I'm ... upset, because it's ... easy.

I've spent a long time struggling with weight. I'd pretend it didn't hurt and I didn't care, but ... I did. I really did.

I'd gone through cycles of boom and bust, and never really had any long term control.

Slimming World worked for me, and now I know what I'm looking for... it's also a 'system' that's particularly ADHD friendly, and I think most of the people there were 'ADHD-ish' based on my (amateur) analysis. (For the same reason I think it would be generally helpful to people with degraded executive function due to stress/depression etc.)

But nothing else really. And more than anything I found the "Just" do X or judgemental views from people who ... didn't understand to be even worse.

I mean, I had no counter argument for why I was fat. I'd tried, but I'd failed, and I'd done that over and over. And so ... perhaps I deserved that judgement?

But no.

I now know why, and that hurts even more in some ways.

- ADHD drops your self control and your longer term risk awareness. That makes binges and addiction far too easy.

- ADHD wants you to 'stim' and munching sweets/crisps/chocolate does that.

- Sugar does boost executive function and concentration. A little. It's not very good at it, but it does do it, so technically sugar dosing is a really shitty self medication.

- Bad sleep pattern - which ADHD can cause - likewise screws with hunger, and of course being tired and 'running on sugar' is a whole thing of it's own.

- And then there's the self hate, depression and frustration that leads to... comfort eating.

Since March 2023 (when I'd 'stabilised' on meds), I'm down 20kg. (45lb).

And whilst that's not amazingly fast, it's also been ... utterly effortless. I can - and do - just eat when I'm hungry, and find a much smaller portion to be 'sufficient'. And I can have open packs of chocolate on my desk and ... not scoff the lot.

And that's a thing I'd never known before.

I very nearly cried when I managed to eat half a chocolate bar, because I knew almost no one else really would understand what that meant.

So I can sort of also understand why the judgy assholes do what they do. For them it really is just that simple, so they don't understand why it might be a struggle at all.

But I guess more than anything that's also another lesson in empathy. In understanding and appreciating that almost no one who's overweight wants to be overweight, and that adding to the pressure they're putting on themselves is almost never helpful or kind.

"Tough Love" is akin to slapping a child for being disobedient - it's abuse and it makes the problem worse not better. Even when it's aimed at ourselves. There's no harsher critic than the one in the mirror.

I'm really frustrated at how much of a difference it makes, and how much easier my life would have been for the last 20 years. But I'm also glad I do finally have an answer to 'what's wrong in my world' and I _was_ right all along - the world is a hostile place to me and people like me.

Superficially I might have looked successful, but ... I just couldn't cope, and I'm sure most people would have been shocked to find out how really not ok I was (and still am - but it's better than I was). Because in no small part, I didn’t want anyone to know.

And like I say, I got lucky. I made a last roll of the dice, and it... blew my fucking mind just how much of a difference that makes to my world.

I'm not honestly sure if it was the ADHD messing me up more, or the Depression that came from all the ADHD screw ups, but ... it doesn't really matter overall. Broke a load of things that can never be repaired, and lost a bunch of things I'll never get back.

And through it all, whilst I am profoundly relieved now, I'm also incredibly angry at the injustice of it all.

There's a lot of people with ADHD. We know the number is 3-4% according to NICE - and it may be higher still. But a large proportion of those don't know it. (Around 200k are actually on medication, that’s the only number I’ve got for sure)

They're all playing on 'hard mode' and it will fuck them up in a bunch of different ways. Ways that may have long lasting and profoundly damaging consequences, and may well wreck the rest of their life.

And it didn't need to happen.

ADHD isn't that hard to diagnose and treat. The meds aren't exactly cheap, but compared to a lifetime of underperforming - let alone if you go off the rails and need more support than that - but even in the MOST MILD and least damaging case, it's still a bargain to enable someone to perform up to their true potential, and be a productive taxpaying member of society.

And all the people who got less lucky? Well, it's just an escalating scale of unnecessary consequences, harm and collateral damage.

I’m coming up on 2 years down the road, and the thing I’ve held onto was some advice I’m inclined to share to anyone in a similar position:

ADHD is totally unfair, and none of us deserved our lives to be fucked over like that. But ... life isn't fair. It never was.

You will get knocked down, time and again - everyone does - and all that ever matters is that we get back up again. And maybe in the process, learn/adapt and do better next time.

It's a small silver lining - it's not worth the price - but I'll take it as my consolation prize.

The harsh lessons that ADHD inflicted upon me, I have learned from. I haven't really had a choice, but that's neither here nor there.

I truly think I am a better person that I might have been. The version of me in my 20s that had coasted my whole life? I was an arsehole. I was exactly the kind of stereotype of toxic moderately privileged youth that goes on to be ... well probably prosperous, but ultimately never stops being a bit of a dick.

ADHD knocked me down, and I crashed and burned. That hurt a lot. But a harsh lesson in humility may have been none the less something that did me some good.

And ever since? I've had to cope with all kinds of self doubt. Of being sure I was a worthless person. A failure. Lazy. Selfish. Careless. So I've tried hard to be better than that. Failed a lot, and beat myself up, but ... I tried. Tried to accept that others who fail and fall deserve more compassion from me, because ... well, I get it, and it's nice when someone's kind to me on my dark days too.

ADHD has forced me to learn to cope with chaos. To ride the whirlwind that is my life. It's not exactly nice, but I have had a lot of practice, and as a result... I'm now professionally ... well, if I'm honest, exceptionally good in a crisis because of it.

Depression is similar. I'm far more familiar with what that's like than anyone should be, ever. But a healthy mind cannot understand what it's like. It's incomprehensible why someone seems to have an easy 'answer' but just ... can't.

So most of all, the thing I'd like everyone who's struggled with ADHD and depression to know is that I'm proud of you all. I think you've done amazing things. It might not look like much - and you're probably talking yourself down even now - but I think of it like this.

Depression and ADHD is 'playing on hard mode'. It's like fighting an invisible war - you're in a hostile situation, you didn't want to be there, and you've pretty much no choice but to fight. And there's no relief coming. You'll never come home a hero. No one will ever really know what your own private war has been like. They can't.

