How the Australian ADHD System Actually Works

Trying to find ADHD assessment or treatment as an adult can be confusing. This guide explains who does what, what Medicare may cover, how medication prescribing works and what to ask before you book.

ADHD & ADULTS

By Larissa Braga · Updated August 2026

Article 2 of 4: The ADHD Adult Series

If you are seeking an ADHD assessment, or have recently received a diagnosis, you may have already discovered how difficult the system can be to understand.

You might hear about item 291, shared care, PBS authority, prescribing permits and Mental Health Treatment Plans, sometimes in the same conversation. It can be hard to know which parts apply to you and what will happen next.

The confusion is understandable. Australia does not have one national pathway for adult ADHD care. Medicare, the PBS and state prescribing laws each govern a different part of the process. Your pathway will also depend on where you live, which practitioners are available and whether your GP can take part in ongoing care.

This article explains the system in everyday language, so you can ask clearer questions and make informed decisions about your care.

This article is Part 2 of 4 in the ADHD Adult Series:

1. ADHD Diagnosis as an Adult: What Now?

2. How the Australian ADHD System Actually Works (you are here)

3. EMDR and Counselling for ADHD: Addressing Years of Self-Blame

4. ADHD at Work, in Relationships, and the Disclosure Question

Who Can Help With Adult ADHD?

Several practitioners may be involved in ADHD care, but they have different roles.

Your GP is often the first person you speak with. They can discuss your concerns, consider other possible explanations for your symptoms, review your physical and mental health and make a referral for further assessment. Some GPs can also take part in prescribing and monitoring ADHD medication, depending on their training and the rules in your state or territory.

A psychiatrist can assess and diagnose ADHD, consider other conditions that may be affecting you and discuss treatment options. If medication is appropriate, a psychiatrist can usually initiate it and may either continue managing it or arrange for an authorised GP to take over once treatment is stable.

A psychologist can assess ADHD if they have appropriate training and experience. They can also provide psychological therapy, but they cannot prescribe medication. If you want to explore medication, you will still need to see a medical practitioner who is authorised to prescribe it.

A counsellor can support you with the emotional and relational effects of ADHD. This may include understanding patterns of self-blame, processing the experience of receiving a diagnosis and finding approaches that fit your life. Counselling does not replace diagnostic assessment or medical care.

You may work with one practitioner or several. What matters is knowing who will be responsible for each part of your care.

What Is MBS Item 291?

MBS item 291 is a Medicare item for a comprehensive assessment and management plan completed by a consultant psychiatrist after a referral from a GP or another eligible referring practitioner.

The consultation must last more than 45 minutes. The psychiatrist completes a diagnostic assessment and sends the referrer a written report and management plan. The item is designed for situations where the psychiatrist believes the referring practitioner can manage ongoing care with specialist guidance.

Item 291 is commonly discussed in relation to adult ADHD, but it is not an ADHD-specific item. It can be used for different mental health presentations when the Medicare requirements are met.

It is also important to know what a 291 appointment does not promise. It does not guarantee:

an ADHD diagnosis after one appointment
a prescription on the day
that your GP can or will take over prescribing
that the psychiatrist will not need further appointments
bulk billing or no out-of-pocket costs

Some people need more than one appointment or additional information before a diagnosis can be made. The psychiatrist may also recommend short-term follow-up while medication is adjusted or decide that ongoing specialist care is needed.

If you are booking an assessment under item 291, ask the clinic what the fee will be, what Medicare may rebate and whether follow-up appointments are likely.

What Does Shared Care Mean?

Shared care usually means that a psychiatrist and GP divide responsibility for treatment.

For example, the psychiatrist may diagnose ADHD, start medication and adjust the dose. Once treatment is stable, the GP may provide ongoing prescriptions and monitor your health, with specialist review when needed.

This arrangement is not automatic. A psychiatrist cannot require your GP to take over prescribing. Your GP needs to be legally authorised, feel that the care is within their competence and agree to accept responsibility for it.

