To introduce Henry, you know who is the CEO of ADHD UK. Mel Webster, is the CEO of ADHD Australia, Moon Lake Lee, who is in charge of unlocking ADHD Singapore, and, Darren Bull, who heads up ADHD music.

Kiara.

Kiara. Yeah. How are you, Kiara? So this section, is called ADHD Without Borders, understanding global variations and cultural insights. And we basically have three broad questions for our last last page. Henry, as you're the person who is is on, I'm gonna ask you first, What was the leading issue or challenge that you've had the past year in the ADHD world that has consumed most of your time?

Man, it's been Only one. Yeah. I mean, it's been pretty wild. The I think the big achievement, the big thing I know later we've got some slides or we've got some we're each talking about the assessment process in our countries to sort of compare and contrast and learn from. We have a very important access path called Right to Choose. So we run a there's a national health service, but it's regionalised in organisation, and that can lead to very big differences in how long you're seeing. So in one area, we have over 6,000 people waiting, but for the year where we last have stats, they saw three people. So we have an effective wait time of over two thousand years. And in another area, we've got wait times of twelve, sixteen weeks. There's.

A thing called Right to Choose, which is, to quote a commissioner, it's the National Health Service, the NHS, the National Health Service, not the Regional Health Service. And so there's a a thing called Right to Choose, enables you to be seen in another area. So if you're in Sheffield with two thousand years to wait and got to learn how to mummify your body Egyptian style to last long enough to get to assessment, you can instead go go to the shorter place. They were going to put in a and if you're Sheffield, obviously, you don't want to you've decided to devalue ADHD. You don't want to pay for it. So if you use Right to Choose, your local area has to pay for it, but you get the service in another part of the NHS.

There were very big moves to change that. They were done in a sort of backwater part of the NHS called the NHS payment system. There was a consultation that was to last four weeks, then there's four weeks, then it gets implemented. And that was going to place a restrictive cap saying that where roughly 25 to 30 people would be able to per area would be able to use that. When you've got a weight of, you know, 6,000 people, then 25 people is nothing. We were able to put up a system, for people to write to their MPs. We were notified of this happening about a week into the consultation. Week two, we had a campaign, writing to for constituents to write to their MP. And in those last fourteen days, we.

Were successful in rallying the community to have 14,000 letters and emails written to their MP, many MPs getting over a 100. We have 650 MPs, and defending what is a legal right, the right to choose. If you put this cap in, it's not there. And we were successful in getting the government to U-turn, but we knew we'd won the battle but not the war. And at the end of our session, we've got a session we've got two political sessions coming up, one with a number 10 insider. He was the number 10 adviser for health care for Prime Minister Rishi Sunak, before that, in senior roles in the Ministry of Health. And we also then have the ex head of mental health care for the entirety of NHS England speaking about.

The fact that there are now new Right to Choose controls being put in place and what we're going to do about it. So that's been the biggest battle, that's because our estimates is roughly eighty percent of people right now in England. That's how they get their ADHD assessment. So it is the dominant path, and it's trying to be stopped, and that would be ruinous.

Back to you. Anything you still end up, Henry? Like, if you were to look one year forward, what do you think is gonna happen?

I mean, we are in a really fragile political set up right now. Right. So you have Labour, Kirstjarma, his statistics are now that he's the most unpopular prime minister we've ever had, since we've been collecting those statistics, which considering, that's now lower than Liz Truss, who was famously less successful than an iceberg lettuce in in her prime minister, ability. For those that don't know, she was considered to last be so last such a short time. I think it was the Daily Star put a live video on an iceberg lettuce and said this lettuce will last longer than than Liz Truss. It did. We have reform, who have made some quite aggressive statements around neurodivergence and there's a viewpoint that people getting an assessment.

Means they then go on benefits, which is not what we see at all. We see people getting an assessment to thrive in life, but that view is one that's being held by people. And so that could make things much worse. We're not expecting an election for many years for the nation, but Wales has one next year and reform are currently polled to win it. There's a lot of jostling and we're seeing a lot of statements around support for mental health and creating a benefit cost rather than being a support. Then you say to people like, what's happening is people are struggling because they're not getting support, and I'm making that argument. I we are going to fight tooth and nail, Rob, but I honestly I it's hard to say what what we expect to happen.

Yeah. The biggest systemic problems by the sound of it. Well, I mean, Darren, better or worse in New Zealand?