And that's really the essence of what makes you a hero. Anyone can grandstand for glory. Anyone can look good when the cameras are rolling. But someone who fights on in silence - whether or not they have a choice - and aren't doing it for any sort of payoff? Those are the real heroes in the world. All of them are beautiful and amazing people who deserve the chance to heal and become whole again.

Just by existing. Just by knowing how it is. You all add value to the world. Just by being there, and knowing that sometimes things are hard, and it's not fair. Nothing else is required of you. You're a worthy person who's been knocked down - undeservedly - and yet still ... got back up again.

So take your time now. Your battle is maybe not over, but the hard part is coming to an end. You can - and probably should - take time to mourn and grieve for your loss. Much like when someone important to you dies, something has been taken from you and it's never coming back. And that wasn't right or fair either.

You cannot change what was - none of us can. But you can do better tomorrow. All of us can do that. That's really the process of growing as a person. Getting knocked down, accepting it hurts, but getting back up again and resolving to do better next time none the less.

It's an older quote, but I think on this one from Rocky quite a lot:

I’ve been wondering how ‘remote working’ would end up, more or less since ‘everyone’ proved they could during COVID.

Some employers have embraced it, some have pushed back. Some have gone for hybrid, or some other policy too.

And my feelings are somewhat mixed - I mean, some jobs definitely do benefit from shared workspaces and facilities. Some jobs work better with a ‘private office’ and it doesn’t matter where. And some jobs … can use both depending on what’s happening that day.

But I think there’s a bunch of hidden costs in this mix here, that aren’t really being talked about. Space-in-your-house being a significant one - not everyone has a suitable ‘workspace’ for … well, working. Some people do, but not for everyone in the household, etc.

It’s a often an absorbed cost, or maybe a hidden cost of sorts to have such a workspace, but it’s not “free” to have extra space to work out of.

And likewise physical office space - even empty office space costs the company. But hot desking is awful, and a miserable experience too.

Commuting? Well, we all know about commute costs, and working remote cuts cost and time. But there’s also a trade off there - again, often hidden - of cost of space vs. proximity to ‘workplace’. A ‘study-room’ in central London will cost a fortune, but anywhere with a ‘sensible’ sort of commute will still not be cheap.

So in some ways ‘hybrid’ is the worst of both worlds - you need to live physically ‘close enough’ that the 2-3 days per week that is typical doesn’t kill you, but proximity to employment usually increases cost of housing too. And you still need to maintain the car to get there, etc.

But that means for the employer, to recruit ‘physical proximity’ might mean an additional cost due to cost of living and demand, where ‘remote’ might mean they can hire cheaper staff who are otherwise similarly qualified. Even if ‘remote productivity’ is measurably reduced, it might not matter if you can pay ‘rural’ wages instead of ‘city’.

The people working remotely - and enjoying that disparity - might find the economics in the long run don’t work in their favour in return.

I don’t know where it’ll end yet though - there’s a load of shuffling to be done still as the dust settles on cost of rent, equalities legislation, travel vs. housing costs, and the premium employers are prepared to pay to hire/relocate for ‘physical’ attendance.

But I do think some of the early movers are going to find the longer term scenario doesn’t stay as attractive.

You may have heard the line before:

"ADHD is a reason, not an excuse"

And I thought I'd take a moment to unpack my understanding of it, and hopefully trigger a bit of discussion.

Y'see for me, I view the two as ... sort of similar and related concepts, but very much in need of a bit of differentiation.

An excuse defined as:

seek to lessen the blame attaching to (a fault or offence); try to justify.

A reason is:

a cause, explanation, or justification for an action or event.

I mean, they're both 'justifications for an event' so I can see why there's an element of confusion.

But for me, it's all about forgiveness. Everyone makes mistakes. ADHD means you'll make more mistakes. That's just how it goes.

When you make a mistake? Well, you learn by it, you try and make amends, and you seek forgiveness from those you hurt.

But that's why I think it's important to differentiate the two. An excuse seeks to lesson the blame, and may try and dismiss someone feeling hurt due to your mistake. It might be trying to absolve a failing without really taking any action to avoid, improve or do better next time.

And that's IMO ... well, I think I'd describe that as pretty toxic actually. Because you're effectively saying that someone's hurt doesn't matter because you have your excuse. You're more or less trying to compel them into a measure of forgiveness.

Where if you offer a reason you own the problem, you accept that it's 'on you' and you take measures to do better next time. And you give them a road to forgive you if they are prepared to.

I think that's a really profound sort of a difference, and it helped me immensely.

Just in general in life, people aren't obliged to forgive you. They're not obliged to tolerate your failure. And the excuse doesn't matter - and mostly it never did - some people will see 'tolerance of failure' as a cost of doing business. Most employers won't sack you for being late occasionally. If you’re routinely late though… they still don't care why - for them it doesn't matter. You can't do your job reliably, so they can't continue to employ you.

And friends likewise - a friend is a person who feels you are worth having in their life. They value you for all that you are. They too are not obliged to forgive you... but they also probably don't care that much why you let them down either. If you're still a person who they feel they want in their life - they will forgive. If you have hurt them to much... they won't.

So I think it very important that I recognise that difference. To try and accept that ADHD is my challenge, and that it makes me fail more than I should in a fairer world. But at the same time, that I also take ownership of my failures - I try to learn and become a better person.

Because I don't want to hurt my people I care about in the first place. I don't want to have to have people 'needing' to forgive me at all. I accept and appreciate the kindness that is, and value it a lot.

If I own my failures and try and do better, then I become a better person. If I dismiss them, and try and tell people they aren't "allowed" to perceive my failures as hurtful, that makes me a worse person.

And that's a huge difference in two seemingly similar concepts.

But I have learned why that is this year - “all or nothing” is such an “ADHD thing”. I mean, I know there’s a bunch of ‘official’ diagnostic criteria, but I’ve also got an ad-hoc list of ‘ADHD flags’ that aren’t, y’know, official, but …. (“Gifted but lazy” people I’m looking at you).

So this year, I’m going to … not do that. I’m going to take a moment to remind you all, that 'good enough’ is good enough. You don’t need to achieve perfection to have none the less made a step forward. And one step is more than no steps, so it’s still a good thing that you should be proud of.

