting Psychological Testing:

• Psychiatrists: Sometimes
• Psychologists: Yes
• Psychotherapists: Sometimes (depending on qualifications)

By understanding these distinctions, patients can make more informed decisions about which mental health professional may best suit their needs.

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Requirements for Adult ADHD Assessment

No	Requirement	Brief Description
1	Blood Pressure, Pulse Weight and Height Form	Records vital statistics of the patient.
2	ADHD Self-Report Scale Symptom Checklist	A self-assessment tool for ADHD symptoms.
3	Adult ADHD Informant Report	A report filled by someone who knew the patient before they were 12.
4	ADHD Cardiac Health Questions	Assesses the cardiac health of the patient.
5	Wender Utah Rating Scale for ADHD	A psychological test that assesses ADHD symptoms.
6	ADHD Self-Report Scale	Another self-assessment tool for ADHD symptoms.
7	PHQ9 and GAD7	Standardised self-report scales for identifying depression and anxiety.
8	Upload the patient's ID and proof of address from the last 3 months.	Verifies the identity and current address of the patient.

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Requirements for Child/Adolescent ADHD Assessment

No	Requirement	Description
1	Blood Pressure, Pulse Weight and Height Form	Records vital statistics of the patient.
2	Conners 4 - Parent Form Response	This is completed online by a teacher who knows the patient.
3	Conners 4 - Teacher Form Response	This is completed online by a teacher who knows the patient.
4	Conners 4 - Self-Report Form Response	This is completed online by the patient.
5	Childhood Behaviour Scale - Self-Report	A self-assessment tool.
6	Upload the ID of the parent/guardian and Proof of Address in the last 3 months	Verifies the identity and current address of the patient's parent/guardian.
7	Upload the ID of the Patient.	Verifies the identity of the patient.

Private care offers several advantages over NHS pathways for ADHD Assessments. These include quicker diagnosis and treatment, more scheduling flexibility, and personalised care options. However, the initial costs of private care are higher, and NHS coverage may vary depending on GP cooperation.

One of the significant challenges with NHS pathways is the long waiting times for ADHD assessments. As per a report from October 2023¹, there are significant variations in waiting times across the country. For children, the waiting time varies from 5 weeks to a devastating 5 years. For adults, the variation is equally stark – it varies from 12 weeks to over 10 years¹.

Consultation Type	Pros	Cons
Virtual Consultations	Convenience: Can be done from the comfort of your home. Efficiency: Ideal for initial assessments and follow-ups.	Limited Scope: Connection problems, software glitches, or hardware failures can disrupt or even prevent virtual meetings, causing frustration and delays.
In-Person Consultations	Comprehensive: Allows for a thorough evaluation. Personalised: Can be tailored to your preferences.	Less Convenient: Requires travel and scheduling time.

An ADHD Medication Review is a comprehensive process to evaluate and optimise your current ADHD treatment plan. Whether you or your child are new to our clinic or transitioning care from another provider, this review ensures that medication and treatment align with your current needs and health goals.

Here are the key aspects of our ADHD Medication Review process:

1. Process of Transfer of Care:
   • We will need the original diagnostic report and any existing medical records from your current healthcare provider, including any records from your GP.
   • After reviewing these documents, a virtual assessment with one of our psychiatrists will be scheduled.
   • During this assessment, we will evaluate your current treatment plan, including the medication you are using, and determine whether any adjustments are necessary, depending on availability and suitability.
2. Costs:
   • The ADHD medication review, including the first prescription, costs £300.
   • We partner with CloudRx, a pharmacy that provides real-time updates on available medications, especially amid the current global shortage of ADHD medication.
   • Please note that Harley Mind Care has no financial interest in any medication purchased through CloudRx.
3. Timeline:
   • We understand that ADHD treatment is time-sensitive. Once we receive the necessary medical reports, we can schedule an appointment as soon as possible to prevent delays in care.
4. Next Steps:
   • To book an appointment for an ADHD medication review, visit our website at www.harleymindcare.com and follow these steps:
     • Select "Book an Appointment."
     • Choose "ADHD & Autism Consultation."
     • Select "Adult Medication Assessment – Virtual."
     • Pick a convenient date and time with one of our psychiatrists.
     • Complete the payment process online.

If you have any questions or need further assistance with booking, please feel free to contact us. We are here to support you and ensure your ADHD treatment continues smoothly.

No	Description	Cost	Time
1	A virtual Child/Adolescent ADHD assessment 1. This includes a full report, including diagnosis and treatment plan. 2. The first free medication prescription. 3. A free Shared Care Agreement with your GP (if required).	£1,245	60-90 Mins
2	Following diagnosis, medication titration involves follow-up consultations costing. £150 - £325 per 15-minute session. Titration can last between 8 and 12 weeks and potentially require multiple visits, depending on your response. to the medication. Our goal is to complete this process as quickly and safely as possible.	£150 - £325	15 Mins
3	ADHD medication, being a controlled substance, requires a monthly prescription. If the patient isn’t transferred to the NHS under a shared care agreement, there will be an approximate monthly cost of £45 per repeat prescription.	£45 per month
4	According to the NICE guidelines, the treatment response for all ADHD drugs should be reviewed every 6 months at £590 per 30-minute session. (This review includes a comprehensive assessment of clinical needs, benefits, and side effects, taking into account the views of the patient and carers, the effect of missed doses, planned dose reductions, and brief periods of no treatment.)	£590 every 6 Months	30 mins

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Once you have subscribed to our secure portal at Harley Mind Care, you will have access for life. We will provide the following services.