It's going to be significantly better. Over last year, the government have announced significant changes to the way ADHD is diagnosed and prescribed, which comes into effect first of Feb. It also, already in effect, removed the barriers to accessing ADHD medication once you've been diagnosed. So in terms of our focus, it's on getting ready for February 1. The main issue we have now are medication shortages in Pharmac, which is our medicine body, have been great with the communication and looking for alternatives. So this change has been a long time coming. It's the biggest change in ADHD for thirty years in the New Zealand medical system. So, yeah, better.

Very good. Very good.

What's your take on things? Thank you. Things are also looking better in Singapore. There's still not sufficient awareness about what ADHD is and the impact, you know, on people's life throughout the lifespan. But organizationally for unlocking ADHD, we turned four years old this month, so we really are the new kid on the block. And what is special this year. About six months ago, we received this status called the IPC status, the institution of a public character. So what this means for a charity like ours is that donations to us are tax deductible now prior to this or not. And in Singapore, the law is 2.5 times the donation amount.

So you can imagine when a donor has a choice between a charity that can give the tax deductibility and one that cannot, which would they favor. So this was a significant breakthrough because we are the only charity that's focusing on ADHD in Singapore that now has that status, and that actually has helped a lot. That's the first thing organizationally. The second thing that I'm really excited to announce just happened a couple of days ago, so it's breaking news. That's a very well established regional conglomerate called Jardine Matheson that has this own charity called mindset that promotes mental health. They have come on board alongside unlocking ADHD with a Singapore $1,000,000 pledge.

Over a three year period to support us to establish for the first time accessible ADHD informed counseling services and other services. So So your lobbying efforts have are are starting to pay off, I mean, like. Yeah. But it's been pretty hairy, okay, to say the least. But we are so grateful because, you know, it's it's such a significant move because this is a very well established regional corporation that, you know, has multiple business units including, let's say, Starbucks here and, you know, pharmacies and and real estate, and they have come alongside us because they recognize the importance of supporting not just on the mental health, but a very often overlooked condition.

So we've already got three counselors on board, and, you know, we're sort of ramping things up. And and I still hope to attract more funding support because we're hoping to roll out executive fund coaching and ADHD coaching next year. So that's the big thing as well. And we are launching a book next week, and it's called differently wired minds. And this year, Singapore turned 60 years old. So to commemorate this, we call it s g sixty. We thought it would be meaningful to have a book featuring 60 Singapore ADHDers sharing their journey from all walks of life and all ages, all ethnic groups. But, you know, being ADHDers, sometimes we overdo things. So I didn't get 60 at 63. But, you know and and we.

Also are gonna be launching a video, the first public awareness video on ADHD called focus on us. And the reason why it's so exciting for the book and the video is created by ADHDers, featuring ADHDers not just for ADHD community, but also for others to help understand us better and also show that, there are ways that we can thrive. So for the book itself, even though there's gonna be limited copies, hardcover available, as a fundraising gift for those who donate to us of certain amount, we're also making sure they're available on our website so that anyone and everyone can access the journeys, the strategies so that no one is having a lack of access in terms of being able to get tools to thrive. So some things.

That are keeping us organized and busy. But in Singapore overall Is that it? Is that it? Is that That is right. Government now is updating the clinical practice guidelines on ADHD. So I'm on that team, and for the first time, adult ADHD is gonna be included. So we hope to release all these things, hopefully, by end of next year. We'll update by then. Thank you.

That's awesome. It's an epoch epochal year for you. That's Awesome.

Yeah. Awesome. Congratulations. Thank you. That's I think we all know how much work you you like that involves and how much you put in and actually how extraordinary you are in your abilities to connect with people and get stuff happening. Right. I'm I'm gonna be needing to take some lessons. You're amazing.

I'm learning I'm learning from everyone.

Well, I have due for a trip to Singapore, so that sounds like a very good idea. Yeah. Look. And then I'll get you to double up on the next question too, which is No.

Not not a problem at all. Look, I suppose what's really interesting is probably for for this the first time ever in Australia, we have seen significant changes this year. If you ask me this question, Rob, back in January this year, I would have said to you one of the most difficult challenges for us was affordable ADHD diagnosis, treatments. We had long waiting times, out of pocket costs, medication shortages, and regulation delays, stigma continuing. We still have that significantly across the states. But what I would say is for the first time ever, we've seen significant changes across different states and we're hoping to see across all states of Australia. One of the biggest is the New South Wales ADHD reform.