Take the year one day, one hour or one minute at a time. Look for individual choices and your opportunity to ‘do better next time’ each time you have a choice to make.

It’s enough.

In some ways it fills the same role as adrenaline - your ‘hunters’ face down the lion, adrenaline helps you win the fight, and depression lets you lock down the emotions so you get home and get treated.

But when it’s longer term than that? That’s when things start to go wrong.

Because some depression is short term ‘crisis response’ - and it’s useful as such.
Some is situational, and for a relatively short situation… that’s fine too.

And some is clinical, caused by neurochemical imbalance and that just messes you up for no good reason.

But that leads to a lot of problems - because the symptom and the root cause often get muddled up.

Short term depression it’s pretty easy to link ‘situation’ with ‘depression’ and understand that you’ll work through it.

Longer term? Not so much. I mean, there are most definitely people who are clinically depressed, and literally NOTHING helps but medication.

But … well, what about ADHD? ADHD comes with an 80% comorbidity rate, and depression shows up quite a lot - why? Well, it turns out that living for a decade with an invisible disability makes you depressed. What a shock?

But it’s so easy for a doctor to correctly recognise that depression, and then correctly recognise there’s no ‘systemic’ issue that should cause it… but then misdiagnose it as ‘clinical depression’.

And that’s the killer here - both ASD and ADHD are long term ‘issues’ that cause ‘situational’ depression. Because life is unfair and hard and it’s not your fault.

That looks an awful lot like clinical depression, it’s just the anti-depressants (in my case a pack of SSRIs) don’t actually do anything, because they’re treating the wrong root cause.

I don’t know what the solution to this is - in my horribly amateurish assessment though, there’s a fuck of a lot of it happening. I know plenty of people who have been treated for depression, found it didn’t help in various ways, and the underlying cause was something else that a GP wasn’t qualified to diagnose in the first place.

I could give PLENTY of examples, but I won’t because that’s not my story to tell. But suffice to say I don’t actually think many of my circle of friends are ‘normals’ and most of those have in various ways struggled with depression that wasn’t Depression.

Worst of all are those that have ‘something’ to which depression could be attributed, but that that ‘something’ actually might not be the cause. Again, I could give examples, but it’s still not my story. But if you’ve a thing going on, and you’re depressed then the Thing might explain the depression. But if it doesn’t, you’re getting misdiagnosed and treated inappropriately.

And then the lead times - and the ‘being fobbed off by an authority figure’ - really start to bite. Living with a cognitive impairment for decades is rough, and depression is expected at that point. But misdiagnosis kicks the ball into the long grass again, and then there’s a … delay before you’ll come back. Or maybe you won’t, because you’ve lost faith.

In the UK our problems with mental health - and not talking - are rife. But misdiagnosis of the ‘easy answer’ is also causing a lot of harm.

But as a result, I was bimbling around the house at a round noon, feeling like a disorganised cabbage, going ‘bleugh’ and suffering decision paralysis.

And then my phone beeped with the medication reminder, I took some, and about 10 minutes later it was like someone had opened the curtains.

Honestly, I’d been starting to take it for granted a bit, and feel a bit more ‘imposter-ish’, but it’s a useful reminder that when my psychiatrist said ‘lol, nope, you’re 98th percentile, it’s not even remotely ambiguous’ they weren’t just trying to make me feel better :)

Because … well, it’s been what, since January/February ish? And this year has been feeling like playing on easy. (Well, easier anyway). It’s still not gone away, and I’m still not a ‘faker’.

I’m a person who’s spent 20 years struggling, with 20 years of building up a bit of a mess of ‘baggage’ and the medication and self understanding is slowly allowing me to untangle ‘all that’.

And it seems I’m not done. I’ve had a few moments recently where emotional ‘sore spots’ have been hit, and particular phrases or concepts have annoyed me disproportionately.

E.g. the kind of phrase that’s not meant hurtfully, and isn’t really unreasonable, it’s just somehow it pushed a load of my buttons and made me intensely angry.

That’s happened a few times now, and … it’s improving. I’m guessing that’s a bit like how PTSD works? I won’t go as far as claiming I have PTSD, but I definitely do have some splinters of trauma and self hate that never healed properly.

And I’ve been working through them - they hurt coming out too, so it’s slow going - but every now and then I’m finding a new one.

But understanding what is wrong, and the medication to help me be clear headed enough to actually think about the problem for a bit and reflect on it, is doing a lot of good.

Because failures are how we learn and grow, but we can only do that if … we understand how and why the failures happened.

I still have a lot of learning and growing to do.

(I’ll write about ‘the right medication’ in a separate post I think).

Most people are driven by:

• Rewards

• Consequences

• Importance

But ADHD brains…. well, they aren’t. They’re much more responsive to:

• Interest / Passion

• Urgency

• Novelty

• Challenge

Which leads to some interesting trends in a professional context - I’ve felt for a while now that Sysadmin as a profession is basically a bundle of ADHD coping strategies, and this isn’t an accident, as ADHD people find a ‘home’ and … well, customise it.

So that’s when we move on to the interesting question - Faith.

I’m sure if you think for a little while, you can think of a religion that basically ‘works’ on a notion of Reward/Consequence/Importance.

But… well, what of the people who are genetically incapable of buying in. What does that mean?

I can also think (admittedly it takes a little longer) about faith structures that work better for people who find Interest/Urgency/Challenge/Novelty more compelling too.

Based on my - admittedly not very large - sample … well, let’s just say I know a disproportionate number of pagans, witchy types, atheists and agnostics than the census would suggest was ‘average’.

So this is where I start pondering - to what extent does cognitive processing and motivational drivers intersect with faith? Is it actually possible that someone is ‘genetically resistant’ to particular faiths? And if they were, what would that mean?

Or is it more simply that faith is a ‘sales pitch’ that tailors to the majority cognitive function. And in turn, what would that mean for it in terms of being divinely inspired rather than manipulated by skilled sales people?

If the faith actually had it right all along, what would it mean if 3-5% of the population were ‘genetically resistant’ to going with the flow, but were MUCH more inclined to ask questions and challenge dogma? Would that be a bug or a feature?

