The NSW government’s new ADHD reform gives general practitioners the authority to diagnose and prescribe medication without requiring input from psychologists or psychiatrists. It’s been framed as a win for access and touted as a practical way to ease pressure on an overloaded system.
Since the announcement broke, psychologists across the country have huddled together whispering in surprise that it seems as though an entire profession with extensive training in assessment and diagnosis has been left out of the conversation again. Coincidentally, psychology is also a profession overwhelmingly staffed by women.
Let me be clear: this isn’t an attack on GPs. Their role in ADHD care is essential, especially in under-served areas. Opening prescribing access is a huge win, as psychiatrists are harder to access and more expensive.
Prescribing is one thing. But assessment and diagnosis require a different kind of expertise. Expertise that is mostly held by women and systematically excluded.
I speak on this topic not only as a psychologist myself, but also as a woman who wasn’t diagnosed with ADHD until my late 30s. Like many women, I flew under the radar of systems never designed to see us.
I remember mentioning my suspicions to a GP I deeply respected. A highly capable doctor and a woman with an excellent track record in mental health. I was part-way through a PhD and felt a familiar struggle that I had first noticed in primary school. Her well-meaning comment stayed with me: “Is it really worth pursuing now? You’ve done pretty well for yourself, even if you do have it”.
The message was clear: achievement cancels harm. If you’re successful, you’re fine. That same logic is now driving ADHD diagnosis – especially when it comes to women.
I see late diagnosed women all the time in my clinic. Some have been assessed and diagnosed by me, and some have had astute GPs flag the possibility and refer on for further assessment. But for every astute GP, there are many more who don’t necessarily have the insight or time within consults to appropriately assess more complex presentations. And the more complex and nuanced presentations of ADHD happen to be found in women.
Let me explain. Psychologists have a minimum of six years formal training in mental health and neurodevelopmental conditions. We listen for whispers as well as shouts and seek what may hide in high performance. This information may need to be coaxed out over hours of building trust and decreasing shame. We typically do this in sessions of 50 minutes at a time – minimum.
Once again, the tools of clinical authority are handed to those higher on the professional ladder, even if they’re not best placed to use them.
As feminist scholar Peggy McIntosh described in her work on privilege, some people carry an “invisible knapsack”. The term refers to unearned tools and assumptions that certain people such as white, cis-het males carry, granting them access, trust, and autonomy. When reform relies solely on those who hold the privilege, everyone else is expected to stay quiet.
Psychology is a deeply feminised profession. And like most feminised professions, it’s underpaid, overregulated, and routinely excluded from decision-making. This reform is just the latest in a long line of system changes where women’s labour — both professional and emotional — is quietly dismissed.
And here’s the other truth: this reform probably won’t even reduce wait times.
Yes. GPs can prescribe, but prescribing without proper assessment is a shortcut. And shortcuts often lead to problems.
The unaddressed questions about this reform are many. How many hours will the requisite training be and what will it cover? Will differential mental health diagnoses and co-occurring conditions also be assessed to rule them in or out of the clinical picture? How long will the GP consults be to do this effectively? And is it possible that this reform will just move the current bottleneck from psychiatry to general practice?
Accurate, ethical ADHD care requires collaboration. Not convenience.
This reform is being hailed for increasing “access” and “efficiency.” But when systems prioritise speed over understanding, they miss people. And the people most at risk of being missed are overwhelmingly women. Especially neurodivergent women, and trauma victim-survivors who have learned to mask and suppress as if their lives depend on it. Because in many cases, their lives have depended on it.
I’ve worked with too many of these women. Some hastily medicated at the expense of thorough and detailed assessment. I’ve seen first-hand the life-altering consequences such as stimulant-induced mania, which can occur when bipolar is not appropriately assessed and excluded. Others were told they were fine, that their suffering was just part of life.
Women’s voices are routinely silenced. When we speak up, we’re accused of being difficult. When we ask for rigour, we’re seen as resistant. When we advocate for accuracy, we’re told to stay in our lane.
This isn’t about turf. It’s about whose voices count in clinical spaces, and whose voices are silenced. It’s about the emotional and cognitive labour women do to hold up systems that refuse to hear them. It’s about epistemic injustice — when certain knowers are disqualified simply because their knowledge couldn’t possibly be credible coming from someone wearing lipstick and heels.
This reform might look efficient on paper. But in practice, it sidelines the very people and professions best equipped to get it right. It reinforces medical and gendered hierarchy at the expense of relational care. And it tells women, again, that if their symptoms aren’t loud, or convenient, or male, they might not count.
We don’t need quicker diagnoses. We need better ones. We need systems that understand complexity and value collaboration. And we need reform that is based on truly listening to women’s expertise and lived experience. The reform we need isn’t about who diagnoses or writes the prescription. It’s about who gets believed — and that has always been gendered.
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