Australian Greens Additional Comments

1.1The Australian Greens thank all those who made contributions to this inquiry. Senators Janet Rice and Jordon Steele-John have been deeply moved by the personal experiences and openness of the hundreds of submitters and witnesses who have shared their ADHD experiences. The time invested by the ADHD community is appreciated.

1.2It has been troubling to hear of the ways the health, education, employment and justice systems have let people with ADHD down.

1.3Having considered the considerable and varied evidence provided, the Australian Greens are of the firm view that more can be done to remove barriers for people with ADHD so that they can receive the assessments, healthcare and support they need.

1.4The Australian Greens are providing additional comments to the majority report, as it is our view that while the recommendations are acceptable, there is more that the Australian Government could do to address thechallenges that the ADHD community have brought to the committee's attention.

1.5The Australian Greens would like to make the following additional recommendations:

1.6The Australian Greens recommend the Australian Government establish a Minister for Disability to coordinate disability issues, services and support systems in Australia and to ensure that improvements identified in this, and other inquiries and reviews are implemented. The position must be filled by a disabled person.

1.7The Australian Greens supports the Disability Royal Commission's recommendation to establish a disability portfolio and a Minister for Disability Inclusion.

1.8Ministerial responsibility and leadership for disability should be established to ensure that disability issues, services and support systems in Australia have the highest visibility and are coordinated in a way that works for disabled people.

1.9A Minister for Disability would ensure that the issues identified by this committee—and in so many other reports—do not continue to fall through the cracks. The position of Disability Minister must be held by a disabled person to give disabled people a voice and agency, and to ensure that government actions and responses address their true, rather than assumed, needs.

1.10The Australian Greens recommend the National Disability Insurance Agency improve the accessibility and quality of information around the eligibility of ADHD as a primary condition under the National Disability Insurance Scheme (NDIS), including (but not limited to):

adding ADHD to List A and List B on the NDIS Access List, noting that ADHD is a neurodevelopmental condition and access to the NDIS remains based on meeting the requirements outlined in the National Disability Insurance Scheme Act 2013;

reviewing the NDIS application processes to ensure they are accessible to people with ADHD;

reviewing communications, including information available on the website, to ensure information is clear for people with ADHD and healthcare professionals. This includes clear information about what the NDIA requires from them when making an application to the NDIS;

completion of neurodivergent-affirming training, including modules on ADHD, by all NDIA staff and contractors;

developing and requiring the completion of an ADHD training module for National Disability Support Partners and NDIS assessors, to improve awareness of ADHD; and

working with people with lived experience of ADHD about presentation of NDIS eligibility and access requirements.

1.11It is the Australian Greens view that much more needs to be done to support ADHDers. Many personal and organisational submissions identified the National Disability Insurance Scheme as the best avenue for support. Additionally, many identified the challenges they have experienced in engaging with the National Disability Insurance Agency; and it is clear that more needs to be done to provide agency staff with additional training, and for the NDIA to improve its communications available to current and prospective participants.

1.12The Australian Greens support the recommendations in the report. However, it is our view that the evidence given to the committee allows us to expand on those recommendations. The following are additional reflections and recommendations from the Australian Greens.

1.13Recommendation 1 states that ‘the Australian Government considers funding and co-designing a National Framework for ADHD, together with people with ADHD as well as ADHD advocacy and community organisations.’ In support of the community expectations:

1.14The Australian Greens recommend that a National Framework for ADHD should support children and adults with ADHD, and should:

be supported by an action plan with targets and regular evaluation against documented milestones;

chart a pathway for systemic reform across government, including changes to education systems, and healthcare systems such as Medicare and the Pharmaceutical Benefits Scheme;

implement shared models of care;

differentiate between medical and non-medical care pathways for both children and adults;

ensure culturally appropriate healthcare and support for First Nations peoples;

create additional information pathways and resources (including online information portals) for people with ADHD, their families and carers; and

promote ADHD awareness through public health information campaigns.

1.15Recommendation 3 acknowledges the need to review the Medicare Benefits Schedule to improve the accessibility of assessment, diagnosis and support services for people with ADHD. It is the Australian Greens' view that this review must take place as a matter of urgency. It is the view of the Australian Greens that to improve the accessibility of assessment, diagnosis and support services for people with ADHD, there must be:

an increase to the Medicare benefits payable, to increase bulk billing rates and reduce out-of-pocket expenses for diagnosis and ongoing health care;

an expansion of the number and range of services covered to include services provided by a range of professional groups (including psychologists, paediatricians, psychiatrists, general practitioners, nurse practitioners and other allied health professionals (e.g. psychoeducation and ADHD coaching); and

specific provisions for increasing rebates on long consultations, and the addition of Medicare items to cover shared and multidisciplinary team care by clinicians, general practitioners and other health professionals.