Found these: https://amzn.to/47BHc0W

And was actually kinda surprised at how cheap they were. Typically 'ANC' is at least a £100 feature. I can only assume the 'less cool' colours (e.g. not black) were less desirable.

Joke's on them though, I like green.

Anyway, so - has 3 modes - noise cancel, ambient passthrough, and deactivated.

Deactivated is ... well, the same passive noise reduction as 'wearing the headset whilst switched off' and having some cups over ears.

Ambient pass through means you don't have to take it off to talk to someone, because you can hear them pretty clearly. (It's not _perfect_ but it's fine for a conversation).

Active cancel does what it says on the tin - I can't hear the kettle boiling when next to it, or the dehumidifier whirring behind me. Or the TV in the next room. I can just about hear that someone else is 'on the phone' but I can't hear speech, so it's background noise rather than distracting noise.

About the only drawback of course is that potentially my mic will be bouncing 'undesired' audio to someone else on a call, and I won't even realise it's happening!

It does have inbuilt mics that work just fine for talking to people too, which was part of what I was after, both for gaming purposes but also so I can use video conference type stuff when working remote.

Has a phone app to adjust modes and stuff, and obviously 'talks' to phone just fine.

Can't adjust ANC mode/standby time from any PC control, which is mildly disappointing, but phone + buttons on the headset are sufficient.

Uses bluetooth, with no wired option, so of course all the usual issues with RF potentially - but it's been fine for me with 'computer-to-kitchen' although it does drop out if I go much further.

Charges using a very standard USB-C lead, and battery life - so far - seems 'ample' in that I've not noticed any warnings with 'normal use' and plugging it in at night.

I did need a USB Bluetooth doodad to go with it, because my PC doesn't have onboard. Those are 'about £10' depending on exactly what you go for though. (And of course, most phones/laptops have it already)

So yeah. Fairly impressed. Audio quality is good enough for me, and noise cancelling is effective enough too.

So what you need to know now:

Your disability is legally recognised. Your employer MUST make "reasonable accommodations". Reasonable is however pretty subjective, and you aren't obliged to notify them. So you probably shouldn't unless you want to use it as a stick to beat them with.

Access To Work is a government scheme designed to fund stuff to help you. Some of that might not be any use, but some might be things you already own because they're already part of your coping strategies. But for example, I'm aware of people who've requested ReMarkable writing/ebook/tablet things, and a few others. But specifically things you feel you can justify to enable you to work.

https://www.gov.uk/access-to-work

Reddit ADHDUK community is pretty friendly: https://www.reddit.com/r/ADHDUK/

I can give you the rundown on what I know about ADHD drugs and whatnot, but it's all published by NICE/BNF 'recommended' treatments. The summary is - most people it's either Methylphenidate or lisdexamfetamine, then swap to the other if it doesn't work for 6 weeks, but with a caveat that 'blood pressure' or 'heart issues' may be significant.

https://www.nice.org.uk/guidance/ng87

And specifically the BNF guidance on methlyphendidate (stop trying to autocorrect that damnit!) and lisdexamfetamine:

https://bnf.nice.org.uk/drugs/methylphenidate-hydrochloride/
https://bnf.nice.org.uk/drugs/lisdexamfetamine-mesilate/

It’s a little older, and research has moved on some, but I still suggest Dr Barker's lecture on ADHD:

It's a bit more 'child oriented' - e.g. how a parent can understand and support their child - but I feel that's just as relevant to someone with Adult ADHD, because the 'child' is 'them'.

You may feel angry/frustrated about being diagnosed - that’s entirely normal, and is a very valid grief response - the person who you might have been, now never will, and so you might need to mourn them. Take your time - it’s very valid, and necessary.

An NHS Prepayment certificate is a bargain for a recurring medication. At a little over 11.5x the prescription charge (at the time of writing) it saves you money on just one monthly medication, and typical ADHD meds are 28 days (so 13x per year) due to being controlled substances.

The BBC responds:

Hello,

Thank you for getting in touch again about the Panorama programme Private ADHD Clinics Exposed and please accept our apologies for the delay in our response.
 
Due to the number of comments we have received from people contacting us a second time, we are again providing a single response which will address the key issues.
 
Many of those who contacted us a second time continue to believe that the programme was damaging to the ADHD community, including those who have received a private diagnosis of ADHD or anyone who might be considering seeking a private assessment.
 
This is something the Panorama team considered very carefully before and during their investigation, engaging with colleagues across the BBC as we would any story about public health which concerns alleged wrongdoing on the part of healthcare providers. They also consulted experts in the field, including clinicians running specialist adult ADHD services. 
 
The closing credits of the programme advise that “If you are affected by any of the issues in this story you can visit BBC Action Line” and two online stories also link to the action line, taking readers to support services.
 
Moreover, the programme made clear that many of those who are diagnosed with ADHD by private clinic will have the condition. The issue the programme highlighted was that unreliable diagnoses can cause problems for both the individuals that receive them and the clinicians seeking to treat them in the NHS. This is particularly the case when people are prescribed medication as a result.
 
It has been suggested that the programme should have highlighted the positive experiences that others, including a small number who spoke to our reporters, say they had when they approached private clinics, or that there was insufficient exploration of what life is like for those living with the condition.
 
Our programme does not gainsay these experiences, or the important role that these clinics play in diagnosis given the considerable problems getting an NHS assessment and the length of those waiting lists.
 
However as we said in our previous response, that does not deny the importance and validity of what was a focused investigation.
 
Indeed it is the scale of involvement of private clinics in this process, and our findings when we came to investigate these serious and specific allegations, which go to the heart of why there was a clear public interest in reporting our findings.
 
We then did so in accordance with the BBC’s Editorial Guidelines, including those on due accuracy https://www.bbc.co.uk/editorialguidelines/guidelines/accuracy and due impartiality, https://www.bbc.co.uk/editorialguidelines/guidelines/impartiality
rather than balance, which say the journalism must be adequate and appropriate to the output and that we give due weight to events.
 
