NAIT Adult Neurodevelopmental Pathways report

Executive Summary

In 2021, there was a recognised need to improve experiences and outcomes for autistic adults, adults with ADHD and those with co-occurring neurodevelopmental conditions in Scotland - before, during and after diagnosis. Current provision is such that in some areas there is no service at all and where there is provision, waiting lists can be long and only accessible to people meeting particular thresholds for access.

There is a need for:

• Neurodevelopmentally informed services developed with and for neurodivergent people.
• Neurodiversity affirming, proportionate, relevant support and information across services, communities and society.
• Timely access to neurodevelopmental assessment, diagnosis and interventions or medical treatments where required.
• Better ways to understand and manage demand and capacity.
• Building workforce capacity including broadening cross sector and multi-disciplinary roles.

Although Community Mental Health Teams (CMHTs) are key leaders in this work, this need cannot and should not be met solely within CMHTs. There is a recommendation from recent review, that a Stepped Care Adult Neurodevelopmental Pathway is required in each locality.

In 2022, work has begun to break new ground, innovate and test out new ways of working towards these goals with local partnerships across 4 tiers, involving third sector and community teams, employers and employment support providers, further and higher education, new Primary Mental Health teams and CMHTs.

This report provides background and context to work of the pathfinder sites, enabled by the National Autism Implementation Team (NAIT), with practical support and mentorship as well as consideration of taking an evidence informed approach to the work.

In 2022, there has been related development work underway in other Health and Social Care Partnerships in Scotland. NAIT have led a national Professionals' Network to bring together those working with a shared focus across the country, to combine and pool learning and experiences.

This report describes the work undertaken in real world settings, outcomes, new resources developed and key learning from this first year of focussed work. Recommendations are provided that could take this work forward in the short term over the next 12-24 month and in the longer term and this report will support decisions about how to take the next steps locally and nationally.

Recommendations:

Short Term: Local work

Recommendation 1: An adult neurodevelopmental pathway strategy and planning group to be hosted in all Health and Social Care Partnerships.

Recommendation 2: Support to develop local neurodevelopmental pathway action plans.

Short Term: National work

Recommendation 3: A Neurodiversity Affirming Community of Practice.

Recommendation 4: A focus on 'Post Diagnostic Support 'or 'Support before, during and after diagnosis'.

Recommendation 5: Build a Neurodevelopmentally Informed workforce in Scotland.

Longer term

Recommendation 6: Development of neurodevelopmental pathway standards and guidelines for assessment, diagnosis and support.

Recommendation 7: Understanding demand and capacity within the system, to meet the needs of neurodivergent adults.

Recommendation 8: Neuroinclusive Further Education and Employment environments.

Recommendation 9: Build a shared expectation that support should be available at any stage for people who identify as neurodivergent.

Recommendation 10: Seek to understand the changes needed to effectively meet the mental health needs of neurodivergent people.