Sphere. And we wanna welcome back some of our international guests and hosts. And what better way than to conduct a panel with the ADHD associations of a number of different countries to ascertain and to determine the similarities and differences in the way that ADHD is administered and looked at around the world. So I'd like to start to welcome in the following people. ADHD Australia welcomes ADHD UK and ADHD Singapore. We're going to have an engaging panel discussion, discuss discussing things like diagnosis pathways, supply chain challenges for medication across the world, and support in the workplace and education system. I'd like to introduce the following people. Moonlight Lee, who is the founder and director of Unlocking ADHD Limited.

Singapore. Melissa, know, as CEO of ADHD Australia, you've seen plenty of her. And after a good night's sleep, he is back. Henry Shelford, the CEO of ADHD UK. Welcome back, folks.

Thank you. Well done on, everything you've done during your day.

It's been a it's been a riveting series of, presentations, as indeed last night was as well. So things seem to be going very, very well.

And this is a good point to remind everyone that, obviously, the videos are kept. They will be on YouTube. Everyone can catch up. No one's expected, to watch all twenty four hours. That's not how this works. We chase the sun going around trying to bring experts and insights from around the world, And that's what we've done. It's lovely to have this collective of ADHD charities here.

Awesome. Now before I go, any questions, Mel or Moonlight, would you like to add anything? Otherwise, please do, and then I'll dive into questions.

I'm very excited to be here. Yeah.

Great. Welcome. Glad Well, to be we've talked about some questions beforehand. The first one wanted to talk about is, again, it's about comparing similarities and differences. I wanted you to describe what the diagnosis pathway is for ADHD in in your country. Melo, could I start with you?

Sure. Singapore, we basically have a public and a private system. So if it's public, that means that most people would go for a subsidized treatment. So it would have to go to a general practitioner or a polyclinic doctor first for referral to a specialist, usually a psychiatrist. So going that route makes it more accessible in terms of financially, but there is a longer waiting period. The other route would be the public, the private route, the private clinic, and that is actually quite speedy. It could be within a week or even a few days to see someone, but, of course, there's gonna be other considerations like financial.

So I think that might be similar in some countries, but I think the big thing to know about Singapore is that we're actually tremendously under resourced when it comes to mental health professionals. So I looked at some data, you know, before I came on. And in 2022, it was, like, 9.7 psychologists and 4.6 psychiatrists for 100,000 public sector. So what the government is doing right now is there's a name to by the by the time 2030 rolls around to increase the number of psychiatrists by 30% and the number of psychologists by 40% because the Singapore government recognizes the importance of mental health. And that's what they're doing to try to make sure that the population is well taken care of.

That's easy. I mean, like, I think it's a no. It's good. I think I think we have some almost replication here in Australia. So the in Australia, what we find is is there is similar, I'm gonna say, system in the sense that, we also as well many individuals can go privately. We also as well have individuals that go through what we have as a Medicare. The, weight for that is quite significant. The cost of diagnosis is, relatively high, for individuals. Many people do not get a diagnosis because of the challenges. And currently, as we sit in Australia today, having a diagnosis, for many individuals, you know, it can range. Some individuals can be paying between 3 to, you know, $10,000.

Plus for a diagnosis across the board, and the wait time for those individuals is quite significant. So similar patterns. We also as well have, very limited amount of psychologists and psychiatrists, particularly in adult space that also diagnose, individuals not just with ADHD, but across the board. So our shortage is is quite prevalent to our us here in Australia. Henry, how about in in The UK?

I was trying to work out how to say it without saying and and bad word show. Like, because we have a completely overwhelmed system. The worst place is Sheffield. We have a localized public health care system. So the worst case place is Sheffield, where there are 6,000 people waiting for an assessment. And the health system only saw three people last year. So we have an effective wait time of two thousand years. But then we have other parts of the country where the wait time for an adult assessment is just twelve weeks. And, you know, with those kind of disparities, but there has been a complete lack of resourcing. I'd be interested to know how the different countries first identify ADHD.