Government now is allowing trained GPs to prescribe ongoing ADHD medication for patients. This is a significant impact positively to individuals. Trained individuals being able to do this means that it reduces the resilience and the overload on individuals as a whole. It also means that now more people are going to be able to access prescribed medication in a in a way that they need to. The next stage is phase two. It's the GP diagnostic pathway, which is super exciting because what it's going to allow us to do in some states and again, ADHD pushing Australia hard for it to happen across Australia. But it's basically for us to be able to to look at initiating ADHD diagnosis.

For GPs, those specially trained to do so. That's really important. It isn't all GPs. It's those specially trained to do so. But this reform is going to change significantly for what we're trying to achieve here in Australia. Also, the expansion of telehealth in Australia has been huge. I think some of that is COVID related, but it continues to be fantastic in driving that not just from a COVID space, but ongoing as we as we move forward. Schools also across Australia and also community are really starting to take that inclusive approach to strategies. We've had some amazing talks throughout the day from, you know, educators, you know, whether that be universities.

But also across schools where schools are really wanting to and commit to making that change for individuals with ADHD and the community as a whole. So for the first time ever, Rob, I think and you're here based in Australia and Sydney. I think it's fair to say that it's a very exciting time for us. We've got a lot a lot still to do, but at the same time, I think it's a significant shift to this time last year when I was speaking to you, Henry and Moon Lake and, actually, Darren and I, I didn't have the opportunity last year, but I think just being in New Zealand, you can hear you know, probably more aware of some of the changes we've had here in Australia.

Great news, isn't it? Being a resident of New South Wales and having family members that have ADHD, it was with excitement that we we agreed to that year. So, yeah, very much so. Darren, changes coming forward in the next year, positive or negative, that you think that you'll be dealing with?

Positive. So the big change, very similar to Australia, because the royal colleges go across Australasia, and we're very much here building on the work with Aetna, which is across both countries. It's positive because New Zealand will go to train GPs diagnosing and prescribing from the February 1, and that will do a number of things that will reduce the wait times. We've got the wait times according to the surveys. We do it's somewhere between three to six months where you live, depending where you live in New Zealand for both public and private. So we're expecting a few 100 trained GPs over the next next few years to sort of come through. So it's gonna have a real, real positive impact. The other aspect to it, they will charge. It will be.

Estimated still to be confirmed 4 to $500. To go private, it's 2 to $3,000. And I've even heard of someone being charged $5,000. So that's that's the really big change. The challenge is now is to ensure enough GPs are trained. So the Royal College of GPs is doing a great job bringing it through along with the University of Auckland School of Medicine. We're really I just wanna call this out with with this is the ten years of work to get this far, but the work that did in Australia has we're really standing on their shoulders, and we're using the Australian guidelines here, which is fantastic, and also the NICE guidelines from The UK. And I can't overstate how important it is to have quality guidelines, obviously.

But to bring on two pieces of really strong work from Australia and The UK means New Zealand doesn't have to build our own guidelines. Guidelines. There is the intention to do that, but we're in a strong place to do that. Yeah. Excellent.

Excellent. Yeah.

I also echo the learnings from each other, and I think it really helps to shortcut the process but also show the best practices. In Singapore, I think there are some movements as well and I'm hopeful. One of the things that's recently launched is the Institute of Mental Health is doing a large population study for children within a certain age group, think nine to 16, and they're specifically trying to assess the prevalence for ADHD, ASD, anxiety, and depression. There really hasn't been any ADHD since I think 2014. So this is something big and it's and I think, from what I understand, if, you know, there is, diagnosis.

There will be further support given then on the next level. So to me, this is very encouraging. And it's important because when there's more data, then people can measure it than they know in terms of, planning on how to address it. So that's important. And then from the mental health side, the Singapore Prime Minister, the Singapore government is very much focused on mental health.

There's even special committee set up. So we're adopting a tiered care model for mental health. So tier one being community. So there's lots of effort here trying to get more people in the community to be upskilled, to understand mental health, to have the tools to support each other, so peer support, but also having, you know, a a next level step up, you know, the basic care, and then further on so that at least the tertiary complex cases.

Are sort of not creating, you know, without having bottlenecks where they should not be. So I'm hoping that, you know, in terms of how we want to roll out coaching next year and subsequently, we can also, show that we're very much in line with this approach. So these are the two main things, that we're looking at.

