i did indeed just reach out to a friend who recommended i talk to my primary care provider (PCP) and go from there.
now that i'm looking into all this, mental health is a luxury in america. sessions are approx $200/visit here in san francisco.
What you're really looking for (in my opinion) is a consultant psychiatrist (i.e. a senior, experienced psychiatrist) who supplements their NHS commitments with locum-style private practice work. (You know how you can use Babylon Health to speak to a real GP on the phone immediately for £10? And they can give you a prescription? Like that, but obviously clinical psychiatry requires meeting in person a lot.)
I think specialist ADHD centres run the risk of having a hammer and thinking every patient is a nail, if you know what I mean, and they also are geared up for the kind of deep clinical assessments which are often not required in adults (imagine the nightmare of trying to diagnose ADHD in a child with comorbidities).
Once you have titrated you can move from a private prescription to an NHS prescription which reduces ongoing costs significantly.
> just to be told you're lazy
Do the research into other people's experiences and think about your own downsides and consequences of e.g. inaction/inattentiveness/inability to focus. You can also check out the DIVA assessment which many psychiatrists will use. A good psychiatrist will also cut through the crap and tell you whether they think it's likely you have ADHD early in the process. They do not want to glean hundreds of pounds for you in order to say "Yup all fine here!".
Ping me on email and I'll share specifics of my consultant.
Here is what I might do if I wanted to cap at $400 (assume $400 is two hours) before finding out whether I need to do any more.
Before I book the appointment:
1. Find the most commonly used clinical assessment tool[1] and commit to undertaking it, with a specific emphasis on any corroborative components (i.e. friends and family who have known you for years helping to share experiences of you in childhood)
2. Research qualitatively: e.g. read essays from people who have had diagnoses and treatment and see how much of it chimes with you.
3. A useful experiment I did was to go to the ADHD subreddit and, ignoring the ebullient teenage blogger-type posts, make a list of posts and experiences which closely correlated to my own.
4. Write down your own summary of your experience and why you're seeking some help. Not necessary ADHD-specific, but what are the things you're aware of that you want to improve on in your life? What are the consequences you experience from those areas?
At the appointment:
1. Explain that you are aware diagnosis of most conditions requires a multi-stage evaluation from a psychiatrist, and that you am committed to taking the process seriously but have concerns about both the cost (hence doing a lot of research and being very organised, which runs contrary to some people's expectations of ADHD!), and the risk of getting a doctor who simply writes prescriptions without a second thought.
2. Tell the psychiatrist that you would like a preliminary recommendation from them on whether it's worth continuing with assessment and/or treatment after two sessions, and you'd appreciate it if they could do their work as methodically as possible but sensitively to the fact that you don't want to initially deploy more than $400 to the task.
3. Share with them that you have researched DIVA or another clinical assessment for ADHD because it feels like the symptoms of that chime with you, and you wanted to be sure it was worth your time coming in at all.
4. Tell them you're giving them this information because you don't want them to think you're doing stage management or trying to score some drugs, and commit to letting them run the session from there.
5. They will likely ask you to explain what has motivated you to attend in the first place. What 'thing' happened to get you off your ass and into their office?
I think it's very probable that you can find someone who understands that this is a debilitating condition in many people and which also needs a sympathetic approach to diagnosis.
The other thing to remember is that there are multiple clinical assessments because many people have comorbidities and it requires unpicking. If that isn't the case for you then you don't need hours and hours of assessments.
Feel free to reach out on my email (in profile) if you have Q's or I can be helpful.
[1] E.g. in the UK it's DIVA https://www.advancedassessments.co.uk/resources/ADHD-Screeni...