Some of those contacting us again have also suggested that the programme presented the NHS assessment our reporter underwent as a typical NHS assessment, alleging that it is not, or suggesting that Dr Mike Smith had prior knowledge of the details of our investigation and so this compromised the comparison between the approach of the NHS service and the three private clinics.
 
For the avoidance of doubt, Dr Smith was not aware of the programme team’s plan to film undercover when carrying out his assessment of Panorama’s reporter and had no contact with the reporter in advance of the assessment.
 
Dr Smith has been working in the area of developmental disorder for over a decade, including as the current lead clinician at a specialist NHS service for adult ADHD. Dr Smith has conducted - as well as supervised - numerous ADHD assessments in adults. There are no grounds to suggest that Dr Smith was not an independent evaluator. He conducted a thorough, impartial and objective assessment, with the programme making clear that they had engaged an NHS specialist to demonstrate how these assessments should be carried out. We did not say this was a typical NHS assessment, as assessments can vary across the health service. However, it was typical of the assessments Dr Smith conducts at his clinic and provided the audience with an example of how a quality assessment is carried out.
 
As the programme and online articles made clear, this process is governed by the guidelines issued by the National Institute for Health and Care Excellence (NICE). We found strong evidence that while the NHS assessment had followed these guidelines, the private clinics had not.
 
There are also no grounds for suggesting that Panorama’s reporter faked his symptoms, or used false Facebook profiles to pretend to be a woman during his research. As our previous response pointed out to those who raised these allegations, the reporter gave honest answers to all of the questions about symptoms during his assessments at the three private clinics, while a female member of the production team joined some groups using her real name and Facebook profile. The programme team always made it clear when they were approaching people – whether on Facebook or elsewhere – that they were working for the BBC on a programme about ADHD.
 
Some of those contacting us have taken issue with the programme’s use of the description “powerful drugs,” or say that the issue of medication was not sufficiently explored.
 
Our wording reflects the fact that each of the clinics featured in the programme offered Panorama’s reporter stimulant medication, a controlled substance under law which has a number of serious side effects, particularly in relation to the weakening of the heart, which can increase the chance of seizure, stroke and heart attack.
 
In addition to those with a history of heart problems, ADHD medication is particularly dangerous for those with complex mental health problems including bi-polar and certain personality disorders. These conditions often present very similarly to ADHD, and can involve some of the same symptoms. According to the experts Panorama spoke to, this heightens the need for thorough and reliable assessments, which minimise the risk that other conditions will be missed.
 
Although Dr Smith summed up these concerns in the programme, we nevertheless sought to present a nuanced picture in order not to cause unnecessary alarm, setting out that these drugs are the standard treatment for adults with ADHD and would be safe for the majority of people if properly prescribed.
 
Others who contacted us have suggested that we were wrong to say that the National Institute of Health and Care Excellence (NICE) guidelines say that someone should only be diagnosed with ADHD if the symptoms have a “serious impact” on their life, on the basis that the guidelines don’t use those words.
 
Panorama judged the phrase ‘serious impact’ to be a fair encapsulation of the requirement for symptoms to be both causing a minimum of moderate impairment in multiple settings, and pervasive across a number of “important” aspects of a patient’s life. This was an attempt to summarise the full requirements under the NICE guidelines, not a reference to the level of minimum level of impairment in isolation. It is echoed in the comments of Dr Mike Smith, a clinical lead and specialist psychiatrist who follows the guidelines in his work heading up a specialist adult ADHD service.
 
In closing, it’s important to reiterate that while many of those contacting us also feel the programme lacked an ADHD voice, and so consider the programme was missing essential context, this was not a programme about ADHD as a condition, or the various problems facing those living with the condition or seeking a diagnosis.
 
Rather this was a specific investigation and it is in the nature of such investigations that they often focus on one aspect of a much wider issue in this way.
 
So although we linked to further resources in our online article, including the NICE guidelines and the NHS advice page for ADHD, and made clear that ADHD is a recognised medical condition which can have a profound impact on peoples’ lives, we do not agree that it was essential, for instance, for the programme to discuss at length what ADHD is.
 
We believe most viewers would understand what is an established approach from a long-running current affairs programme, although the various points which you and others have raised have been discussed in detail with the team, and circulated internally on our audience log.

We hope this reply addresses your concerns and thanks again for taking the time to contact us.

This concludes Stage 1 of our complaints process. That means we can’t correspond with you further here. If you remain unhappy, you can now contact the BBC’s Executive Complaints Unit (ECU). The ECU is Stage 2 of the BBC’s complaints process. You’ll need to explain why you think there’s a potential breach of standards, or if the issue is significant and should still be investigated.

My response:

The Panorama Program "Panorama, Private ADHD Clinics Exposed" misrepresented a lot of issues around ADHD.

> There are also no grounds for suggesting that Panorama’s reporter faked his symptoms, or used false Facebook profiles to pretend to be a woman during his research. As our previous response pointed out to those who raised these allegations, the reporter gave honest answers to all of the questions about symptoms during his assessments at the three private clinics, while a female member of the production team joined some groups using her real name and Facebook profile.

The prescreening used by every ADHD assessment I have encountered, very specifically uses a very similar format to the ASRS v1.1. Which is _literally_ the diagnostic criteria for ADHD. It is of course, not a diagnosis, because it's just a questionnaire, but those same questions your reporter _truthfully_ answered indicates he meets the criteria for an ADHD diagnosis.

> Some of those contacting us again have also suggested that the programme presented the NHS assessment our reporter underwent as a typical NHS assessment, alleging that it is not, or suggesting that Dr Mike Smith had prior knowledge of the details of our investigation and so this compromised the comparison between the approach of the NHS service and the three private clinics.

> For the avoidance of doubt, Dr Smith was not aware of the programme team’s plan to film undercover when carrying out his assessment of Panorama’s reporter and had no contact with the reporter in advance of the assessment.

So he didn't notice the TV cameras? But the way I know it wasn't a typical assessment is because the reporter wasn't waiting 2 years for it in the first place. The NHS _does_ perform video consultations and it _does_ use 'non-consultant grade psychiatric assessors'.