Awesome. Henry, in terms of what you think is gonna happen, over the next twelve months, we may have covered that unless there's something you'd like to add. Otherwise, we might move on to the diagnosis pathway. What would you like to do there?

I think we have there's there's too much happening all the same time. Certainly, I think some of the lessons from what's happening in your territories, the GP is taking a bigger role is is really important. We're seeing that conversation happen. We have, what they're called, rural colleges, who take the the lead on that. We, unfortunately, are dealing with a very large industrial dispute with GPs. So the there is a standard contract with GP practices. The current government has essentially foisted that on GPs. They were trying to they were looking to negotiate for change. As a part of that, they they their union, the British Medical Association, listed a 122 different things they could do industrial dispute on. They chose the.

Predominant GPs have chosen three of those, and guess who's one of them? And so we are finding GPs aren't actually doing the reverse of taking over. We've had a thing called shared care where you get assessed by a specialist, the GP takes over your monthly reviews, and many GPs are now refusing to do that. And that's particularly significant if you've been seen privately because then privately, you have to pay the retail price of medication. So, you know, 100, $140,160 pounds every month versus an NHS standard prescription of £9.90. This is a huge, huge difference, as well as not going needing to go and see that specialist, some of whom will charge. And and Darren spoke really well to the problem that we have really high price variability.

So I know some places are charging £50 for that monthly meeting and others paying 250. I mean, so then that's $2.50 plus $1.60. Right? It's a huge amount every month. GPs are not only not accepting new shared care, been some areas they're dropping their patients entirely. And then you're dropping to a service that has a wait times of years. So it's an absolutely massive problem. I would like to say most cases where that's happened, we have seen the central service. Well, we get mixed messages on it, but it seems to be getting better at making sure people continue with medication. But what that then is doing is it means that those local services.

Instead of seeing new people, have to use their capacity to see current people. And so it's making the backlog even worse. So it's great hearing the GP initiatives that are happening in your areas. But we are clearly playing a completely different game. We're having to just play play defense and Mhmm. Trying to stop an erosion. Whereas you're talking about progress, which right now, honestly, seems far away. It's fighting, and we definitely have a big community, you know, 14,000 people.

It's clearly a writing therapy. You know, in a lot of the territories to for the GPs to take on these roles and responsibilities. I think in most instances, it's paid for, and we'll talk about that in detail in a second. I can't imagine it's any less of a vote winner in the people's hearts back in The UK. It's just whether the system allows that to come to the forefront. Is that is that a fair comment?

Yes. We actually, in every single party, have found support, and it's important to say because there are you know how this works. We've got this like ADHD is where we're everywhere, and people impacted by neurodivergent are everywhere. And so you find allies in unexpected places. And so it's definitely not clear cut. And what's being said, at one level, is not reflected at others. So I I think we are definitely going to make it a political thing. We we I think we showed ourselves as a political force when 14,000 people wrote in fourteen days to their MP. We need to do more of that. And I think with that, we can we can get change. But it's definitely a plan.

Melon, let's speak back to you in terms of the diagnosis pathway and the costs and what's involved. I mean, it's fair to say that whilst initiatives like GP is being trained will reduce the waiting time to get seen and assessed, it's still a reasonable waiting time, and they're still not inconsiderable cost. Is that a fair comment?

That is. Yes. Absolutely. And I've just put a little bit of a PowerPoint presentation, Rob, because I think it's quite good just to if we can bring that in, talk about some of the and I don't know if you can bring that in, Talk about some of the differences that we have, which is the public pathway and the private pathway here in Australia. And one of the things I think just to to call out here is our two pathways, but there's there's Could you just hit could you put slide presenter?

That little button next to the slide button? That'll enlarge it for us. Yep. Slideshow presenter mode. Oops.

Sorry. Slideshow from the beginning. Sorry. Is that better?

Henry, you can call up the.

I don't think it was quite there there yet. I think we can share it.

Is that better? I've I've done it now, so you should be able to see hopefully. Oh, okay.

Is that better or not? You might need to share a different screen.

