Psychiatry UK

3. Mr O complains about the care Psychiatry UK provided him between October and November 2023. Specifically, he complains about the way it carried out an ADHD assessment. He considers this assessment was not robust and the assessor did not understand answers he gave before and after.

4. He also complains that it did not properly consider new information he provided after the assessment. He considers this new information should have led it to reconsider the outcome of the assessment.

5. Mr O says the experience left him feeling abandoned at a time when he was already distressed. This caused him stress, disruption and affected his wellbeing.

6. In bringing the complaint to us, he would like Psychiatry UK to apologise and make service improvements.

7. What follows is a summary of events. We have not included all details as both parties are aware of this.

8. At the time of events Mr O was 33 years old. On 27 January 2023 his GP referred him to Psychiatry UK for an ADHD assessment via NHS Right to Choose (this is a pathway where the patient chooses which hospital or service they go to).

9. On 27 February Psychiatry UK added Mr O to the waitlist for assessment. It asked him to complete screening forms on its online portal. This included an informant report for a family member to complete.

10. On 30 October a psychiatrist carried out an ADHD assessment. They considered Mr O did not meet the criteria for ADHD diagnosis.

11. On 8 November Mr O raised concerns with Psychiatry UK. He said it did not tell him to gather information about his childhood from family members, meaning he asked his partner (who had only known him as an adult) to provide supporting information.

12. Mr O sent Psychiatry UK new information about his childhood from his mother. He asked it to reconsider his case either by reevaluating his case with the new information or providing a second opinion.

13. On 24 November Psychiatry UK spoke to Mr O. It advised it could not provide a second opinion. It sent over another informant report for Mr O’s mother to complete. Mr O’s mother completed this the same day, and he sent this across.

14. On 27 November Psychiatry UK advised it had reviewed the new information alongside information from the assessment. It did not consider this changed the assessment outcome. It told Mr O he could ask his GP for a re-referral if his symptoms worsened.

ADHD assessment

18. Mr O complains about the way a psychiatrist carried out an ADHD assessment. He considers they did not understand answers he gave before and during the assessment. He also considers the scoring tool they used was not right for him.

19. The relevant guidance for this aspect of the complaint is NICE guideline 87 (NICE guidance). This says only a specialist psychiatrist or other appropriately qualified healthcare professionals with training and expertise in the diagnosis of ADHD should make a diagnosis.

20. The guidance explains assessing clinicians should carry out a full clinical and psychosocial assessment of the person including discussion about behaviour and symptoms in the different domains and settings of the person’s everyday life. They should obtain a full developmental and psychiatric history, observer reports and carry out an assessment of the person’s mental state.

21. Mr O had an ADHD assessment on 30 October. Clinical records show a psychiatrist specialising in ADHD carried out the assessment. Our adviser confirmed this was an appropriately trained clinician as per NICE guidance.

22. Documentation from the assessment shows the psychiatrist reviewed information within Mr O’s partner’s informant report and Mr O’s ADHD self-report. Both Mr O and his partner completed these ahead of the assessment. The psychiatrist took Mr O’s: • psychiatric history • medical history • personal and developmental history • drug and alcohol history • family medical and psychiatric history.

23. We can see the Psychiatrist noted nothing of significance in the above areas. They also carried out a mental state examination which showed Mr O interacted appropriately and demonstrated a stable and responsive emotional stage.

24. Clinical records show the psychiatrist used diagnostic criteria from the Diagnostic and Statistical Manual of Mental Illnesses (DSM-5) to score Mr O’s answers. We recognise Mr O considers this tool was not right for him. NICE guidance makes it clear that clinicians can use DSM-5 to reach a view on ADHD diagnosis meaning we cannot say that the psychiatrist’s decision to use this was wrong.

25. Our adviser reviewed notes from the assessment and confirmed these show consideration of current symptoms, patient need and occupational circumstances. They did not have any concerns about the conclusions the psychiatrist reached. They said clinical records contain what they would expect to see from a robust ADHD assessment.