It's fallacious to assert that when you've been diagnosed 4 times, that the one with the 'proper' TV cameras got it right, and the ones with the undercover cameras got it wrong.

ESPECIALLY when your reporter - truthfully and accurately - reported that he DID meet the criteria - for being diagnosed with ADHD!

> He conducted a thorough, impartial and objective assessment, with the programme making clear that they had engaged an NHS specialist to demonstrate how these assessments should be carried out. We did not say this was a typical NHS assessment, as assessments can vary across the health service. However, it was typical of the assessments Dr Smith conducts at his clinic and provided the audience with an example of how a quality assessment is carried out.

Perhaps they _should_ be. But the reality is - they are not. The NHS process takes MUCH longer to even see someone, and the assessment is typically much faster. Painting this as a 'NHS' vs. Private issue is thoroughly disingenuous and deceitful, because the same processes and guidance is being used in each.

If you had framed ADHD diagnosis in general as being severely inadequate in this country, and that everyone should have access to a high quality assessment in a reasonable timescale if they meet the pre-screening criteria, I'd have had absolutely no issues with the program.

> The issue the programme highlighted was that unreliable diagnoses can cause problems for both the individuals that receive them and the clinicians seeking to treat them in the NHS. This is particularly the case when people are prescribed medication as a result.

The issue that the programme _failed_ to highlight was that almost no one is seeking a private diagnosis just for the sake of it, almost all of them have NO CHOICE, because the NHS process is extremely long, and the _typical_ NHS assessment is no better.

When the choice is between suicidal depression (caused by ongoing long term ADHD) and paying some money to a private clinic as a last ditch attempt before actually killing yourself, it's not really a "choice" at all. I can assure you that I absolutely would have gone to the NHS for treatment for that suicidal depression and subsequent ADHD treatment if that had been at all a viable choice. And it wasn't. I'd have been dead today if I'd done that.

That's the harm your program caused, whilst actually not highlighting anything of substantive merit at all. It did not, at any point, establish that the diagnosis conducted was actually incorrect. Not from your reporter, and not from anyone else consulted. Why was that do you think?

MAYBE you could assert that the diagnostic process for ADHD generally is not as good as it should be. But first I'd like you to look at and consider how many people are diagnosed in the UK (about 1%) and the estimated prevalence of ADHD (3.5%-8%) and ask yourself why there's such a large discrepancy.

Because that's the Scandal here. That potentially a LOT of people ADHD don't know about it, and are suffering life long 'significant life impact' as a result . It took me 20 years to get diagnosed. Privately.

Can I offer you an insight that I've picked up recently?

It's this: That a lot of people simply don't know the difference between real friends and fake friends.

I've always had a tough time with relationships and making friends. Turns out I had ADHD.

But as a result, I was never able to slot into 'conformity social' slots.

But what happens is, a lot of people will hang around together, doing the 'default things'. They won't be friends, they'll just be people who broadly conform.

But they might look a lot like friends, and you might very well not realise that you don't actually have any at all.

And this extends into relationships. There's a lot of people who do the 'default' thing, get a (boy|girl)friend because they feel they should, but they play on 'easy mode' following expectations, rather than, actually building a partnership.

As long as things _stay_ easy.... well, this whole situation can just carry on a long time.

But .... I've seen too often people who don't realise they _didn't_ have any friends, and when their circumstances change, they're alone and don't understand why.

My brain never let me do that - I felt lonely a lot, but I do have a much smaller circle of people who will come and see me when I'm ill, or make an effort to come visit. And when I finally found someone who 'got' me, we ... built a partnership together, and it's strong enough to endure some difficult times.

So whilst my life has been hard so far, I haven't ever fallen into the trap of having a bunch of 'fake friends' who disappear one day.

Most forms of cancer are variants on the same theme - they’re when your core body mechanisms break down, and cell replication starts to happen in ways that are problematic.

But even then, benign tumors might very well do nothing of note, and will do you no harm.

And Depression is sort of the same - it’s also a very normal sort of mechanism in the brain, that - mostly - does what it needs to, and it’s beneficial.

But in both cases? You can lead to a systemic problem that spirals out of control. That leads - eventually - to death in an uncomfortable and miserable sort of way. It’s hard to be sure about the statistics though - Depression is by it’s nature a stealthy killer. For everyone who is suicidal as a direct result, many more are dangerously reckless before getting to that point.

And in both cases? Spotting and treating it early, goes a long way to avoiding long term harm caused.

ADHD fits in this picture too of course - statistically speaking ADHD can drop life expectancy by a whopping 25 years. But part of that is due to the depression it’ll inflict upon you.

So really - whilst we need to be good at ‘dealing with Cancer’, I think we really do need to start treating ‘mental health’ in the same sort of way, for the same sort of reasons.

Because whilst it never actually kills you quickly (neither do!) early intervention prevents a lot of misery and bad life outcomes.

And we’re bombarded with choices. It’s a tenent of a capitalist society, that we choose cost-benefit. We choose pay more for the the faster thing, or the more reliable thing.

We pay for safety. We pay for efficiency. And capitalism optimises for the utility efficiency. Profitable is supplying good choices, efficiently.

But hidden in this, is the assumption that the consumer is informed about the choices, and can effectively do so. Which is very seldom the truth.

I can choose if I want steak today, or if I fancy chilli con carne. But if you ask me about complicated things - like cars, washing machines, or healthcare - I don’t actually want a choice, because that assumes I know all the nuances of that choice.

And I don’t. What I want is a decent quality option, that’s reasonably priced.

Healthcare not least. I don’t want “right to choose” - I want healthcare that’s near me, and adequately good and adequately fast. I don’t care who’s supplying it.

Exorcisms in the Catholic church, spirit worship in many pre-Abrahamic religions.

And they’re all sort of right.

Demons are real. They’re malign spiritual parasites, that attack and maul the psyche and the soul.

And you can’t fight them the usual way. They’re invisible, and ethereal. No amount of force can push them back.

All the demons are unique, although they do come in broad type-groupings. Some prefer to strike at the young, and latch on at a very early age. They dig in early, and start doing damage as a child develops.
Others prefer a more mature host, and will usually latch on in later life, and start do deplete a fully grown soul.