No	Type	Patient Portal Lifetime benefits
1	Patient Portal	You will have access to view and upload documents, billing activity, reports, and Educational resources (see below)
2	Automated Reminders	We will send out automated reminders for appointments, questionnaires, and 6-monthly reviews.
3	Educational Resources	We will upload educational videos on managing ADHD and pamphlets to assist you in things like monitoring your blood pressure and other health-related matters.
4	Communications	Portal, Email, Telephone, WhatsApp, Telegram and Messenger.

Medication Titration: Understanding the Process

No	Description
1	Medication titration for ADHD is a personalised process designed to identify the most effective medication and dosage for each individual. This process begins once a treatment plan has been agreed upon. When starting on new controlled drugs for ADHD, the medication titration process is crucial.
2	The titration period is characterised by a series of regular, brief follow-ups with your Consultant Psychiatrist. These follow-ups allow for the monitoring and evaluation of the individual’s response to the treatment.
3	Titration involves gradually adjusting the dosage of the medication to find the most effective dose with the fewest side effects. This process requires close monitoring and communication with your Consultant Psychiatrist.
4	Given the unique nature of each individual’s response to medication, it’s challenging to predict the exact number of follow-ups required. Typically, this process involves between 3 to 5 follow-ups, but this can vary based on the individual’s response.
5	Titration can last between 8 and 12 weeks and potentially require multiple visits, depending on your response. to the medication. Our goal is to complete this process as quickly and safely as possible.
6	It’s important to note that General Practitioners (GPs) often review the frequency and number of these follow-ups before accepting a Shared Care Proposal. If they find the titration process unsatisfactory, they have the right to decline to take over the care on the NHS.

Initial Dosage and Adjustment:

No	Description
1	It’s important to note that when medication is started, sometimes the dosage could be too low to have an effect. It is crucial to let the doctor know as soon as possible - perhaps after 3 or 4 days. This will allow for timely adjustments and ensure the effectiveness of the treatment.
2	Many patients report feeling a sense of clarity and improved organisational skills once the medication reaches an optimal level.

Target Symptoms of ADHD Medications

ADHD medications aim to improve several core symptoms:

No	Type	Description
1	Inattention	You may notice an increase in your ability to focus, concentrate, and complete tasks.
2	Hyperactivity	There might be a reduction in excessive movements and fidgeting.
3	Impulsivity	You could experience better control over your actions, emotions and a decrease in impulsive behaviours.

Potential Side Effects and What to Watch For

While ADHD medications can be highly effective, they can also cause side effects. It's important to be aware of these and report them to your Consultant Psychiatrist

Common Side Effects

No	Description
1	Appetite loss
2	Insomnia
3	Dry mouth
4	Headaches
5	Stomach-aches

Less Common, but Serious Side Effects

No	Description
1	Increased heart rate or blood pressure
2	Mood changes, including increased irritability, anger or nervousness
3	Small increase risk of psychosis & or tics

Monitoring Emotional Changes

It's important to monitor for any changes in mood or behaviour, especially during the initial titration period. Some patients may experience an increase in anger or irritability. Loved ones should be aware of this possibility and provide support and understanding during this time.

Tips for Managing Side Effects

No	Description	Action
1	Appetite loss	Eat smaller, more frequent meals, and opt for nutrient-dense foods.
2	Insomnia	Maintain a consistent sleep routine, avoid caffeine in the afternoon and evening, take your ADHD medication early in the morning so that it wears off by the evening and create a relaxing bedtime environment.
3	Dry mouth	Drink plenty of water, chew sugar-free gum, or use over-the-counter saliva substitutes.
4	Headaches	Ensure proper hydration, take breaks from screens, and use over-the-counter pain relievers if needed (after consulting with your Consultant Psychiatrist).
5	Stomach-aches	Take medication with food and avoid spicy or greasy foods.

Requesting a New Prescription

No

Description

1

To ensure a seamless continuation of your treatment, please request any new prescription at least 7 days before your current medication supply runs out. This time frame allows your Doctor to thoroughly review your current treatment's effectiveness, discuss any necessary adjustments or alternative options, and then issue and send the new prescription. This process ensures that the pharmacy has adequate time to dispense your medication, preventing any gaps in your treatment.

Communicating with Your Consultant Psychiatrist

Regular follow-up appointments are essential during the titration process. Keep a journal of your symptoms, side effects, and any changes in behaviour. Share this information with your healthcare provider to help them adjust your dosage effectively. 

Support from Loved Ones 

Inform your family and close friends about the potential for mood changes, such as increased irritability or anger. Their understanding and support can be invaluable during this period. Encourage them to be patient and provide a calm, supportive environment.

Final Thoughts

Starting new controlled drugs for ADHD can be a transformative experience, leading to significant improvements in attention, focus, and overall functioning. However, the titration process requires careful monitoring and communication with your Psychiatrist. By understanding potential side effects and seeking support from loved ones, you can navigate this period more smoothly and achieve the best possible outcome.

If you have any concerns, contact your Psychiatrist.

If you experience severe side effects or a rash, contact emergency services immediately and stop your medication. Your safety and well-being are the top priorities. Your Psychiatrist can explore other alternatives with you.

Our clinic issues prescriptions, which are filled by external pharmacies. Each order incurs a separate charge from the pharmacy, providing you with the most effective and current medications. Rest assured that our clinic has no financial incentives tied to your medication purchases.

• While psychologists are experts in diagnosing mental health conditions like ADHD, they are not medical doctors. Therefore, they cannot prescribe medication.
• Psychiatrists are medical doctors who can prescribe medication. If a psychologist diagnoses you with ADHD, you will need an assessment by a psychiatrist to discuss medication options.
• The NHS shared care agreement requires a psychiatrist’s report to continue medication. This ensures that your treatment is monitored and adjusted as necessary by a medical Doctor.