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Behind the Screen: BBC Panorama Misrepresents ADHD

BBC's Iplayer screen showing a hand with some pills in it.
Image sourced under fair use from https://www.bbc.co.uk/iplayer/episode/m001m0f9/panorama-private-adhd-clinics-exposed

Staff writer Yuke Zhou looks at the recent BBC Panorama episode “Private ADHD Clinics Exposed” and asks if this really was a journalistic exercise or if it wrongfully shamed ADHD sufferers.

The release of the “Private ADHD Clinics Exposed” episode by BBC Panorama on 15 May 2023 ignited a heated, ongoing debate about the practices of private ADHD clinics within the UK. The documentary has had profound and far-reaching consequences, leaving a trail of damage in its wake. After the BBC Trust apologised for an inaccurate Panorama episode on Attention Deficit Hyperactivity Disorder (ADHD) in 2010, this documentary shows that Panorama has failed the ADHD community once again in 2023. 

In “‘Private ADHD Clinics Exposed”, BBC Panorama reporter Rory Carson went undercover as a patient with the mission of exposing private ADHD clinics for their alleged low standards for a diagnosis. Carson was told by an NHS psychiatrist that he does not meet the clinical threshold of ADHD and yet was diagnosed with ADHD by three private clinics (Harley Psychologists, ADHD 360 and ADHD Direct). He shares that this was done after short online video calls and that he was quickly prescribed “a powerful controlled drug”. With the episode, Carson intends to show that private ADHD clinics are letting people down by being too quick to diagnose the disorder.

BBC Panorama is investigating valid concerns about the quality of private ADHD clinics, but the credibility, reliability and validity of the investigation have come under intense scrutiny. As I will argue throughout this article, Carson’s investigation is unethical, inaccurate and disingenuous and it should be deemed inadmissible due to biases and lack of impartiality. As Henry Shelford, the CEO and Co-Founder of ADHD UK, stated, “our research from over 1,500 people, shows Panorama’s show to be factually incorrect.”

Carson’s refusal to disclose many details of his assessment has left a clear void in the available information, making it impossible to establish a meaningful comparison. In the documentary, he only provides snippets of the assessments that fit his narrative but fails to show the detail of the assessments, impeding us from reaching a conclusion different to his own. This means that potential inconsistencies and discrepancies in the assessments remain unaddressed and undisclosed. The lack of access and transparency to these crucial details hampers the ability to conduct a comprehensive analysis and raises questions about the validity and credibility of the assessments – this is the basis of Harley Psychologists’ defence of their practices. 

The narrative of the episode presents a one-sided account that lacks comprehensive and multidimensional perspectives. By selectively including findings and cherry-picking information to support a specific predetermined narrative, the episode undermines its credibility and overlooks important information. The episode centres around exposing the unreliable and dangerous practices of private ADHD clinics. Carson claims that private practices “hand out unreliable diagnoses” to most of those who pay. However, this does not consider that, according to one email apparently from the ADHD 360 Secretariat, out of 4,808 patients who accessed their services, 75% were refused an assessment after being screened negative by the screening tool.

Several individuals have claimed online that they were approached by Carson to discuss private practices, but Carson disregarded their accounts as they did not fit his narrative. The BBC has not yet recognised or responded to these specific complaints. The evident one-sided nature of this episode raises concerns about its credibility, as it fails to incorporate other perspectives or present a balanced view on the matter at hand. By excluding alternative viewpoints, the episode is biased and lacks objectivity, undermining its reliability as a source of information.

While we may expect certain outlets to prioritise bombshell headlines over trustworthy content, we certainly did not expect this from the BBC. The BBC’s entire existence is justified by a structure that avoids relying on such tactics to secure its funding, allowing it to pursue the truth, no matter how bland or complex, without fearing putting its existence into jeopardy. According to its Royal Charter, the BBC’s mission is “to act in the public interest and provide impartial, high-quality and distinctive” content.” Unfortunately, this BBC Panorama episode has not met this guideline.

Another issue with the ‘investigation’ is its non-compliance with media ethics. The three private clinicians filmed for the investigation were not informed, unable to give consent, and given no right to withdraw before their identities were revealed on a national platform. While this is the standard procedure for investigations into politicians, such as a recent Led By Donkeys exposé, it seems questionable to apply this to medical practitioners. Carson also took away valuable assessment time from those who are genuinely in need and awaiting urgent care. This deceptive practice violates the trust in the clinician-patient relationship and undermines the integrity of the healthcare system, exacerbating the distress experienced by those who are desperate for help while being stuck on years-long waiting lists.