The one that's been Oh, Okay. I'll try sharing again. Bear with me a second. Two seconds because I know we're stuck for time. So I don't want to be taking all the time on the the showing of this. I could definitely talk to it. So I'll try one more time. But if not, I'm going to to talk to it and just go with that. But basically we have two we have basically the private and the public. And look, we're still faced with significant challenges. So, you know, the diagnostic access is really still quite problematic. So we have it's by a GP referral. Generally getting GPs to make a referral, people get in to see the GP. But the difficulty is public psychiatrist.

Or pediatrician. The wait times could be between six to twelve sorry, six to eighteen months. So it's quite significant. The private pathway, there's direct access to private specialist. But there's still significant wait time. But while some people get in between two to eight weeks, the cost of that is quite significant. And in some cases, the private pathway, people actually having to or choosing to, should I say, travel from one state to another to actually get that diagnosis. So cost is more and the actual ability to get to people is quite significant. The cost of diagnosis ranges. So whilst the public pathway GP visits are covered and we have a Medicare scheme for those that, you know, able to access Medicare.

Everyone can access Medicare but those that choose to do so through the Medicare scheme. And then basically it's referred to a public psychiatrist or pediatrician. The assessment may be free in some cases for younger people or at low cost, but the wait times is significant. So again, it's the wait times and here we're looking still at six to eighteen months. In some cases, it's even longer. So people are not actually getting what they need when they need it. The cost to go private is absolutely I'm gonna say ridiculous in some cases, particularly for those individuals from low social economical background. We're talking between $600, roughly about £300 to basically $3,000, £1,500. Sorry. I don't know that in Singapore translation.

So please excuse me. Certainly, I'm not that you know, I don't have the ability to do that, but it's a high cost. And in some cases, I've got people to pay up to $9,000 to actually get a good diagnosis and actually to go with some of the leading psychologists. Treatment options are still limited. So limited due to clinician availability. Clinician availability is significantly challenged, particularly as well in rural and remote regions. So in Australia, we are so spread out. The travel that people have to do to actually get access to a clinician is quite significant. And in some cases, if you're more or remote, you might have to travel three, four hours to come into a metro area. The medication is available through pharmaceutical.

Benefits theme. But as we know, we've got challenges with access to medication at the moment. So it is subsidized under the pharmaceutical benefits scheme. The access to things medication is just, you know, is a real challenge for us here in Australia and I know globally. We've got problems where people are saying that they're, you know, they've tried to go to their prescribing doctor to look for alternatives. They sometimes need different strategies as well to implement because medication is just not able they can't access it having to drive far and field. So in the private pathway, it's the same. It's, you know, there's medication via the pharmaceutical benefit scheme and also some people pay private.

The advantages for the private pathway, it's affordable, it's regulated, and it's integrate integrated with a public health. But the cost of that and the waiting of that and access to that is, I'm gonna say in some cases, near or impossible for some people. And sadly, the private pathway, unless you're somebody that has the ability to do so financially, yes, it is more flexible and it's tailored to individual needs. But the ability to access that is still challenging, but financially for many is not possible.

The advantages I think we I think we've got another ten or twelve minutes, so we might No. I'll move on to Darren, and then we'll move on to Moonlight. Alright. So.

In terms of diagnosis in New Zealand, effectively, if Melissa could put up a slide, it's exactly the same with a different cost structure. I suspicious when I see things like that because I wonder how the colleges really work together. But as I mentioned before, the the pathway moving forward is a GP. If they're unable or haven't had the training, they'll be able to refer to a special interest GP. And they will start that process from there and do the diagnosis. There's one thing I feel I have to mention. This is where all our media conversations about is not a fifteen minute meeting. So they'll have a prescribed process. It might be a couple of one hour or two hour.

Meetings. So that's really important. It's not that quick fifteen minute interview, which is good. The second aspect I should mention is the GPs will have a supervisory psychiatrist as well. The way I've been describing ADHD is like your typical bell shaped curve, where there'll be some that won't need help or medication. There'll be some in the middle who could go with the GPs, and there'll be some who are quite complicated and present with a range of comorbidities. And they are the ones that can be referred to a psychiatrist. Now the big advantage of the change that is being made is we're freeing up a lot of psychiatrist time. So we're hopeful that for those that need to see a psychiatrist, be able to get much quicker access.

Typically, in the public sector, it's those who have mental health issues as well. I should also mention that one of the big issues in New Zealand is our mental health sector is under pressure, like in many places. And even freeing up their time from doing diagnosis for those with ADHD, we've been pushing that to GPs. We'll free them up for other things as well. The one thing I didn't mention, a change that's already in effect is about the prescription of medication. So in New Zealand up to a few months ago, if you got prescribed ADHD medication from a psychiatrist, every two years, you had to go back and prove you still had ADHD. I can't say that with a straight face. And.