The Crusade is a hard one though - many don’t even realise the war is here. Because you cannot win this fight with obvious and easy heroics. There are no chances for glory.

And we can’t win. Parasites cannot be killed or destroyed - by the time we can even notice their presence (and they’re insidious, so this doesn’t happen quickly) it’s already too late.

But they can be pushed back. A process of exorcism might take a long time - forget the ‘media’ portrayal of a night of ordeal. Exorcism might take months or even years to complete.

Because it’s only when the Host is ready, that it can be completed. Only when they feel strong enough to make the final push for themselves. The process of exorcism is one of building up the strength of the host. In strengthening their spiritual energy, you will struggle against the Parasite resisting your attempts.

And the Host will have been damaged by the struggle, and will remain more vulnerable for the rest of their lives.

Hunting demons therefore is not for the faint hearted. It’s very easy to find a cause to die for - and this isn’t one of those. This is a cause to live for.

Not all, sure. I’m pretty sure there are true ‘supervillains’ who did have a free choice.

But most? Nah. They’re in prison for one of their latest bad choices going bad and getting caught. (Lets face it, effective criminals don’t get caught. Really effective criminals don’t even break the law!)

The reason this relates to ADHD - and mental health issues generally - is because ‘prison populations’ are significantly skewed towards neurodiversity:

https://www.justiceinspectorates.gov.uk/cjji/wp-content/uploads/sites/2/2021/07/Neurodiversity-evidence-review-web-2021.pdf

25% are thought to have ADHD, which is substantially higher than the NICE estimate for prevalence in population (3-4%). 19% ASD, which again - is an awful lot higher than the 1% population prevalence.

Why? Well, I mean, in some cases it’ll be as simple as ‘not as adept at trial’, but I think just in generally, given we _know_ that both ADHD and ASD are strongly correlated with ‘bad life outcomes’ it seems that it’s far more likely that both lead to that chain of ‘bad choices’ I was talking about, a lot more readily.

ADHD for example, isn’t strictly speaking dangerous - it’s when undiagnosed and untreated, it correlates with a whopping 25 year reduction in life expectancy, due to compounded ‘bad life choices’.

ASD similarly has a lot of ‘unfortunate' indirect side effects.

But with that in mind, one of the things that’s considered a good thing in prison, is rehabilitation - the process by which you restore a person to “normal life” through training, therapy, etc.

… so why do we wait until someone has gone off the rails entirely before doing that? I’m sure there’s as lot of people who have difficulty with ‘normal life’ who might very well not end up in prison in the first place - due to not having broken laws/causing harm - if they can simply get the support to understand and adjust beforehand.

And that’s leaving aside those for which those ‘bad life choices’ aren’t prison worthy, they’re “just” living in difficult situations, struggling with life, bouncing through abusive relationships etc. The people who’ve set their sights low, because they know they’re a failure, deep down in their hearts, and that they don’t deserve more. And maybe they don’t quite self destruct, but … in many ways they might as well have done.

So here’s what I think - we need to start rehabilitating people early on. All the children out there who aren’t adjusting to ‘normal life’ for literally any reason, could become happy and productive citizens with just a little support.

To my mind, ADHD is often less of a problem than the Depression it brings to your door. 

ADHD is manageable and treatable. It's difficult, but you can live well with it, with the right support.

Depression is insidious and cruel. It kills you very slowly, by taking away all the things that make you want to continue existing. It might take years, but that road? It's self destructive, it's miserable, and at the end of it? Suicide starts to look so very reasonable and rational. 

It turns the world grey and misty. It removes bright colours and mutes emotions. It makes choices impossible, because you simply cannot summon the emotional response to decide, because you don't care. It makes you reckless. It makes you your own 'evil twin' - certain that the world would be a better place without you in it. And capable of taking steps to do precisely that. To remove yourself, and isolate yourself from people you can. And to push away the people you can't. To become a worse person, because you truly believe that it's "better this way". 

And after you have followed that road for long enough? You're just tired. You're exhausted. You don't care and you just want everything to stop. Ironically perhaps, this may even delay you taking the 'final step', because you can't even be bothered to do that either. This is a known danger of treating serious depression - because someone that close to the line, increasing their executive function and their motivation can be catastrophic. 

ADHD sows the seeds of depression. ADHD means you'll fail more, and you'll struggle more. It means you'll be mistreated by people who don't understand your needs. Often inadvertently, but occasionally with cruelty and malice. And maybe you'll have difficult understanding your own needs. Why your brain doesn't let you do things that look 'simple'. 

So it's very easy to hit an ADHD induced 'failure' in your life, and be unable to forgive yourself for it, because you don't understand either. 

And over time? Those failures will eat away at you. Maybe they'll be just little things, that other people barely noticed. Sometimes they'll be bigger things, where you _know_ you hurt someone, but you still can't understand how or why or what you did wrong. Those all add up to pieces of psychological trauma, that will stick in you like splinters, and fester until you remove them. 

But when you don't have time to stop and heal, to 'extract' the splinters, they'll just stay there. Heal over, and become even harder to deal with, but still be there hurting you over and over. 

And that's where ADHD comes in again - your life is hard. You're struggling. You're fighting an invisible war. You don't have time to stop and heal, and your executive function isn't working at full strength even when you do. 

So slowly, gradually, and insidiously, depression takes hold. It makes your ADHD harder to cope with - your executive function is already degraded, and depression hits that too.  And in turn, ADHD? Well, you don't have the executive function to tackle the depression either. 

It might take a very long time. It took me 20 years of gradually getting more and more depressed, as I accumulated more and more 'splinters' of failure, that wouldn't heal. I was steadily becoming my own 'evil twin'. I was a horrible person. Truly. I wish with all my heart I could say I 'didn't mean it'... but I did. I really did. My hollow justification of 'it would be better this way' as my rationale for hurting and pushing away the most amazing people in my life? Well, it's hollow. But I _elieved_it. 

So what of this? Why am saying this?

First of all - I want you all to know: I get it. I see you. I know how bad it can be. 

I know why you don't feel like you can reach out. Why you're hiding it from everyone around you. I know exactly where this road goes too. 