Before an assessment, it is worth asking your GP whether they are willing and able to provide ongoing ADHD care if a psychiatrist recommends shared care. If they cannot, ask the psychiatrist’s clinic whether the psychiatrist provides ongoing medication management.

Clarifying this early may prevent you from completing an assessment and then discovering that no one has agreed to continue your prescriptions.

How Does ADHD Medication Prescribing Work?

Medication decisions are individual. A diagnosis does not mean you must take medication, and medication will not be appropriate for everyone.

If you do want to consider it, three separate systems may affect access.

The TGA

The Therapeutic Goods Administration regulates medicines in Australia and approves them for particular uses. Your prescriber considers whether a medicine is suitable for you, taking account of your health, other medicines, possible adverse effects and personal preferences.

The PBS

The Pharmaceutical Benefits Scheme determines whether the Australian Government will subsidise a medicine in your circumstances. Eligibility may depend on the medicine, your diagnosis, age, treatment history and the relevant PBS restriction.

Some ADHD prescriptions require PBS authority. This relates to the subsidy. It is different from permission to prescribe a controlled medicine under state or territory law.

If you do not meet the PBS criteria, a medicine may sometimes still be prescribed privately when it is lawful and clinically appropriate. You would pay the private cost.

State and Territory Prescribing Rules

Stimulants such as dexamfetamine, lisdexamfetamine and methylphenidate are Schedule 8 controlled medicines. Each state and territory decides who can start or continue these medicines and whether an approval or permit is required.

This is why the pathway may differ depending on where you live. It is also why advice from someone in another state may not apply to your situation.

Why Your State Matters

Prescribing rules are changing across Australia. These examples were checked against government information in August 2026.

New South Wales

Psychiatrists, paediatricians and neurologists can prescribe psychostimulants for ADHD under the NSW class authority when the relevant conditions are met.

Since September 2025, GPs who complete the required training and receive authorisation can continue prescribing for eligible patients whose ADHD medication is stable. NSW is also introducing a more limited pathway for specially trained GPs to assess ADHD and initiate medication. This pathway is still developing and is not available through every GP practice.

Queensland

Since December 2025, specialist GPs, meaning GPs with specialist registration, have been able to initiate, adjust and continue psychostimulant treatment for adults with ADHD within the relevant dose limits.

This does not mean every GP provides ADHD assessment or medication management. Individual GPs still decide whether they have the training, capacity and clinical experience to offer this care.

Victoria

Psychiatrists can prescribe approved psychostimulants for adults with ADHD without an individual Schedule 8 permit when the conditions for the exemption are met. Most other medical practitioners require a Schedule 8 treatment permit unless an exemption applies.

Victoria has announced additional ADHD training for GPs beginning in September 2026. At the time of this update, this should not be understood as an established statewide GP service.

Other states and territories have their own requirements. Check the health department website for your state or ask your prescriber which rules apply to your care. This is especially important if you and your prescriber are in different states or territories.

What May Happen After a Referral?

Your pathway may look something like this:

You speak with your GP about the difficulties you have been experiencing.
Your GP considers your broader health and refers you for an ADHD assessment when appropriate.
The assessing practitioner gathers your developmental, educational, medical and mental health history. They may ask for school reports or information from someone who knew you when you were younger.
If ADHD is diagnosed, you discuss the available options. These may include medication, psychological support, practical changes and treatment for other conditions affecting your wellbeing.
If you choose medication and it is appropriate for you, an authorised prescriber starts and monitors it.
Ongoing prescribing remains with the specialist or transfers to an authorised GP who has agreed to provide it.

The process does not always follow this order. Assessment may take more than one appointment. Other conditions may need attention first or alongside ADHD. Finding a suitable medicine and dose can also take time.

What Does Medicare Cover for Psychological Support?

Under the Better Access initiative, eligible people can claim Medicare rebates for up to 10 individual and 10 group mental health treatment services in a calendar year.

Eligible providers include registered and clinical psychologists, and appropriately qualified social workers and occupational therapists who meet Medicare requirements.

You may be referred through a Mental Health Treatment Plan, a psychiatrist’s assessment and management plan or a direct referral from a psychiatrist or paediatrician. For individual treatment, the first referral can cover up to six sessions. You will need another referral to access any remaining sessions within the annual limit.

