ADHD Services at Breaking Point: Understanding the Backlog Crisis

The United Kingdom is facing a growing crisis in ADHD assessment and diagnosis services. Demand for ADHD evaluations has exploded in recent years, far outpacing the capacity of the NHS and private providers. The result is ever growing waitlists and unacceptable delays for patients seeking life-changing care. Many areas now report backlogs so severe it would take years to clear them at current rates. In this first part of our series, we unpack the scale and causes of the ADHD backlog,  from soaring referrals to staffing gaps,  and why it demands urgent attention.

Soaring Demand, Limited Capacity

ADHD awareness has increased dramatically, leading to a surge in referrals. In fact, NHS England data shows ADHD was the second most-viewed health condition on the NHS website in 2023, indicating the heightened public interest. Referral rates have risen fourfold since 2019, according to a BBC investigation. This spike is partly due to greater recognition of ADHD in adults and previously underdiagnosed groups, for example, more women seeking diagnosis in adulthood.

However, service capacity has not kept up. Many NHS clinics lack the necessary staff and resources to handle the influx. Experts describe a “massive mismatch” between demand and the system’s ability to deliver ADHD diagnoses, with a severe lack of trained psychiatrists available. The Royal College of Psychiatrists warns that the NHS simply doesn’t have enough clinicians with the appropriate training, experience and time to provide timely, quality assessments. Broader workforce data reflects these staffing gaps: as of late 2023, around 28,600 positions in mental health services were unfilled, roughly 19% of the workforce,  highlighting widespread shortages.

This combination of skyrocketing referrals and limited specialist capacity has created a perfect storm. Some NHS trusts have even had to close their waiting lists entirely, unable to accept more patients into an already overwhelmed system. Private providers, often seen as a fallback, are also feeling the strain. By early 2023, many private ADHD clinics had shut their doors to new referrals because they were “swamped” by demand. In other words, no part of the healthcare system has been spared the pressure.

Ballooning Waitlists and Multi-Year Delays

The impact of this imbalance is starkly visible in the waitlist numbers. A mid-2024 BBC investigation found that across the UK, at least 196,000 adults were stuck on ADHD assessment waiting lists. In roughly half of services reviewed, the backlog was so large it would take eight years or more to clear at the current pace. Such figures are almost unimaginable – yet they match reports from patient advocacy groups. For example, ADHD UK’s data (though incomplete) suggested tens of thousands of adults and children waiting, with some regions reporting waits of 8–10 years for an assessment.

Even “average” waiting times are far beyond acceptable standards. There is currently no formal maximum wait target for ADHD diagnoses under NICE guidelines, and the lack of national data makes it hard to measure. However, surveys and regional audits paint a bleak picture. One parliamentary survey found a quarter of people awaiting an NHS ADHD assessment had already been waiting over a year, and about 10% had waited longer than two years. These averages hide even more extreme cases: one NHS trust’s backlog topped 6,000 patients, yet it managed to assess only three patients in an entire year. In another area, an adult who had been referred was still in the queue 443 weeks later (8.5 years) with no end in sight.

With such prolonged waits, many patients feel forced to seek private diagnosis despite the cost. Those who can afford it sometimes pay out-of-pocket rather than spend years in limbo. Unfortunately, private pathways are not a panacea; as noted, the larger providers have also struggled, and some have imposed their own waiting list freezes. For people without the means to go private, there may be no choice but to wait indefinitely or travel far from home for an assessment. Geographical “postcode lotteries” have emerged, where wait times vary wildly depending on the region. Inconsistencies in data reporting mean that in many areas, even local NHS commissioners cannot say exactly how long their ADHD waitlists are – a sign the problem’s full scale isn’t even fully tracked.

Impact on Patients and Care

These delays have devastating consequences for individuals and families. ADHD is highly treatable,  proper diagnosis followed by medication and therapy can significantly improve a person’s daily functioning and quality of life. Yet untreated ADHD leaves people struggling with symptoms that affect their education, work, and relationships. “Pretty much any adverse outcome you can think of is more likely if you have untreated ADHD,” warns Dr. Max Davie of ADHD UK, noting that society faces “excess adversity” because so many are not getting help quickly or effectively. Indeed, stories from patients illustrate the toll: one young woman in Sheffield waited two years for an assessment and felt “speechless” and hopeless on learning that thousands ahead of her might mean she never gets seen Another patient described feeling so distressed by the endless waiting and lack of understanding that she experienced suicidal thoughts– a tragic outcome that timely care might have prevented.

Beyond the personal suffering, these backlog delays can also pose broader safety and system risks. General practitioners, for example, are often hesitant to initiate ADHD medications without a specialist’s diagnosis and oversight. This can leave patients in limbo without treatment or drive them to seek unregulated sources of help. Moreover, overstretched services with long queues may struggle to monitor those on waiting lists, potentially missing those whose condition deteriorates while they await assessment.

The crisis has grown so acute that it’s now recognized at the national level as a systemic failing. The government itself has described the delays in ADHD diagnosis as part of a “broken NHS” in need of fixing In March 2024, NHS England launched a cross-sector ADHD Taskforce to address these challenges, acknowledging that rising demand, service variation, and data gaps require a coordinated response. Professional bodies like the Royal College of Psychiatrists insist that “no one should be made to wait years for life-changing care” underscoring the ethical imperative to act.

Facing the Backlog Crisis

The growing ADHD assessment backlog is a complex problem fueled by both external pressures and internal constraints. Surging public awareness and referrals have exposed the chronic under-resourcing of neurodevelopmental services. Without enough qualified clinicians or clinics, even good policy intentions fall short on the ground. The result is untenable waiting times that leave patients in distress and clinicians frustrated. If there is a silver lining, it’s that awareness of this crisis is leading to calls for innovation and reform. Tackling the backlog will require multiple strategies – from expanding training and funding, to optimizing how existing teams work.

In our next installment, we will explore one critical piece of the solution puzzle: the process of onboarding new staff. While hiring more clinicians is essential, how we bring them into service can dramatically affect how quickly clinics can scale up ADHD assessments. Inefficient onboarding and compliance processes may be silently contributing to the backlog by slowing down the rate at which new providers can start seeing patients. Understanding and fixing those internal bottlenecks could directly boost assessment throughput, enhance patient safety, and improve staff morale – all key factors in beating the ADHD backlog.

Sources:

• Burns, C. et al. (2024). BBC News – Eight-year ADHD backlog at NHS clinics revealed.bbc.com
  Foster, A. & Crew, J. (2024). BBC News – NHS cannot meet autism or ADHD demand, report says.bbc.co.uk
  Topping, A. (2023). The Guardian – ADHD services ‘swamped’, say experts as more UK women seek diagnosis.theguardian.com

ADHD UK. (2023). NHS ADHD Assessments Waiting Lists Report.adhduk.co.uk
Care Quality Commission. (2014). Health and Social Care Act 2008 (Regulated Activities) Regulations: Regulation 19.