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05 September 2022
Hon. Adrian Dix
Minister of Health
Parliament Buildings
Victoria, BC
V8V 1X4
Re: Improving training for health careprofessionals re: Attention Deficit and Hyperactivity Disorder (ADHD) in BC
Dear Minister Dix,
I am a family physician practicing in Vancouver. Since the Covid pandemic, I have been seeing many patients with mental health problems. More than 90% of my daily patients are mental health related. I have witnessed their struggles and how our healthcare system is failing them.
There are many aspects of our mental health care system that need to change but one of the most important places to start is to equip health care professionals with the tools and training that they need to recognize and address the early precursors to more serious mental health and addiction issues.
The purpose of this communication is to highlight the particularly urgent need to train family doctors, GPs, and psychiatrists in screening, diagnosing, and treating ADHD by including this condition in our provincial psychiatry and family medicine residency programs.
Since the COVID-19 pandemic, for a variety of reasons,patients who had been coping with anxiety, depression, and ADHD, are struggling more and this is leading to a crisis point in BC. The estimated prevalence of ADHD is 7% in children, with at least 60% experiencing impairment in to adulthood[1].
I understand the challenge of diagnosing ADHD both as a physician and as a parent. My son was not diagnosed until he was an adult. Isee firsthand the struggles. I also see how treatment changes lives and why it is so important to have better training on how to recognize and diagnose ADHD as early as possible.
I see how young people come off disability, start looking for job after years of failing in school and their jobs and their relationships, get promotions, starting school again, and thrive, with just a simple treatment. Fortunately, people are becoming more aware of ADHD symptoms and seeking help. However, there are very few physicians and even psychiatrists who feel comfortable diagnosing and treating this condition.
ADHD is a real neurodevelopmental disorder. Throughout Lifespan ADHD can have a negative effect on people’s lives in many domains like academic achievement, work and financial stability and social relationships. Rates Of ADHD among adult patients with other comorbid disorders: 9.4% of patients with Major depression, 21.2% of patients with bipolar disorder, 22.6% of patients with persistent Depressive Disorder, 9.5% of patients with any anxiety disorder,and 10.8% of people with Substance Use Disorder[2].About 1/3 of patients who were referred to an obesity clinic were subsequently diagnosed with ADHD[3].
We know that people with ADHD are twice as likely to be engaged in substance use; they start from a much younger age, their substance use is more severe, and the chance of a relapse is higher. Studies Also show there are many similarities in symptoms of these disorders with ADHD.If doctors are not adequately trained in this area, they can easily miss important information and treat patients in an entirely different direction which ultimately does not help the patient. Studies clearly show that physicians cannot treat comorbidities successfully if they don’t address the underlying ADHD.
I have personally had several patients who have been diagnosed with bipolar disorder and put on high doses of mood stabilizers and antipsychotics and they remained unwell. By treating their underlying ADHD they became stable on lower doses of their other medications. I have seen quite a few patients who were labeled as Borderline Personality Disorder, when their problem was actually severe ADHD, which is easily treatable. The reason these patients were missed is that our physicians, including psychiatrists, do not have enough training related to screening and treating ADHD.
There are two major centers in the lower mainland that I am aware of: one is the Access and Assessment Center (AAC) and the otheris the Surrey Mental Health and Addiction outpatient center where patients can self-refer. Both centers have a high number of people looking for help, and both are clearly announcing that they do not see ADHD in their clinics. Therefore,hundreds of patients are being missed, or treated in an incorrect way. Lack of enough training is the only reason for this ineffective approach.
It is surprising to see ADHD is not included or highlighted in our provincial psychiatry and family medicine residency programs. I strongly believe this needs to change. I encourage you to prioritize including this very important, easy to diagnose, easy to treat and life changing condition in the residency’s curriculum.
Please note that this request is in line with the second Pillar of CADDAC policy paper which is submitted to federal government and is now public. For more information, please refer to: https://caddac.ca/wp-content/uploads/Creating-Equitable-Access-to-ADHD-Care-in-Canada.pdf
If there is an opportunity to discuss more fully,I can be reached at:
...
Sincerely,
Dr. Mitra Motamedi,
Family Physician
CC:
1. Dr. Mark McKenzie, Family Medicine Residency Program Director and Shivangi Singh, Program Assistant
2. Dr. Irfan Khanbhai, Psychiatry Residency Program Director and Ahsan Sahibzada, Senior program assistant
3. Dr David May, President, BC College of Family Physicians
4. Toby Achmtman, Executive Director, BC College of Family Physicians
- President, BC Psychiatric Association
- Dr. Ramneek Dosanjh, President of Doctors of BC
1. Alex MacDonald, Senior Ministerial Advisor
2. Stephen Brown, Deputy Minister, Health
3. Shirley Bond, Official Opposition Critic for Health
4. Honorable Sheila Malcolmson, Minister of Mental Health & Addictions
5. Kelly Newhook, Senior Ministerial Advisor
6. Christine Massey, Deputy Minister Mental Health and Addictions
7. Trevor Halford, Official Opposition Critic for Mental Health and Addictions
8. Honorable Anne Kang,Minister of Advanced Education and Skills Training
9. Eric Peters, Senior Ministerial Advisor
10. Shannon, Baskerville,Deputy Minister, Advanced Education and Skills training
11. Coralee Oakes, Official Opposition Critic for Advanced Education
[1] American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. 2013. DOI: 10.1176/appi.books.9780890425596.
[2]National Comorbidity Survey; Kessler RC, et al. Am J Psychiatry 2006;163:716
[3] de ZwaanM, et al. Obes Facts. 2011;4(3):204-211. Pagoto SL, et al. Obesity 2009;17:539-544.
