Patients are being offered powerful drugs and told they have attention deficit hyperactivity disorder (ADHD) after unreliable online assessments, a BBC investigation has found.
Three private clinics diagnosed an undercover journalist via video calls.
But a more detailed NHS assessment in person showed he didn’t have the condition.
The clinics say they conduct thorough assessments and follow national guidelines.
Panorama spoke to dozens of patients and whistleblowers after receiving suggestions about poor-quality, rushed evaluations at private clinics, including Harley Psychiatrists, ADHD Direct, and ADHD 360.
All three diagnosed undercover reporter Rory Carson with neurodevelopmental disorder, a recognized medical condition that affects behavior and can be considered a disability under the Equality Act 2010.
The investigation found that:
- The clinics did only limited assessments of the patients’ mental health
- Potent drugs have been prescribed for long-term use, without advice on possible serious side effects or adequate consideration of patients’ medical history
- Patients who posted negative reviews have been threatened with legal action
- The NHS is paying thousands of patients to go to private clinics for assessments
Commenting on the Panorama findings, Dr Mike Smith – a consultant psychiatrist at the NHS – said he was seriously concerned about the number of people who could ‘potentially have been misdiagnosed and started taking medication inappropriately’.
There has been a large increase in the number of adults seeking ADHD diagnoses in recent years, due to successful treatments and increased awareness of the condition. Support groups say it has long been underdiagnosed.
Discussion of ADHD is rife on social media, with #ADHD drawing more than 20 billion hits on TikTok alone.
In some areas, it can take more than five years to get an NHS assessment, so many patients are willing to pay hundreds of pounds to be seen at private clinics instead. The NHS is also collecting bills for thousands of these private assessments, as part of the government’s campaign to bring down waiting lists.
Having ADHD can be considered a disability – it depends on whether or not someone’s condition has a “substantial” and “long-term” negative effect on their ability to carry out normal daily activities.
The Panorama undercover reporter answered questions about her symptoms truthfully during each of the assessments. However, he did not tell the private clinics the real reason he had booked the appointment.
His first assessment was during a face-to-face meeting with Dr Smith, who heads a specialist adult ADHD service in the NHS.
Carson and her family filled out questionnaires about her habits and childhood history before an appointment that lasted more than three hours. He involved a full psychiatric evaluation. Her assessment followed guidelines issued by the National Institute for Health and Care Excellence (NICE).
Some of the symptoms of ADHD can include things that many people experience, such as fidgeting, distracted, and acting impulsively. But NICE guidelines say someone should only receive a diagnosis of ADHD if those symptoms are severely impacting their life.
Dr. Smith concluded that Carson does not have ADHD.
There are 18 recognized symptoms that may indicate someone has ADHD, and Carson has not reached the clinical threshold for just one of them.
But when the journalist went undercover at Harley Psychiatrists, he was given a score of 15 out of 18, after a 45-minute video call with a psychologist.
He paid 685 for his evaluation and the psychologist told him, “There’s no expiration date on this. You’re diagnosed for life.”
More and more people are turning to private clinics for an evaluation to determine if they have ADHD. Panorama investigates whether some are giving unreliable diagnoses
Watch the full investigation on BBC iPlayer and BBC One on Monday 15 May at 8pm in England and Scotland and 8.30pm in Wales and Northern Ireland
There was a follow-up appointment with a psychiatrist a week later, lasting less than 10 minutes, during which Carson was prescribed a stimulant called methylphenidate.
This is a standard treatment for ADHD. The drug interacts with chemicals in the brain and can help someone with the condition focus better, be less impulsive and feel calmer.
The drug is considered safe and effective for most people who have the condition, but it can have serious side effects for some patients, such as those with heart problems or some mental health issues.
Being exposed to this drug if you don’t have ADHD can be a dangerous health risk, according to Dr. Smith, and can also exacerbate existing mental health conditions. Stimulants used to treat ADHD are Class B drugs – controlled substances under the Misuse of Drugs Act.
Harley’s psychiatrists did not ask the BBC reporter detailed questions about his mental health before prescribing the drugs, and he was not warned of the potential for serious side effects.