26. Mr O considers the psychiatrist did not understand answers he gave before and during the assessment. It is not possible for us to establish whether there was a difference between what he meant and how the psychiatrist perceived this using the available evidence. Our adviser said the psychiatrist would have had no reason to doubt what Mr O was saying and the evidence suggests they took his answers at face value.

27. We recognise the result of the ADHD assessment did not meet Mr O’s expectations as he was hoping this would lead to diagnosis. The evidence suggests the psychiatrist carried out the ADHD assessment in line with NICE guidance. We have seen nothing to suggest this was not robust and have seen no indication of failing. We recognise Mr O strongly asserts the assessment was not fit for purpose.

Consideration of new information

28. Mr O complains that Psychiatry UK did not properly consider new information from an informant report his mother completed after the assessment. He considers this new information should have led it to change the outcome of the assessment.

29. The relevant policy for this aspect of the complaint is Psychiatry UK’s policy on ‘Adult ADHD assessment and treatment’. This says clinicians use information from the patient’s self-report and informant report towards a diagnosis.

30. Mr O says Psychiatry UK did not make him aware someone who had known him since childhood needed to complete the pre-assessment informant report. This meant he got his partner who has only known him as an adult to complete this.

31. Clinical records from 27 February show Psychiatry UK contacted Mr O via email advising he needed to complete screening forms on its online portal. It advised him the informant report was for a family member who knew him well to complete. Given that the report asked questions about Mr O’s childhood we cannot say there was a lack of clarity about who needed to complete it. Mr O provided Psychiatry UK information from his mother about his childhood on 8 November. He asked it to reconsider its view on diagnosis or refer him to another clinician for a second opinion.

32. The psychiatrist advised that the outcome of their assessment was based on the information Mr O provided before and during the assessment. They said they did not feel comfortable doing a reassessment and could not make any decisions regarding a second opinion.

33. The same day Mr O asked Psychiatry UK to refer him to another professional for a second opinion on his initial assessment. Mr O continued to engage with Psychiatry UK and on 24 November it provided a second informant report for his mother to complete. Mr O forwarded across the completed second report the same day.

34. On 27 November Psychiatry UK advised Mr O that its clinical lead had looked at all the information from the assessment and the initial information. The clinical lead agreed with the original assessment outcome.

35. Mr O asked Psychiatry UK how its clinical lead had come to their decision. Psychiatry UK explained its clinical lead had taken everything into account in line with the diagnostic criteria, including the information his mother provided and agreed with the original assessment outcome.

36. We note Psychiatry UK’s policy does say it can offer a follow up appointment if a service user provides information from their childhood after the initial appointment. The policy does not say this is something it has to do. In this instance we consider it had a responsibility to properly consider the new information Mr O had already provided

37. In seeking clinical advice, we understand that the psychiatrist would only reconsider a decision not to diagnose if the new information Mr O provided showed evidence of more ADHD impairment than they had already seen. We note Mr O wanted a second opinion. Our adviser explained that whilst there is no right to a second opinion within the NHS, Psychiatry UK did provide a second opinion on Mr O’s assessment in house by getting a separate clinician to review it. They said both clinicians appropriately considered the new information Mr O provided and reached reasonable conclusions.

38. We recognise Mr O considers the new information he provided after the assessment should have led to him receiving an ADHD diagnosis. We acknowledge the distress Mr O experienced during the period of complaint. We are pleased to hear he has since obtained an ADHD diagnosis via a different provider.

39. The evidence suggests that Psychiatry UK appropriately considered the new information. We have seen nothing to suggest the conclusion it reached was unreasonable and have seen no indication of failing. We hope we have explained our decision clearly.

1. We have carefully considered Mr O’s complaint about Psychiatry UK. We are sorry to hear about the stress and disruption he experienced during the period of his complaint.

2. Mr O complains about the way Psychiatry UK carried out an ADHD assessment and considered new information he provided after this. We have seen no indication that anything went wrong in the issues Mr O raises and therefore will not be taking any further action.