Putting journalistic concerns to one side, the stigma and scepticism of ADHD produced by this episode should also be scrutinised. In a survey conducted by the charity ADHD UK, out of 1,580 people, 87% think that Panorama wasn’t fair in the representation of ADHD and 89% think ADHD stigma has increased due to the show. It induces a harmful understanding that people can easily fake ADHD, especially via private practices. This implication raises concerns about the portrayal and stigmatisation of individuals with ADHD, who are already bogged down by the increasingly unpopular yet persistent stigma that their condition is made up.

Olivia Blake MP commented that “this programme is incredibly harmful to those with ADHD diagnosis. Given the massive shame many of us carry from not being diagnosed as children the harm cannot be understated. We’ve spent our whole lives thinking there was something morally wrong with us. So one-sided.” The episode has heightened the imposter syndrome common in people with ADHD, leaving many of us feeling invalidated and doubted. Adrian Chiles responded to this episode in the Guardian, explaining that ADHD is not a con. Chiles voices the struggles and demands of the ADHD community at the end of his article, “no one wants ADHD, no one wants to hand over a substantial amount of money, no one wants to take medication every day. All we want is clarity, and for everyday life not to be so damn difficult.”

Carson unjustly generalised private practices in his ‘investigation’ and this may lead to the condemnation of private ADHD practices. This sweeping assumption could have severe impacts on the ADHD community by potentially invalidating private diagnoses altogether. In a survey by ADHD UK, many expressed worries that their GP will not accept private diagnoses in future. The ADHD Foundation has also stated that “​​we believe the unscrupulous behaviour of some people/organisations in the private sector should be challenged, but it must also be contextualised within the wider environment of our health services. Not doing so irresponsibly risks discrediting the entire private sector, jeopardising patients’ access to NHS Shared Care Agreements with their GP”. 

Therefore, we must ensure that this single incident does not paint the whole landscape. Out of the ADHD UK survey respondents, 89% of people with ADHD stated that the show lacked balance in its representation of private clinics. Service quality opinions appear similar across all sectors, with positive views scoring 74% on NHS local, 85% for the right to choose and 87% for private services. Well-qualified and high-quality private ADHD clinics do exist. Reputable private providers, such as Psychiatry UK, have established partnerships with the NHS as well, to help deal with enormous patient lists and exorbitant waiting times. 

Evaluating the quality of ADHD clinics is undoubtedly necessary, but it is crucial that such assessments encompass all clinics, regardless of whether they are private or part of the NHS. Condemning private clinics, while barely touching on endemic NHS issues, results in polarisation of private practices and the NHS, exacerbating the challenges faced by individuals with ADHD by creating unnecessary barriers to treatment. It has caused many individuals to find themselves caught in a challenging situation, choosing between ridiculously long waiting times within the NHS and the ‘unreliable’ private practices. Just don’t choose private clinics, they said. But what they have yet to come to understand is that there is no ‘choice’ or ‘agency’ when it becomes necessary for living. As Michelle Beckett, the founder of The ADHD Co., shared, “I’d be dead by now without my private diagnosis… If I had steered clear, and gone on a several years long waiting list, my daughters would be putting flowers on my grave, I’m not exaggerating.” 

BBC Panorama has failed to assess the real problem: at the heart of the matter lies the pressing need to address the issues of accessibility and capacity for ADHD healthcare. ADHD is an “under-identified, under-diagnosed, and under-treated condition” in the UK. An ADHD assessment within the NHS shows that there are extensive waiting periods, with wait times extending up to five or even ten years. This should not be the case, especially when considering the profoundly debilitating nature of ADHD which is characterised by impaired executive functioning: we struggle with studying, working and day-to-day life more generally. The truth is, many of us cannot afford to wait and are forced to pay for private care in order to survive. In a time when the NHS struggles to meet the increasing demand for ADHD assessments, many well-qualified private ADHD clinics have emerged as a lifeline for us, providing crucial support and services. This episode has debilitated the already fragile support system, with studies showing 83% of people with ADHD believe that this show will stop people with symptoms from seeking an ADHD assessment.

BBC Panorama must acknowledge the detrimental impact caused by the episode ‘Private ADHD Clinics Exposed’ and take immediate action to rectify the situation. In solidarity with everyone suffering from ADHD and those hurt by the episode: you are heard, you are not alone and you are supported. 

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