It's particularly frustrating if you're a child or a teenager with ADHD because you'll find when you go back, they'll suddenly say, hey, you're an adult, so you have to go start the process again. That's what's been removed as well. And the other aspect that I should mention that there are safeguards built in in terms of the checking of clinical notes by clinicians and also the checking of blood pressure and things like that are built into the system as well. Will our GPs be able to quote? Like everywhere, they are under pressure, So it will take a while to build it up, but we're really excited about the change. One thing I didn't note that is nurse practitioners.

Also have the green light to be able to diagnose and treat ADHD under supervision, which, again, is a big step forward. Many of our nurse practitioners here are more experienced with neurodiversity and ADHD than some of the doctors. This is where I think, oh, who's watching? But I think that's an important first step. The other other change amongst all of this is how we're talking about ADHD and that it's a health issue. And when I reflect back five, six years ago, it wasn't talked about as a health issue. So it's been really positive few years.

I have to admit, one change we did get through is we got this through a change of government from a left leaning labor government to a right leaning national government who weren't too sure what ADHD was. So all credit to the respective governments as well.

It's encouraging to hear, Darren. Terrific. Bring us home.

Thank you. I actually prepared a slide, but I won't share it because I think Melissa did a great job. And, you know, her, her slide is pretty much as guaranteed or covered very similar. So we know that at least these three countries have very similar pathways. So I'll just add more localized information. So in terms of, the subsidized route, which goes through the government polyclinic before the specialist hospitals, at a subsidized fee, it could be as low as Singapore $45 for the consultation, which, I think is about similar with Australia. The currency exchange, UK, maybe 1.7.

But it'll I should have checked before I went online, on the air. But for the private side and the good thing about the public hospitals is that there are two routes, a subsidized route. And, also, you could see someone in the public hospital as a private patient. That means you pay a little bit more, but you can choose who you see and it's a shorter waiting time. So I call it a bit of a hybrid mode, I'm actually seeing my psychiatrist that way. The other way is the purely private clinic pathway, which is a much shorter waiting time, sometimes as early as the next few days or next week or so, depending on availability.

However, of course, fees will be different. So let's say, for example, a psychiatrist fees would be probably about 300 Singapore to $3.50 for a session. For the psychological assessment and testing, it could go up to about 3,000 in some cases. So that's still gonna be a bit of a reach for many families, particularly if there's more than one person in the family that needs to be assessed. Medication also is still And it's all likely that there is, isn't it? Yeah. Yeah. So so what we're trying to do about this is that early on in unlocking ADCs first started, and we were actually in, regular meetings with, the different ministries and also the public institutions, we learned very early that there aren't enough psychiatrists.

In Singapore for the population needs, let alone those who are familiar with ADHD. So it's really no point complaining about structural issues that you can't change in the next few years. So I did ask at that time, what can we do? And the answer was ADHD literacy or rather psychoeducation. So that's what unlocking ADHD has been focused on because people still support while waiting for the appointment or in between visits.

But alongside from that, with the Singapore government's move towards supporting mental health, they've actually targeted by the year 2030 to increase the number or the percentage of psychologists by forty percent and the percentage of psychiatrists by thirty percent. And there's also a graduate diploma in mental health for general practitioners. So all these are moving. I still think it probably more needs to be done, but at least, again, we're starting to move somewhere. So I I hope that there'll be more done, and I would love to speak separately with Darren about this nurse practitioner idea and to find out more, and definitely with Melissa and Darren about the side as well. Yeah.

It's precisely why we have these forums.

Yeah. And one one more to say. Sorry, Rob. So what we've done is that we've incorporated on our website in our restart starter kit for adults. That's free download, the WHO adult ADHD, breathing scale. So that for those who are not able to access a formal diagnosis, at least they could do so called a self assessment first, and at least know after that to seek maybe the non medication type support, you know, strategies while waiting so that you don't have to be left without support.

Very good. Yeah. Very good. Well, I'll leave it to you, Henry, to bring us home. Hopefully, we're close to time as well.

