Rule-breaking GP may yet see ADHD treatment changes he fought for

It's taken five years and 312 meetings but agreement on the changes needed to improve the management of Attention-deficit/hyperactivity disorder (ADHD) has finally come.

The chairman of ADHD NZ, Darrin Bull, has given 1News an exclusive insight into the latest meeting of minds, saying, "I never thought I'd see the day when all the Royal Colleges, the health sector, and the Government would agree on what's needed".

There's consensus for the removal of the special authority renewal process that patients with ADHD have to go through every two years. The process requires a costly appointment with a psychiatrist and can involve waiting times of months during which medication might run out.

There’s also a short-term goal to allow GPs to receive extra training to manage ADHD as a chronic condition, as they do for other chronic conditions like asthma. In addition, there's a long-term goal for comprehensive guidelines for the treatment of ADHD to be written. Once in place, this will support the idea of special training for GPs to enable them to diagnose ADHD.

ADHD NZ has spearheaded the campaign. But chairman Bull said East Auckland GP Dr Tony Hanne paved the way.

"He was the only one who spoke out when restrictions were tightened in the '90s," Bull said.

Dr Hanne has paid a high price for his advocacy. Tonight's episode of Sunday details how he's been suspended by the New Zealand Medical Council for one year, banned from prescribing restricted Class B ADHD drugs for three years, and ordered to pay costs and fines of $175,000.

The penalty is in response to Dr Hanne ignoring current rules and continuing to treat patients with ADHD. Dr Hanne said he saw it as his duty and felt he couldn't let his patients down.

In the '90s, there were no regulations against GPs diagnosing ADHD and prescribing drugs as well as offering other therapies such as counselling. But a rapid rise in cases in the US towards the end of the century sparked fears of over-prescribing, and restrictions came into place.

Dr Hanne, who had become one of the country's leading specialists in ADHD, was able to continue his work under the supervision of a psychiatrist, Dr Allan Taylor. But when Dr Taylor retired, he was unable to find a replacement.

Dr Hanne told Sunday he wrote to the Ministry of Health, saying, "I've got all of these ADHD patients who are settled on medication, can you provide me with somebody? There was silence."

He said he then volunteered the information to the Ministry that he was going to continue to care for the many patients on his books. This meant continuing their prescriptions without the required psychiatrist sign-off over a period of at least six months.

His patients include people like Marsh Page, a man who's been in and out of jail all his life.

Dr Hanne had met Marsh while helping with a drug rehabilitation programme. He encouraged Marsh to undergo tests for ADHD, where he was diagnosed with the condition. Medication and counselling helped dramatically.

"I believe that if it wasn’t for Dr Hanne I’d be back in jail," Page said. Instead he is now living in the Auckland suburb of Ōrākei and has finally got his driver's license.

"Dr Hanne calls me a success story, and I think I am."

There are so many similar stories of lives dramatically changing for the better following a diagnosis for ADHD. Dr Hanne helped over 5000 patients over the years, many of whom were women who hadn't been diagnosed in childhood. This has sometimes been because symptoms such as lack of focus and acting on impulse haven’t been as widely recognised or picked up in girls, compared with the classic symptom of hyperactivity in boys.

Seeing the difference he could make was what drove Dr Hanne to break the rules. But for him personally, the outcome hasn't been good. He's closing his practice and has had to find places for his many patients elsewhere. His suspension also means he won't be able to help train other GPs over the next year – something he has been doing in the Pacific Islands, and has wanted to do here in New Zealand.

But this goal may yet be realised given the progress made at the Parliamentary hui on ADHD that took place last Thursday. Bull was amazed at the interest. It was attended by Corrections, the police, the NZ Drug agency, the Royal College of GPs, the Royal College of Psychiatrists, and the NZ College of Clinical Psychologists, as well as by representatives from all the main political parties.

"We finally agreed to remove barriers that are causing a treatment gap," Bull said.

It's a significant step forward for the ADHD community, Bull said.

"The amazing thing for me is that it started under Labour and is continuing under National and they all agree to keep going with it."

The office of National's Minister of Mental Health, Matt Doocey, said: "The minister is interested in moving this issue forward, however there is a formal process to work through".

"No commitments can be made until that process is worked through."

It's an issue that's been driven for years by Green Party co-leader Chloe Swarbrick, who has ADHD. She's worked with ADHD NZ and with successive ministers to ensure momentum continues.

Having organised both parliamentary huis, she's excited that substantial progress can now be seen, "we've made huge inroads these past two years with sustained effort and with the second parliamentary hui we've identified the solutions and accountable agencies to get things done".

Bull feels equally positive, saying while there are steps to through, the agreement between the groups and political parties for its direction is a win in his eyes.

"I've had interest from all over the world, other countries asking how we managed to get everyone to reach a consensus," he said.

Bull hopes the next steps happen in a timely manner so that patients can get the care they need, at a cost they can afford – but also in honour of Dr Hanne.

"My dream is to get most of this approved in time for Dr Hanne to see the change ... so that I can say, 'Mate, this is your legacy, this is what you did'."

For more on Dr Tony Hanne’s story and for an insight into the barriers ADHD patients face, watch Sunday tonight at 7.30pm on TVNZ1 or TVNZ+.

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