I also want you to know that the very first step of 'fixing' this, is the only one that's actually hard. Breaking down that wall of pride, self doubt and self worth, and admitting that you need help to someone who can do that for you... and accepting that you deserve that help too. 

After that first step? The rest is gentle and slow. People experienced at treating depression are good at what they do. They will understand you and see you in a way your friends and family cannot. 

So if you recognise this in yourself - you don't even have to say anything right now. I just want you to know that I believe in you. I am just some guy on the internet. I have no reason to lie to you, or pretend I want you around. 

Because what I believe is that your struggles so far? They're all that you need to be a worthy person. You are fighting an invisible war. Other people don't know or understand. But I do. I get it. Your will to go on makes you magnificent. You've fought every day, and kept going into the darkness, with no end in sight. And you're tired. I get that too. 

But the world truly would be a lesser place if you did succeed in removing yourself from it. There's a shortage of beautiful people, and one fewer would be a shame. 

ADHD won't go away, it's part of what makes you who you are. It's part of what makes you beautiful. But without the depression dragging you down, it's absolutely possible to live well with ADHD.

And what I'd like you to do - if all this resonates - is to take that small, but oh so hard first step. Reach out to someone who can help you, and make them understand that you need it. 

Do it for me, if you can't do it for you. Some guy you will never meet, who will never judge you, but that believes you are a beautiful worthy person, who makes the world better by being there. A person who believes that you deserve to be happy, and that you  can be happy.

I'm writing to you about mental health again, because I have to say - I've been digging deep into the subject, and I'm actually getting really angry about how big a problem this is.

I have always thought that one of the major benefits of a national healthcare systems is economic - it's able to offer efficient interventions, rather than profitable ones, that keep a productive and healthy workforce available to support business and growth. 

Quality of life is irrelevant to this argument - the concept justifies itself on economic basis alone. Healthy citizens are productive taxpayers, enabling innovative businesses to thrive with an engaged workforce. 

On this basis - I'm a very productive taxpayer. I'm well above the line of 'net contributor' to the treasury, and have been almost every year of my working life. 

So with that in mind I come back to Mental Health services - in the grand scheme of things, mental health support and therapy is actually really cheap. Whilst it requires medical skills and training, it _doesn't_ need expensive hospital infrastructure, emergency response services, or indeed even much in the way of subsidised medication. 

And that's why I am angry here, because on economics alone, having effective well funded mental health support is trivially justified. Anyone who's off work for a week, has already 'cost' the economy as much as a program of treatment prior to that would have cost. 

But I know so many direct examples of people who were missed as children for their diagnosis of ADHD, ASD, and a smaller number of other underlying conditions - things that are neurogenetic in origin, and cause brain development problems from a very young age. 

A child that is spotted, can be very easily supported - these conditions are well understood, and not hard to diagnose. A child that is spotted early? The very vast majority of them can, and negligible cost, become productive taxpayers in their own right. 

A child that is not spotted? Is incredibly likely to become  a net drain on the treasury. Almost all fail to live up to their potential. A very large proportion end up with significantly problematic life circumstances:

- Any woman with ASD has a 90% chance of having been sexually assaulted. 

- The prison population of people with ADHD is around 10x that in the normal population. 

- The chance of a failing out of an inaccessible education is much higher, but even from an early stage 'failing to live up to potential' is still life altering in a negative way. 

- The frequency of depression and suicide is also vastly magnified. 

- The probability of risky sexual behaviour, leading to unplanned, early life parenthood is also substantially increased. 

All these things cost the taxpayer _FAR_ more than the mental health screening and treatment that would have prevented almost all of it. 

As a 'productive taxpayer' myself, I feel I should let you know that I came very close to suicide last year. It might seem inconceivable, because on the surface I do have all the trappings of a successful life. 

But depression just doesn't work like that. It's a slow insidious killer, that works by destroying all the things that make you want to live in the first place. Depression destroys your sense of self worth, and demolishes your self confidence. It suppresses your emotions, and turns the world grey and dreary. It makes you cruel. And most of all, it makes it hard to reach out and seek the help and treatment that is necessary to change course. 

Because that course? That's nihilistic desire to cease existing. To remove yourself from the lives of everyone around you. To become reckless and to push people away, so they don't hurt as much when you 'disappear'. So you get to a point where you've nothing left, and suicide seems a very simple and rational final step. 

I hope you've not experienced or encountered this - because I truly wouldn't wish it on anyone. But in my case? It was brought on as a direct result of ADHD. Slowly, over time - I've been depressed for 20 years probably, and it's just slowly been getting worse. The turmoil of COVID almost certainly didn't help either of course, and I think this is why were seen a very large increase in demand for mental health services. Because people have 'moved forward' on their depression journey faster for a couple of years. 

I was cheap to 'fix' - I think I paid around £900 for some therapy, and around £1000 for ADHD diagnosis and treatment. I did it privately, because if I hadn't I'd still have been waiting. Only I probably wouldn't, because I'd have taken my own life. 

That's less tax than I pay in a month, and I do that every month, and have done for a LONG time. 

If I'd have been spotted as a child? None of this would have happened at all. It'd have been even cheaper. And likely I'd have flourished and 'lived up to my potential' and who knows what benefits that might have brought? 

My story though, is not any sort of unusual one. I can probably introduce you to 10 people I know who have similar stories to tell. ADHD alone is approximately 3-8% depending on what metrics you use, and that's one - or more - child in every classroom. Many of those are missed, because they're not quite the squeakiest wheels. Because our teachers too, are stretched, and not any sort of mental health experts either. ADHD and ASD goes unnoticed. 

Not all of those people end up suicidal - but plenty will, eventually. But all of those people fail to live up to their potential. They fall into unfavourable lifestyles - cycles of abuse, criminality, or just sustained depression and alienation. 

So please Mr Courts - could you take on this cause? 

I'd be more than happy to come and see you to discuss it, because I earnestly believe that doing this is justified in so many different ways. The quality of life impact is huge, but so is the economic impact. The costs of screening and treatment and additional training resources are downright trivial - even on an entire cohort - compared to the future economic impacts. 

Yours sincerely,

Ed Rolison