No. We're doing a a great job. Right. I was I took my homework to create a slide, and I think the thing that's immediately obvious compared to you all talking how Melissa's model, in private pathways, self refer. You don't need the GP, so different for, I think, in the cases you talked about. Sometimes you're screened. So we know one very large ADHD assessment provider. They'll do a screening before before they take your money, and they actually will say in they, say around seventy five percent of people, they don't they don't find meet the initial criteria. They don't take the money. They don't assess them. When we're talking about that dialogue of people going.

You know, the challenge of and of on people self assessing online going, think this is me having read stuff, like, there's a huge benefit to that because people recognize ADHD themselves and come forward. But there is also the problem that some of those conversations aren't saying how serious ADHD, the level that's needed, and so people self diagnose incorrectly. And it's a very, very difficult conversation. Okay, then you get assessment, you guys talk, so we have already expanded in The UK, so you can be seen by a psychiatrist, a clinical psychologist can diagnose. We also have nurse practitioners, so they're nurses who've got, taken additional training to become prescribers. We also have that, for pharmacists, so pharmacist prescribers.

But if you're a GP, you can't, assess. There is a new course that's been developed by the Royal College GP. My understanding because no one's done it yet. And so you've got this sort of messy it's a it has to be a specialist, but it's it's a it's a group. When we've talked to the people who actually wrote the NICE guidelines who put in that criteria, a specialist, but didn't specify, they did they say they did that on purpose because they knew that the level of psychiatry isn't substantive enough, it's already overworked with the work that's there, and that different options were going to be needed. And so they built that into the NICE guidelines. And then you've got if you go down the NHS pathway, you have to have the GP referral.

I talked previously before about right to choose option, versus local. The local, though, does something else often. It triages. I was invited to go to a select committee in parliament, and, when I spoke about triage, I just said the thing about triage because what people hear is, oh, we just segment on need. We see those in, you know, if this is an ER, you know, we the people who have got their leg chopped off, we see them first and one go, we've got a sniffle, we see them last. But everyone gets seen.

But that's not what happens here. If because of the overwhelm of the system and the system is not fit for purpose, if you're not triaging to that top group, you're not getting seen. And that means you're not getting supportive medication. You're not and what that really means is you can only get seen once you hit crisis. Are you at risk of suicide? Are risk of harm to yourself or others? Are you risk of having your family breaking up in family court? That list is the actual triage list for, an area of Yorkshire. Risk of suicide, harm to others, family court. And even despite that, it took them a year to see the first people on that list.

And we're seeing more of that come in. Then you've got a twelve to two thousand year wait assessment by all the different providers. Sometimes we see a second medication wait. We see that quite often in the local system. And that can be like a person in my family had to wait three years. So they got assessed in their first year of university and didn't get seen till the last year, didn't get medication till the last year. Entire life trajectory changed. And then we've talked about the industrial dispute. Yeah. I think I've covered it, but we covered a lot of it before. I'm obviously aware of time. I don't wanna muck your MC ing up. Right.

Well, I I'm I'm glad we don't have those challenges. But we all do have our challenges as well. I think it's terrific that we can we can share this information. Well, I think it's also fair to say, Henry, in the next week or two, a lot of the presentations that have been done today yesterday and today will be up on websites and available for people to review, and I would I would invite viewers from all countries to be able to access those sites and watch these videos again.

Is that is that fair? That is. Yep. And they're all on they will be on YouTube as you all know. Here before. We segment them up and put them up onto YouTube afterwards so people can go back and and see them. It's a delight having everyone here. Like, it's and you'll get together. Yes.

It is. What we all know one day. Right? In in in person. I met Melissa, right, last year, so, you know, and I hope the rest of you Yeah. Very good. Next year. So hope to see you.

Henry, it's so good of you to host us. It's wonderful to be here to host We hosted together, isn't it? I can't I think it's a wonderful collaboration, and it's a big deal. This conference is very special. Mhmm. And actually, we can take a moment to celebrate it because we all come together and contribute in our different ways. Obviously, Australia and UK taking the streaming lead and it We get extraordinary people giving their time for free and allow us to get information to people and to celebrate ADHD awareness month in a really positive way, in a way that helps change people's lives. This is now the fourth year, and it keeps getting bigger and bigger and bigger, and it's wonderful. Genuinely, it's wonderful. I yesterday.

You'd expect me to be exhausted, and I was just so happy. I'm looking forward to today. Yeah.