Because you both talked about an overall process. Like, in The UK, we rely on teachers. And in fact, for the public system, the NHS, in many cases, has to be a referral from the school. And those people aren't medically trained. We have a wild issue of people not picking up those teachers not picking up ADHD, particularly girls, particularly inattentive, either boys or girls. And we can see that in the numbers. We we get good numbers on pharmacies, the amount of medication, which is a proxy for assessments. And that shows the ratio at twenty one percent for girls instead of the third it should be. There is a private system like yours and it can wildly vary. And actually, lots of people find themselves not realizing how expensive it is.

Particularly because they're used to the NHS system. So they'll go and get a private diagnosis. They'll see the price for that, and then they discover every month they need to go back. And that bit can really vary. So some providers are like, you're all in. That bit's gonna cost about £500 the whole year. Other providers are like, right. That's £250 per month plus your prescription, which is you're not gonna be NHS, you're gonna have to pay the retail price. That's gonna be maybe another £140, that sort of amount. And, you know, a lot of people are suddenly looking at going, oh my gosh. And then you go to your NHS GP, go, look, I've got a I've got a diagnosis. I like, it's.

A medical condition. Like, can I get it on the NHS instead? Like, you know, it's it's medicine. And the GP goes, no. No. You can't because I'm not going to. So 50% of GPs will say yes, and 50% will say no in a survey we did. And then that's worse. That's for England. In Scotland, it was 60% saying no. Wales, was 70% saying no. And you're just like it's just very unreasonable. Like, I have a medical condition, a need for medication, and you're just refusing it to be on the state because I had to go private, because the wait list in my area is eight years. I mean, I just feel like I'm in some kind of ridiculous Greek tragedy style setup. So it's a yeah. It's tough. And we the other major issue we've got is from child to adult.

So we have a child system in the state and then an adult one. And we see people age out of the child one at 18. They're supposed to just get picked up by adult services. Adult services is overwhelmed. And so they're like, yep. See you in two years. And people's medication is stopped. So that child turns 18, and we snatch defeat from the jaws of victory. I've spoken to GPs who say, like, I just see people on my roster, they turn 18. And, you know, the next night I go talking to our earlier sessions and your earlier sessions on crime, you know, we see people being failed in education falling into crime. And and this GP just said, you know, I see the 18. I see the medication stop.

And then I see the next thing I see is a note from the prison service asking for medical records. And it's just awful.

Back to you. Tell me, what is the post diagnosis situation like in each of your countries? You mean, like Should I start with this? Okay.

Yeah. Post diagnosis, I think it really depends on the professional that is making the diagnosis and whether it's in a public hospital or in a private clinic because it really varies. And and that's the thing that we're trying to do here to be more consistent Because for many years, a lot of people in the ADHD community were were thinking that medication was the only way to manage ADHD, and it is an important strategy, but there's other ways to, you know, whether it's therapy, coaching, lifestyle changes. So not everyone is presented with as comprehensive.

List of tools as we would like. So what we're trying to do now as an organization is to work alongside the mental health professionals to let them know that we are very much community based and we're there to support from a peer perspective. So in between appointments, you know, if people need support online, you know, in person, and so on. And also trying to come alongside to upscale the knowledge of professionals in the field, whether it's mental health professionals, teachers, even those working in HR departments so that there's better understanding and support for the condition. So it's really scattered in in one word, I guess, if you would say. Yeah. Mhmm.

Yes.

It's interesting. I mean, like, we're we're we're similar. So look. What I would say is children and, when a child has a diagnosis, often that's still firmly similar to your comment, Henry, earlier. A lot of that is is stemmed around the school. The school seeing some challenges and they're wanting to engage. They see that there's some some challenges a child don't necessarily know what it is, but seek, family to get some additional support. What can then happen is is when a diagnosis happens, depending on the person that does the diagnosis around Also, the family's ability to be able to purchase therapy and the availability of therapists or the availability of coaches or support and or cost ability from a family perspective.

Or a person as an adult if they're working. So it can vary. But if you're an individual that has received a diagnosis and you've had a diagnosis, for example, by a psychologist, and you may come away if you're a person that doesn't necessarily have the financial stability to back you up. What that could look like is for you, you may not get the supports. Seeking a therapist, seeking some additional support could be quite limited. We have a lot of in Australia family help groups, volunteer groups, supports that are really trying to step in and really trying to work with other family members and other individuals also with ADHD. And there's a lot of work that's trying to be done. But in terms of paid services and the, ability for ADHD.

