How we deliver person-centred mental health care.
You will be asked to complete a number of questionnaires on relevant issues.
The assessment consists of a semi-structured interview probing the main areas of functioning that are usually involved in ADHD; this is called the DIVA (the Diagnostic Interview for ADHD in Adults). This interview yields scores for attention deficit and for hyperactivity and impulsivity and these scores are mapped against internationally agreed diagnostic thresholds, above which it is highly likely someone has ADHD and below which it is clear they don't.
This information is merged with the information elicited in the general assessment with the psychiatrist, during which relevant issues are explored which are having an impact on someone's life. Assessments are conducted in person or in video consultation format, Patients who have booked a video consultation appointment will receive a video Appointment Confirmation Email after a virtual booking is made and this email will contain a link to start the video facility.
The platform we use (called ‘Semble’) is specifically designed for medical clinics, ensures confidentiality and does not require any other software to be able to connect with the clinician.
All in person assessments take place at 10 Harley Street W1G 9PF. The patient should travel there to attend their in person consultation.
Ultimately the psychiatrist establishes the diagnosis: they can overrule any scores from the DIVA if there are sound clinical grounds to do so.
All the findings will be summarised in a report, which is held securely in our practice system: you will be sent a unique link by email, which will enable you to download the report in pdf format and save or print it. The report is your property: you can choose to share it with others (e.g. your GP), but you don't have to. Before the final version is shared with you, you can ask for amendments if you think something important is forgotten or a detail is wrong.
The assessment concludes with deciding a treatment plan: ADHD is eminently treatable with medication, although there is sometimes also a role for other approaches, such as ADHD coaching or psychotherapeutic interventions.
The assessment fee covers the assessment and the ensuing report.
If the patient decides to try medication, they will need follow up appointments to evaluate the response to that treatment and these incur a separate fee (usually ‘brief follow up’ appointments are sufficient: these last for up to 15 mins and cost £150, and for children, follow up appointments cost £335).
Frequency and interval between follow ups are decided by the patient and clinician on each occasion.
If medication is prescribed, the patient will have to pay for the medication itself to the dispensing pharmacy (i.e. not to Berkeley Psychiatrists).
The prescription is free during the titration period. The cost of medication is naturally not included and will need to be paid extra to the pharmacy.
At the end of titration, i.e. when it is clear treatment is optimal, we put a shared care proposal together that invites the GP to take over prescribing on the NHS.
As this is an 8-page document, it incurs an admin fee of £150. Unfortunately the GP can refuse and is not obliged to give a reason or to inform the patient and we can’t force them. It is therefore advisable to check with the GP what their stance is, before booking the assessment.
Berkeley Psychiatrists can in such a situation continue to prescribe, but after titration has concluded each prescription (which can only cover for a month: see below) incurs an admin fee of £65 and of course the patient also then has to pay the dispensing pharmacist for the medication itself.
Berkeley Psychiatrists has (as of September 2023) over 600 active shared care agreements in place in all areas of the UK.
In case the patient is under 18 and therefore follows the CAMHS pathway, there is no fee for the final shared care proposal. However, the parents still need to pay the dispensing pharmacy for any medication prescribed by our clinician during titration.
In both situations (GP takes over or Berkeley continues to prescribe) the patient needs reviewing once every six months by booking a ‘half-yearly review’ (we send automated reminders to do so four weeks before the due date). This is following NICE guidelines and ‘Best Practice' and ensure that response, efficacy and functioning continue to be monitored.
We normally recommend using a pharmacy that delivers the medication to you, as it is more secure. You will get a payment link from them on your mobile phone and once you have paid, they will deliver the medication to you: within 24hrs if you are within the London area and within 48hrs anywhere else in the UK.
Once a treatment plan is agreed, a so-called titration period starts. As it is largely unpredictable what medication and what dose is the right one for a particular individual, it is a matter of trial and error to establish it.
The titration period involves regular brief follow ups with either the Consultant or our Specialist Pharmacist in order to monitor and evaluate the response to the treatment.
It is impossible to predict how many follow ups are needed, as that is dependent on the individual’s response. Usually it would involve between 3 and 5 follow ups, but it may be less or more.
Often GPs will check the frequency and number of reviews, prior to accepting our Shared Care Proposal. If they are not satisfied with the course of titration, they can refuse to take over on the NHS.
Most ADHD medications are so-called ‘controlled drugs’, which means prescribing and dispensing is subject to legal restrictions. This means these can only be dispensed for up to one month at a time (30 days for most, 28 days for Elvanse).
The frequency of follow ups and the time interval between them is decided by the patient and clinician on each occasion, so the patient decides but on advice of and in agreement with the clinician. The clinician may insist on a further follow up and timing thereof, as they take responsibility for the clinical care of the patient with respect of the agreed treatment plan. In between follow ups patients can contact the clinician via email but only in pressing circumstances. This is free of charge.
Before the assessment you will be sent a questionnaire to complete: the RITVO AUTISM ASPERGER DIAGNOSTIC SCALE - revised (RAADS-R). This consists of 80 statements, covering a range of symptoms and features in four areas of daily functioning: social relatedness, circumscribed interests, language and sensorimotor features. You may also be asked to complete other questionnaires on relevant issues.
We recommend you complete the questionnaires with the assistance of a relative or close friend, as often someone who knows you well can provide useful insights into certain characteristics that may be less clear to ourselves.
The assessment consists of an interview, probing the main areas of functioning that you are worried about. The findings of the interview are merged with the result of the RAADS-R and the various scores are explained. That may lead to a diagnosis. If a diagnosis of Autism Spectrum Disorder is made, there will often follow a free-floating discussion in which you can ask for clarifications and explanations.
Although autism is not an illness that can be treated with medication as such, there are symptoms and phenomena that may respond to treatment and this will be discussed and a treatment plan formulated, if that is appropriate.
All the findings, as well as any agreed treatment plan, will be summarised in a report, which is held securely in our practice system: you will be sent a unique, password protected, link by email, which is held securely in our practice system: you will be sent a unique link by email, which will enable you to download the report in pdf format and save or print it. The report is your property: you can choose to share it with others (e.g. your GP), but you don't have to. Before the final version is shared with you, you can ask for amendments if you think something important is forgotten or a detail is wrong.
Often people just want to know if they have autism or not and in those cases there may not be a need for further follow-up. But sometimes there are issues in someone's life that are the consequence of autism and have a detrimental effect on e.g. work or relationships. In such cases follow up sessions can be arranged to explore these matters further and to find out how best to manage them.
We can also refer you on to specialist resources, e.g. therapists and counsellors who are themselves neurodiverse and are specifically able to give further guidance on how to manage some of the consequences of being autistic.
We use the terms Autism Spectrum Disorder and Asperger's Syndrome interchangeably: the first is a wider term, covering a range of presentations whereas the latter is more defined. There is a debate about which name is correct: we consider these debates largely ideological and not scientific and such opinions vary over time. It is noteworthy that many people with Asperger's Syndrome prefer that name, over the term ASD. We feel that it is up to people with autism themselves to decide what name they prefer.