The the interesting thing, Henry, when we first did this, and I remember three years ago, you know, we we met and there was a couple of weeks to to pull it all together for for The UK for the Australian team, should I say, because we obviously wasn't part of it then. And in true ADHD style, we went, okay. We could do it. And two weeks later, we've got this big GoPro conference. And then from then, Rob said to me, right, what we're gonna be doing now is we're going to be making sure that we're more planned. And then last year, what was really interesting was a little bit more planned, but we still did somewhat procrastinate. And then this year, Rob was like, no. We're getting this in order. And for the first year ever.

Thank you to Rob. And this is why we celebrate diversity and need people that are neurotypical in our team because if everything was left to true ADHD Melissa, it'd procrastinating right until the last week and the global conference would come out. But thanks to Rob and the team, it's helped us to be able to bring it all together. And, you know, Henry, as always, the amazing, amazing presentations by the UK team and fantastic. And it's just great to get to see everybody. Again, Moon Lake, definitely, we're gonna get to meet again in person. It was great when we got to catch up with The States. And one day, we'll get to see yourself, Darwin and Henry, and I'm sure we'll be talking all things ADHD.

And comparing countries. I'm hoping by then, Henry, The UK's come on a little bit more.

I mean, it's gonna be exciting times. It's It's weird. Like, the next few months are gonna be a big deal. We're about to kick off a really big legal push, which we're talking about in the last hour of our segment. And if we're successful in that, we'll we'll have changed everything. But I can tell you the government will not want us to be successful it has knock on impacts for their metrics. And but I think the big big issue, which I think we all have to fight, is defeating the issue that the idea that ADHD people are just an expense, that we're broken and in fact that we can be amazing and do extraordinary things. But an assessment, the understanding that brings the medication intervention for those that want it, are game changing. And.

Well, certainly in The UK, you know, we've got wait times. We've always got that one at two thousand years, but over ten years is not uncommon. And we have other problems that when you turn 18, you get past the adult services and you get dropped, And you get so you get put to the back of the queue. You we we snatch. And actually, that's what is happening right now. We're snatching victory. We're snatching could I get it wrong way around? Snatching defeat from the jewels of victory. We're actually progressing here, but it's being reversed. It's listening to you is wonderful, hearing the positive side. Yeah. And hopefully, year, we can join you in saying we've had progress.

Well, we'll be here and then we'll have that conversation.

Oh, really? Right. Who's gonna do the sign out from Australia? It's it's that it's time. So who wants to do the goodbye? Melissa?

Yes. Look, I just want to say absolute huge thank you to everybody across the globe that today has listened and participated in for those individuals that will be after as well because I know some have been sleeping during the period of time. I want to say a huge thank you to you, Henry, the dedicated hours that you've given to ADHD Australia to to make this happen. And Moon Lake, Darren, it is absolutely amazing to hear your stories in your countries and hear a bit more about what's happening and actually how similar we are over here in Australia. So but look to to finalize, I just want to do a call out to the ADHD volunteer team. This conference would not happen without you, Rob. Your dedicated.

Hours upon hours of every single moment of, you know, what you have given to ADHD Australia. We also have Matt Cameron behind the scenes. People have not seen him, but he's been tech all day and, you know, constantly working exceptionally hard. Andrew, that you've got to see at at various different points and many, many others. But this is a a real team effort, and it could not have happened without of all of our volunteers. We've had exceptional speakers, and I want to just do big shout out to every single professional today, whether that be a carer, a person with ADHD, a professional, all of our medics and researchers.

Everybody that's come in to do the conference for us and to educate the globe. So thank you so much. We are really, really excited for next year. Maybe we need a bit of sleep before then, but we will be here again next year. And hopefully, we'll have some more countries join us as well. So thank you everybody.

That's all. Thank you, Fiona.

For Australia and UK officially taking over. Thank you, Dan. Thank you. Moon Lake, you guys are amazing. Wonderful to see and correct on what you've been doing. Melissa and Rob, ADHD Australia and UK, we do this together. We we do each other's respective nights and and operate in the days, and it's absolutely wonderful. Like, the reason this has this energy is this ridiculous idea that we just livestreamed for it was twenty four hours now. I think it's twenty eight hours and we're ruminating on making it even longer next year.

We'll have to talk to you people, but yes.

And it gives it an energy that brings people in and and has and is wonderful. So thank you for well, it's great. I love doing this with you. So brilliant. And then time for us to take over. So goodbye. Goodbye, Australia. Bye.