Who this service can't see

Where the psychiatric picture needs a psychiatrist

ADHD rarely turns up on its own. Some conditions sit alongside it in ways that change how stimulants behave, or that can't be reliably told apart from ADHD in a single appointment. These need someone with more time and more scope than a GP pathway has.

• Psychosis of any kind, including psychosis brought on by stimulants

• Bipolar disorder, either type

• Complex trauma that is active or untreated, sometimes called complex PTSD

Trauma and ADHD overlap in several ways — trouble concentrating, strong emotional reactions, restlessness, feeling switched off or detached. When trauma is unsettled, those overlaps can't be reliably separated in one appointment, and trauma treatment usually needs to come first. A history of trauma is not itself a barrier. Many adults with ADHD have one. If you are in treatment and things are reasonably settled, this pathway is open to you — please mention it in your referral.

Where current substance use changes the picture

Stimulants are controlled medicines. Where there is active substance use, two things happen at once: the safety of prescribing changes, and the assessment itself becomes unreliable, because it is no longer clear which difficulties belong to ADHD.

• Substance use disorder, including alcohol

• Current participation in the opioid pharmacotherapy program

• A record of dependence, or of oversupply of a controlled medicine

• Current THC use, whether prescribed as medicinal cannabis or not

THC can mask some ADHD symptoms while independently driving anxiety and motivation problems, which makes judging whether medication is working unreliable.

Where safety has to be settled first

Some situations need to be stable, with a treating team already in place, before ADHD assessment is the right next step.

• Active suicidal thoughts, self-harm, or other high-risk presentations

• A current eating disorder involving restriction or purging, or one active in the past 12 months

ADHD medication reduces appetite, which risks making these conditions worse, and safe prescribing needs heart tracing and monitoring that sits better alongside eating disorder treatment than apart from it. Binge eating disorder without restriction or purging is not affected and can be assessed here.

Where the assessment needs more than an appointment can give

Some presentations need formal testing, or a level of detail that a structured GP assessment isn't built to deliver. Going ahead anyway would risk an answer nobody could rely on.

• Significant intellectual disability

• Autism spectrum disorder, Level 3

• Anyone who needs comprehensive neuropsychological assessment

• Anyone who needs intensive behavioural treatment beyond what general practice can provide

Where the prescribing itself is limited

These are limits on what a designated GP prescriber is permitted to do, rather than judgements about you.

• Atypical or concerning responses to previous ADHD medication

• A stimulant dose above the WA routine maximum

• A ScriptCheckWA authorisation flag. ScriptCheckWA is the state prescription monitoring database, and some patients' profiles carry a flag on them. This one only becomes visible at the point of prescribing rather than at referral. Where the flag is present, a designated GP cannot prescribe at all.

Age and location

• Children under 10

• Ages 10 to 15 are seen through Paeds Plus, with paediatrician support alongside. For a young person starting a stimulant, having paediatricians in the same building is worth more than convenience.

• Anyone living outside Western Australia

This service is also not a crisis service, a second-opinion service, a medico-legal or third-party report service, a psychology or therapy service, or a route to stimulants for another indication.