In Australia to be recognized in the way that it needs to, there's a huge amount that needs to be done for people. A real lack in education across the board. Anyway, I'm gonna hand across to you to see how different we are in The UK.

It's it is actually fascinating listening to the different situations, both the commonality of the the sort of awfulness and the different the different parts. And listening to it, think and having talked to other people, in some respects, I think some parts of The UK support are are the best in the world, and some parts are the absolute worst in the world. And best in the world, we have an absolutely extraordinary government grant for supporting people with disabilities in the workplace. So people are able to access a grant of up to £66,000 per year to support them. And often we see for people with ADHD, they're getting coaching. So that's one to one bespoke support to.

Build out strategies that make a difference. We've seen purchases of equipment where, for example, you've got very time pressured equipment. For example, I was working with a medic, a very, very time pressure piece of equipment and access to work bought another piece for them so that they were able to have more time time with it, which was a pretty substantial purchase. The obviously, we we then managed to make that up mark that up somewhat, and the wait time is eight months, which means that although it's important to know that if someone starts a new job, then they accelerate that, and you'll you'll expect to be seen within two to four weeks. So they recognize that that first start point is important. Worst.

Within the health system, I mean, it's I mean, it's just absolute shamble. So it's oh, you gotta laugh how awful it is. Right. You go. You go and get a diagnosis. You're like, you go you wait often years. You go and see the person. You get an assessment, and they go, right. You have ADHD. And you go, okay. And they go, would you like to explore medication? You go, you know what? I I would. They go, great. See you in two years, maybe three. Unbelievable. Right? You're sitting there with the person who can prescribe and can help, and they're like, see and that happens frequently. They're sort of dual cue. What's happened is one of those quirks of a.

You know, when a system isn't monitored well enough. So the wait times for getting an assessment people started to pay attention to. And so a number of the regional areas have gone, right. People are looking at that. They're not looking at this. What we can do is we can release resource. If we do titration, I know, on the never never, but, you know, later. And that then means we can use that same resource for assessments, which is being measured. And and so you suddenly saw this dual queue thing happening. And so that's been I mean, that's I think can you imagine you get this recognition and you suddenly like, right. I know I've got ADHD now. I want to change my life, and one of the most significant tools is withheld from me. And so.

Yeah. That's why I think some of us it's groundbreaking to support in the workplace is like, has the it has so many problems in terms of particularly the weight of eight months from those people when they're getting a direct you know, they're not new starter.

But for Do you have people across to the we have a lot of people that can't get supports in a state and they go to a different state. So they up and take not just themselves, but their family in some situations to live in a different state because the supports are just not in one of our states or some states. So we have situations where people have, because of the lack of support kind of and, you know, in some areas, it may be gonna say, not fantastic, but a little bit better. We see situations where people move across state to state, and it'd be interesting if in The UK and Singapore, you have that as well.

Well, Singapore is a small place. So, we can't really move around too much. Maybe just to a different area, but it's still the one once very small island. Yeah.

And do you have people move out of Singapore, though, just actually to get to a different place? Do you find that?

I think that the I mean, there is some on the ground trying to arbitrage, you know, in terms of things like medication and all that. Or if people do have family members and they were from a neighboring country, they might go back there. It might be, maybe easier access. But the fact that the regular appointments make it a little bit prohibitive, except the person is going back and forth quite regularly for business or for other reasons.

Yeah. That's an interesting And, Henry, how about you? No. I just thought that's interesting sort of international aspect of of Singapore that people are going to other countries. Yeah. Again, I like the like, I don't know if it's a theme, but, like, best and worst again. So in NHS England, they realized we had we got nicknamed the postcode lottery, so also the ZIP code, where people in one area, as I talked to earlier, you know, you got a twelve week wait, and another area, you've got a 2,000 year wait. And some legislation was passed to say that you could be seen in any part of the n of of the n of NHS England. So if you are in the 2,000, you could be seen as well. Now that meant absolutely nothing.