A Medicare rebate does not always cover the full fee. Ask the practitioner about their fee, the expected rebate and the amount you will need to pay.

Counselling sessions are generally not eligible for a Medicare rebate unless the counsellor also has a separate Medicare-eligible professional qualification and provides the service in that capacity. You do not need a GP referral or Mental Health Treatment Plan to see a private counsellor.

Where Counselling and EMDR May Fit

An ADHD diagnosis can explain longstanding patterns, but understanding the diagnosis does not immediately change how you feel about yourself.

You may still carry the effects of years spent being described as careless, difficult, lazy, too sensitive or unreliable. You may understand why certain things were hard and still feel shame when you struggle with them.

Counselling can offer space to explore those experiences without reducing everything to ADHD. The focus may include self-criticism, anxiety, relationships, grief about a late diagnosis and the practical effect of ADHD on daily life.

EMDR does not treat the core symptoms of ADHD. It may be considered when a person with ADHD also has distressing memories or trauma-related difficulties that continue to affect them. Whether it is appropriate depends on the person, the difficulty being addressed and careful clinical assessment. Research specifically examining EMDR for ADHD remains limited.

Psychological support and medical care can sit alongside each other. They address different parts of the experience.

Questions to Ask Before You Book

You do not need to understand every regulation before seeking help. A few practical questions can clarify what a service offers:

Does this practitioner assess adults for ADHD?
What does the assessment include, and how many appointments might be needed?
Is it billed under item 291, another Medicare item or entirely privately?
What will I pay after any Medicare rebate?
What records or information should I bring?
If I receive a diagnosis, does the practitioner prescribe medication?
Will they continue managing medication, or will they expect my GP to take over?
Is my GP authorised and willing to provide ongoing prescriptions?
What support is available if medication is unsuitable or I choose not to take it?

If a clinic cannot explain its fees, assessment process or follow-up arrangements clearly, you can ask for written information before committing to an appointment.

If You Live Outside a Major City

Finding ADHD services can be harder in regional areas. Some psychiatrists provide assessment by video when telehealth is clinically appropriate. MBS item 92435 is the video equivalent of item 291.

Telehealth can reduce travel, but availability, fees and waiting periods still vary. Your GP or local Primary Health Network may know which services operate in your area.

Changes to GP prescribing may improve access over time. They do not mean every regional GP is trained, authorised or accepting ADHD patients. Contact the practice before relying on this option.

Making Sense of Your Next Step

The system becomes easier to follow when you separate the questions:

Who will complete the assessment?
Who will discuss and initiate medication if I want to consider it?
Who will provide ongoing prescriptions and monitoring?
What will Medicare rebate?
Is the medicine covered by the PBS in my circumstances?
What will I need to pay privately?
Where can I find support for the emotional and practical impact of ADHD?

You should be able to ask these questions without feeling that you are being difficult. Clear information is part of informed care.

What Comes Next in the Series

Article 3 explores the emotional effect of years spent blaming yourself for difficulties that were not yet understood. It also considers how counselling and EMDR may fit, with care not to present EMDR as a treatment for ADHD itself.

Article 4 looks at ADHD in work and relationships, including the personal decision of whether to disclose a diagnosis.

If You Would Like Support

If you are adjusting to an ADHD diagnosis, counselling can help you understand its emotional and relational impact. It can also provide space to consider what you need, without reducing you to a diagnosis or a list of symptoms.

I offer ADHD-informed counselling and EMDR therapy for adults and young people aged 16 and over. Sessions are available in person in Billinudgel, in the Northern Rivers of NSW, and online across Australia. I work in English and Portuguese.

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About the Author

Larissa Braga is a PACFA Clinical Counsellor and EMDR therapist based in Billinudgel, Northern Rivers NSW. She works with adults and young people aged 16 and over, with a particular interest in trauma, anxiety and ADHD. Larissa offers counselling and EMDR therapy in English and Portuguese, in person and via telehealth across Australia.