Lawyers for Harley Psychiatrists said Panorama doctors are also taking into account information contained in the pre-assessment forms: “The suggestion that there is an elevated risk that our client is misdiagnosing adults with ADHD is false and baseless, as well as the suggestion that proper controls are not being conducted.”
They said “the diagnosis of ADHD depends on the answers the patient provides” and there have been “a number of patients who have not been diagnosed with ADHD.”
Lawyers said the clinic accepted that Carson “shouldn’t have been able to get a prescription” and has updated its processes.
Lawyers for the psychologist Harley who evaluated Carson told us that while her tests produced results “suggestive of an ADHD patient,” that “diagnosis is formally made by a psychiatrist.”
Lawyers for the psychiatrist – who prescribed the drugs – said their client supported his diagnosis. It would have “normally taken him between 30 and 45 minutes” to complete the consultations, they said, but in this case he “didn’t feel it was necessary” because of the psychologist’s report.
Carson also had an assessment with Glasgow-based ADHD Direct.
He was evaluated by a nurse who was new to the clinic and supervised by another nurse. NICE guidelines state that assessments should be conducted by a psychiatrist or suitably qualified medical practitioner.
The evaluation lasted one hour and 40 minutes and cost 1,095. The nurses asked more probing questions than Harley’s psychiatrists about Carson’s medical history—and he and his family were asked to fill out a questionnaire beforehand. But Carson says the rating still felt “like an exercise to tick off.”
Again he was diagnosed with ADHD during a follow up appointment and offered a prescription for stimulants.
The reporter revealed to the clinic that he was an undercover reporter before going any further.
ADHD Direct’s lawyers said there would be more checkups before Mr. Carson gets the drugs. They say the evaluation of him included a “complete developmental and psychiatric history” and the clinic “supports the diagnosis of him.”
“ADHD is under-identified, under-diagnosed and under-treated,” the lawyers added, saying the clinic “has no incentive to overdiagnose” and that an audit had found that “10% of patients seen he didn’t have ADHD.”
The undercover reporter also booked an appointment online with ADHD 360, a Lincolnshire-based clinic, which assesses thousands of NHS-funded patients.
The patients and former staff had told the BBC that the appointments were short and almost everyone who went there was diagnosed with ADHD.
One doctor said that while working for ADHD 360 he saw a patient “every hour, every hour” and that he didn’t think it was safe. ADHD 360 says doctors should do just two assessments a day.
Carson was evaluated by a pharmacist. He did not take a full psychiatric history, but diagnosed the reporter with ADHD after an hour and 15 minutes. He also prescribed stimulant drugs, without proper supervision.
ADHD 360 claims to be a regulated NHS provider and offers “best-in-class assessment, diagnosis, treatment and care” to thousands of patients. Its “qualified clinicians” are trained in its own academy and its “assessments meet all accepted best practice.”
On this occasion he states that his “time-barring policy has unfortunately not been followed” and that “procedures have now been reviewed” and improved.
People who spoke to Panorama also expressed their concerns about the quality of care private clinics offer to vulnerable patients who come to their services in desperation because NHS waiting lists are so long.
Casey faced a three year wait for an ADHD assessment with the NHS and borrowed nearly 700 to be seen by Harley Psychiatrists.
She says she was diagnosed with ADHD – by the same psychologist as the BBC reporter – after a video call that lasted about 40 minutes.
Casey posted a number of negative reviews online and the clinic sent her a letter – seen by Panorama – stating that she had written “potentially illegal” reviews and that the matter had been passed on to the company’s legal department.
The BBC is aware of a number of other apparent legal threats made to patients after they left negative reviews of Harley Psychiatrists.
The clinic’s lawyers said they have the right to request the removal of false and defamatory reviews.
There’s no question that many people who come to private clinics will have ADHD, but experts say patients may not get the right treatment if the assessment is unreliable.
“These people were supposed to help me and they took advantage of me,” Casey told the BBC.
“I wasn’t someone who was struggling with their mental health and needed help, I was just money to them.”
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