Prior to the pandemic because you're not gonna do regular appointments just as Moon Lake's talked about in a completely different area. You just it's just not feasible. But with the advent of this, the virtual meeting and virtual and the associate virtual assessments, it is possible. And so post pandemic, we suddenly saw this explode in terms of people using that system, and it's called Right to Choose. We have very extensive guidance. And and what the other big thing that happened was some subcontractors for the NHS were allowed to you're allowed to go straight to them. And so essentially, you're you're going to a private company within the the state system, and that's.

We've been monitoring those in terms of wait times. And the shortest wait time you go to is six weeks, which is incredibly different from two thousand years. But worse, we've got we have this devolved nation system. So we've got Wales. We've got Scotland. We've got Northern Ireland. We have some nice guidelines that provide the the rules and what you're what you should expect. They don't apply in Scotland. And Scotland doesn't even have guidelines for ADHD. They had some. They got rid of them because they got out of date. But that's a big deal because you have to provide the service in the guidelines.

So we spoke to someone in Wales. They weren't offered they were told there was no adult ADHD service. And we said, fine. You can actually force the local area to pay for you to go anywhere you want, private cost, because it's a service that should and has to be provided. And in Scotland, we can't say the same. So we have people we spoke to someone recently and they said, I went to my GP. I got a referral. I was put on a list. I called the list, and the people running the hospital running it, and they said, we don't have one of those. We've got no ADHD service. Your cue is a fake queue, and it's just made to make you feel happy, and it does nothing. And, obviously, we've been and they have talking to their MSP.

The member of parliament of Scotland, to try and address and say how awful that is. But so in those areas, you can't go out of the postcode lottery. So if you're in Wales and you're told, if someone was, your wait time's gonna be eight years, you're just like, man, sucks to be me. And and that kind of disparity needs to change.

Mel, could I ask you a question? How confident are people in declaring their ADHD status in the workplace in Australia?

From from what I know and from my personal experience, there's still a lot of organizations where people with ADHD feel very uncomfortable disclosing. I know that individuals themselves, people I've worked alongside, and we did a presentation earlier about individuals feeling that they're they're nervous. The higher you go into particular roles, leadership roles, executive roles, people feel more nervous about disclosing their ADHD. And also, a lot of organizations don't know what to do when people do disclose. So individuals themselves feel, why would I disclose if nobody's gonna be able to make a difference to provide some, additional support or.

You know, whatever that looks like for a person in terms of, differences to help that person to succeed. So we know that people choose often not to disclose, and the outcome of not disclosing for some individuals is really tricky. So that could look like people having to mask at work and struggling from a, ongoing perspective of being somebody different in the workspace to your genuine you. In other individuals, we see situations where people struggle. They have challenges, and sometimes there's a worst case scenario, individuals are performance managed because they're not disclosing, and they then get to the stage of being challenged in the workplace. And then in other situations when people do disclose.

It's really difficult because individuals feel as though the people working with them do not understand their needs. And in some cases, people actually have very negative experience of disclosure. I know personally, I have have ADHD, and I basically am successful in the workplace as an executive. I have disclosed, and I know that disclosing in my case has helped other people disclose not only ADHD, but disability. So my advice is is where leaders can't disclose. I think it's better then because it gives that sense of security for the team. I don't know, Moon Lake, if you have a similar experience or what it's like over there in Singapore.

You see me nodding my head. Okay? So I definitely resonate with you. You know, many similarities, and I think there's a little bit more conservatism here because ADHD or the awareness is not as established as, you know, for Australia and The UK. It's not even considered a disability in Singapore at the moment. So, you know, there's lesser frameworks for accommodation. What we normally share with our community who ask this question over and over again is we say treat it like a date. You know, you're not gonna, like, reveal everything the first time because you don't know what the recipient knows about ADHD or thinks about ADHD.

We're gonna wait until the at the right time. But definitely we do encourage people to share. And in fact, yesterday, we were celebrating our hangout, and we had a board member who's a very senior financial industry professional share with everyone. And he's very open about it, and he says that that's something that is important for him in his position to share too so that there's more openness and more acceptance. And, four, unlocking ADHD in Singapore for ADHD awareness month. We're having this, you know, champion for ADHD campaign, particularly on LinkedIn. Because we want people.

Particularly in on LinkedIn because most of them are, like, working folks, you know, who have ADHD to feel comfortable to share. Because as you said, Mel, when one person shares, then people don't feel they're so alone and they feel the courage to also share. So that's what we're trying to do here to make it a little bit more conducive to to have that openness.

