Why Scotland must be a leader in building a society where people with neurodiversity can flourish

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Dr Jim Crabb – a consultant psychiatrist and policy lead for the RCPsych in Scotland – writes for The Herald on why we have a framework and evidence to support the view that Scotland can lead the way in supporting autistic people and those with ADHD. 

For far too long patients, families, clinicians and campaigners have been grappling with a health system which is no longer fit for purpose.

What was once a manageable level of need has transformed into something far greater -which is driven by greater awareness and a growing willingness among people to seek support.

We now face a choice. Continue to patch up an outdated mental health system or build something modern and genuinely effective.

Up to 20 per cent of Scots experience some form of neurodevelopmental condition like ADHD. But our NHS mental health service was built to only serve one per cent of the population - those who experience the most severe types of mental illness, such as schizophrenia and bipolar disorder.

The result is predictable. We have long waiting times, inconsistent provision and a postcode lottery across the country that leaves individuals and their families, fighting simply to be heard.

Working on the frontline we know referrals for these types of conditions has risen by as much as 800 per cent over recent years.

In the dark days of the past, many would have been afraid to come forward for support. But now people feel able to recognise what they are experiencing and ask for help. That should be something we celebrate.

Instead, the system has turned increased awareness into increased frustration because capacity has not grown alongside demand.

Scotland still has no national referral or treatment pathway. Instead, many people are diverted into an already overstretched mental health service that is struggling to cope.

A national pathway would not only streamline access to medical assessments but also give professionals clarity, reduce duplication and ensure people receive the right support first time.

Without it, individuals are left to navigate a maze of local processes that vary dramatically between health boards.

This failure serves no one. It leaves neurodivergent people without timely or appropriate support and increases the pressure on already over stretched staff.

Frontline teams are doing their best, but burnout is rising, morale is falling and professionals report feeling distressed at being unable to offer the timely care they know people deserve.

It’s striking that in some health board areas in Scotland, waiting times for assessments are approaching ten years.

Such figures are staggering in a modern health service. They also show that incremental tweaks will not be enough - Scotland needs systemic reform, not short-term crisis management.

Ten years for a child means their entire school journey and if you’re an adult, it means a decade of lost opportunities, reduced wellbeing and unnecessary struggle.

These delays are not abstract. They affect thousands of people’s relationships, work, education and mental health. It’s time they’ll never get back.

Research consistently shows unsupported neurodivergent people face higher rates of anxiety, depression and unemployment.

But these outcomes are not inevitable - they are the result of inaccessible support systems.

The cost of inaction is both human and financial. If so many people remain without help and support, the cost to Scotland over their lifetimes could run into the billions.

Investing now is not only the right thing to do morally – it’s the smart economic choice.

Every year we delay on this issue, Scotland loses potential and productivity and wellbeing that can never be reclaimed.

But here is the good news – we already have a framework capable of transforming this picture.

For months, the Royal College of Psychiatrists in Scotland has been working to develop a national plan for neurodevelopmental support, which is a world first.

This plan provides the kind of clarity and ambition that has been missing for years. It gives our country a credible roadmap - something concrete that policymakers, professionals and communities can unite around.

It’s built on evidence, expert consensus and lived experience. It provides a clear way forward - rooted in partnership rather than conflict.

Our plan is based on a needs-based system, one which supports people across their life span.

It means putting help into people’s hands no matter where they live in Scotland.

There is no value in blaming one another for how we got here. Every country in the world is experiencing the same rise in need for support. Nowhere predicted or prepared for it.

But Scotland has a chance to be one of the first countries to respond with clarity, compassion and structure.

We can now be world leaders in building a society where those who experience neurodiversity can get the help they need. Instead of becoming stuck – they’re been given the opportunity to flourish.

If we build a coordinated, properly funded pathway, we can shift from reacting to crises to investing in potential.

We’re fortunate to have committed people across government, healthcare, education, social care and the third sector who all want to make things better.

The appetite for collaboration is real. What has been missing is a national mechanism that brings everyone together behind a shared plan.

Our approach is not about pointing fingers. It’s about rolling up our sleeves. We’re determined to work with the Scottish Government, local health boards, clinicians and the public to ensure progress is real, measurable and felt in every community.

Measurement matters as families must be able to see waiting times fall, support expand and outcomes improve – not just hear promises.

Scotland led on smoking legislation, minimum alcohol pricing and social policy. We can lead again.

With political will, collaboration and proper resourcing we can end the postcode lottery and be a world leader in neurodevelopmental support.

We have the framework. We have the evidence. We have a shared desire to build a fairer, more inclusive future for people with autism and ADHD.

Now together – we must deliver it. To help, please contact your MSP and ask they support our plan.