1.16Recommendation 4 acknowledges the need for a review of the Pharmaceutical Benefits Scheme (PBS). It is the community expectation that this review would enable:

subsidised access to the full range of available ADHD medications approved for use in Australia;

removal of the requirement for a childhood diagnosis for some medications, ensuring adults can access the medication they need; and

a review of age restrictions, maximum dosage restrictions and delivery methods for ADHD medications.

1.17Recommendation 5 acknowledges the need to expedite the development of uniform prescribing rules to ensure national consistency. The committee heard the significant impact the current prescribing rules are having on people. In this review, the Australian Greens are calling on the Ministerial Council of Health to include:

reviewing the prescribing conditions for stimulant medications, including an acknowledgement of the role of self-medicating and review of no prior known history of substance dependence;

removing current age access limitations and reviewing maximum dosages on some medications;

lessening restrictions on who can prescribe ADHD medications, with authority to be expanded to a wider range of appropriately trained healthcare professionals;

less restrictive co-prescribing arrangements;

extension of prescription validity across states and territory borders, over longer timeframes; and

clinician review requirements, including frequency.

1.18Recommendation 6 acknowledges the need for the government to improve access to accurate information about ADHD through an ADHD information portal. The Australian Greens heard through this inquiry that the priority for the community in this portal is to include information on:

available ADHD assessment, diagnosis and support pathways;

government funding and support available to people with ADHD;

where people can go to access further information and supports;

information about ADHD, and practical strategies which can be used by individuals with ADHD and their families, educators and employers; and

the specific contexts, needs and supports available to gender-diverse, First Nations, and culturally and linguistically diverse communities.

1.19Relating to Recommendation 9, it is the Australian Greens' view that the funding provided by the Department of Social Services for Advocacy Organisations and ADHD organisations needs to beon a needs-basis, and will include supporting people to make applications to the NDIS.

1.20The committee heard that there are significant areas of improvement to be made across industries including in educational settings, institutional settings and in the workplace. Recommendation 10 states that 'the Australian Government works to improve training on recognising and meeting the needs of ADHD people in a variety of settings, such as in education, institutional settings and the workplace, including considering setting minimum standards for neurodiversity training.'

1.21It is the view of the Australian Greens that the following recommendations reflect the extent of the challenges raised by the ADHD community:

1.22The Australian Greens recommend the Department of Education develop training in ADHD awareness and education and provide it to teachers, educators and pre-service educators. Such training should address the stigma associated with ADHD, including how it presents and an understanding of the supports available to children and adults with ADHD.

1.23The Australian Greens recommend the Department of Education further explore needs-based funding models to provide more support and resources for neurodivergent students and their families, including those with ADHD.

1.24The Australian Greens recommend the Australian Government, through the Education Ministerial Council of the National Cabinet, engage with the states and territories to establish minimum neurodiversity and ADHD awareness and training requirements for teachers and educators.

1.25The Australian Greens recommend the Australian Government, through the Education Ministerial Council of the National Cabinet, engage with the states and territories to establish nationally consistent recognition of Nurse Practitioners as valid diagnosticians for the purposes of ADHD diagnosis and subsequent educational support.

1.26The Australian Greens recommend the Department of Employment and Workplace Relations engage with businesses across Australia to deliver training and resources to ensure employers meet their workplace obligations, and more workplaces are suitable for a neurodiverse workforce.

1.27The Australian Greens recommend that the Department of Health, in conjunction with the Attorney-General’s Department develop guidelines for the diagnosis and ongoing healthcare support for adults and children with ADHD in institutions, prisons and correctional facilities. The guideline should stipulate how people with ADHD will have equitable and ready access to culturally appropriate ADHD diagnosis and support services while in an institution.

1.28The Australian Greens recommend that the Department of Health, in conjunction with the Department of Employment and Workplace Relations and the Attorney-General's Department, develop culturally appropriate training guidelines and programs for the workforce in out-of-home care facilities, prisons and correctional facilities, to assist them with identifying and meeting the needs of people with ADHD. The training should explain how people with ADHD should have equitable and ready access to ADHD diagnosis and support services while in an institution.

1.29The Australian Greens recommend the Department of Employment and Workplace Relations engage with healthcare colleges and other key medical training organisations to ensure that all core and allied health professions are given appropriate training on ADHD assessment and treatment. Ongoing professional development programs should target current healthcare professionals to ensure their skills are up-to-date. Such training should address the stigma associated with ADHD, including how it presents and may be treated, and how gender bias can impact assessment and treatment.

1.30Relating to Recommendation 15, it is clear there is an urgent need for the Australian Government to support further research to better understand ADHD and to address the stigma that people experience.

Recommendation 12

1.31The Australian Greens recommend that funding that is to be distributed through the National Health and Medical Research Council, Medical Research Future Fund and other research bodies should prioritise research conducted by neurodivergent researchers who are women or gender diverse people, First Nations people or members of culturally and linguistically diverse or lesbian, gay, bisexual, transgender, queer, intersex, asexual plus (LGBTQIA+)communities.

Senator Janet RiceSenator Jordon Steele-John

ChairParticipating Member

Greens Senator for VictoriaGreens Senator for Western Australia