Excellent. I love the analogy of dating. I think it's fantastic. I think I shall use that myself.

There is one question I wanted to ask because I'm sure it's it varies from country to country, but what is the supply chain situation in your country regarding medication? Is it improving or is it more of the same? Henry, can I start with you?

Yeah. Sure. So then particularly because we have a UK problem on this one. So we have a national patient alert. It was interesting to because we had the conference last year, it was right in the middle of that talking to to you guys. And at that time, you said, we don't have a significant problem. And the factory that made that particular medication was in Ireland. It's one factory for the whole world. And what then became clear, because we then talked about a month later, we said we've now got a massive problem, was essentially because Australia is quite far away in the supply chain meant there was medication on on ships getting to you. And it was there, and then it wasn't. And you you had that that lag. We then had another.

Medication alert around a different medication, and it's a huge it's a huge problem. In The UK, we just make it so much worse. So not only can you not you know, your medication's out, but you can't see the specialist because of that two thousand year queue. You can't see the specialist to get a different prescription. So in Hinton UK, you can only get it from your ADHD specialist. The GP cannot change your medication. And so you've got to see that specialist and you can't. And so instead of being able to go, right, I can't have this one. Can I muddle through on one which isn't quite right for me but will help me? And it's it's not. So our situation is is made much, much worse by our our the way we do it locally.

Mel? Yeah. Just reflecting on your comment, Henry, and, you know, something that we we find here as well and have a lot of feedback from our community is the the challenges when, a specialist obviously, prescribes, medication and the individual then, is required to continue to go back to book appointments and to get the, prescription from that particular medical professional. The difficulty is is getting appointments with the medical professional that's prescribed the medication is quite difficult. And therefore, what happens is the same reason as you, the GP, for example, can't, prescribe the medication or to change the medication because the medication basically can only be changed by the prescribing doctor.

It creates challenges for people. So we have situations where we've got individuals that, contact us, which say that they're running out of medication. That they're really struggling, they can't get appointments with their regular individual that they're seeing, their prescribing doctor. They they, for example, have difficulties where things may, from their perspective, might not be impacting in the way that they need to. They need some additional support. The wait lists are huge. So similar challenges, that we face. One of the other challenges is actually about the cost as well for the medication. Again, in Australia, for some individuals, the cost of the medication, is, difficult for families that.

Really struggle to be able to afford not just the diagnosis, but the ongoing cost of medication, whether that be an adult or other. So that that cost also can occur, additional for people which people struggle with. And we also have state differences. So we different slight differences and nuances per state. And I won't go into that because, there's a huge amount of, differences that, I could talk about all day. But subtle changes, and it is quite complicated across Australia.

I mean, like, I'll go with you. And then after your response, I've got because I've given you an eye on time. I know that there are people in The UK waiting to come on. After I get your response, I've got three more questions, and I'll do rapid fire around the horn if that's okay. K. Mine will be quick because I did a quick research with a medical medication provider.

A public institution, mental health professional, and also in private. Just to have a rough idea what it is before I share about this today. And so far, the situation here is being managed. So so far, okay. You know? So and and we hope it stays that way.

Excellent. So oh, I think we just lost Mel for a second. So here are my two questions. Firstly, what is the big change you would like to see your country make regarding ADHD? And the second thing is, all our organizations are limited in terms of time, funds, personnel, and the lot. Yeah. If you could wave your magic wand, what is that one thing that you wish you had in terms of resource that would make a difference?

I'll go A million pounds.

That's a good answer. There's not my my wand isn't working. Yeah.

That was reminds me, do go to globaladhd.com and donate. Particularly, if you happen to have a million pounds there. I think we are all it is tough. We all struggle for money. Sorry. Back to Moon Lake. I jumped in.

Well, I think for us, the main thing, if I had to pinpoint one thing, is really to have a better understanding of what ADHD is and its impact. Its impact across the lifespan in multiple settings. Because right now, there isn't that much understanding of that, which is why among the five charities in Singapore that are in the special education needs, which is where we fall in, there are only two charities ourselves and another one that are not as supportive with tax deductible donations. We're hoping to change that soon, but in terms of funding, significantly lower because it's not perceived as as big an issue. So we are working hard here to show the connection, you know, with the comorbidities, you know, the prison system, you know.

Many other aspects, right, that will affect someone with ADHD. So that's what the magic wand is. It's really to understand the the social, the economic impact of ADHD.

Thank you. Now the two questions were, what would you most like to see change in Australia regarding ADHD? And the second thing was, in a world of limited resources, what is the one thing that you would put ahead of all of others that would help ADHD, a, achieve its objectives?

Yeah. Look, I think from my perspective, we've just had a fantastic inquiry, as you know, an ADHD inquiry. There's been some amazing recommendations that have been pulled out of that. I would love to see some of them come to reality. So from a diagnostic perspective, research perspective, looking at education right the way through to the workplace, really being able to enact upon those recommendations to make a significant difference to the lives of those young people and those adults with ADHD and the people also working alongside them and supporting them as parents and carers, to be able to make that difference. So it's it's really about we've we've got the foundation here in Australia. It's about putting it into actually make it happen.

And, you know, supporting with that, obviously, from a government perspective.

Excellent. Excellent. Well, Henry, we said that we would hand off to you at this time. This is what we'll do now. Thank you, Moon Lake, for joining us. It was a compelling and fascinating conversation. I appreciate the time. Mel, I'll let you do the formal handover to Henry. People in the Southern Hemisphere can continue to watch, but we might retire and hand the stage back to the Maestro.

You are looking fresh as daisies. Like, it's very impressive.

It's facadeism. Did you miss parting words?

I just wanted to say, you know, wow. It's been a fantastic experience. I I feel really privileged to be able to have great conversations with, obviously, yourself, Wing Lake from Singapore, Henry, today. As countries getting together to have a conversation, the experience that we've also had, sharing the conference across the twenty four hours. Outstanding. I don't know how we do it, but we do. And I'm just really, really delighted to hear all of the the messages and emails and feedback that we've received so far. Really, really great outcomes. And, it's a honor to obviously do this every year and really, really looking forward to, being able to continue to share these stories, because as you mentioned earlier, Henry.

This is obviously a as it sits today, live, but many individuals won't be able to see it live. So creating the opportunity for people to look back and look at it at their own time as well.

Yeah. I'm just amazed to find that, you know, we're all different countries, but there's also similarities fundamental similarities, but also a lot of things to learn from each other. And I've and I think Singapore is just very, privileged to be here with Australia and UK. And I think there's a lot of things to learn from your inquiries and and and, you know, we hope that as time progresses, we'll get more similar. Right? We all progress together as a global community. So thank you for having us.

No. Well, thank you for being part of this. And, obviously, what you've done is extremely impressive in Singapore. Essentially, she'll never say this, but she always says it's a team effort, but essentially single handedly created unlocking ADHD and pushing for change. The Singaporean system is pretty difficult to set up a charity, and she's in that process of doing already set up the charity, now talking about getting the the the tax deductible status, which is a big deal for unlocking funds. All of us struggle for money. It's it's part of a stigmatized condition. People don't do the the the wearing the t shirts, doing the runs.

Proudly shouting about their involvement in the same way they do for other conditions. And so we have this sort of double fight that we're trying to change that stigma, but that change is made more difficult through lack of funds. One of the things we're trying to do with the conference and successfully doing is build a coalition of ADHD charities around the world so we can take the best of each other, learn from each other, and advocate for change with the benefit of that learning. It's wonderful to have three leaders from around the world in this.

This arena all here together talking and swapping notes. So I thank you all both for for doing that, for all your work, the work we do together. We're all in the same fight. It's just wonderful. And I think it's a wonderful expression of global conference, us all here to get together. And as we said, we have a hundred and hundred and four, 106 people, different countries register. Total cumulative livestream users is currently sitting at 31,000 a 112. It's a wonderful testament to this. And, yeah, I look forward to doing it doing it again next year. I'm say goodbye to you both. Moon Lake, thank you. Mel, you're amazing. It's been wonderful. And now the baton's passed over seamlessly.

I have to say. Like it's it's really very good. But I have to say goodbye Moonlight, goodbye Mel.

Thank you so much. Bye bye. Thank you. Well done.