Natalia's story started with a simple thought in 2019, just five words long:
"What if I have ADHD?"
She'd been reading about ADHD in the news, and many of the symptoms sounded familiar.
"I was having problems concentrating, becoming really distracted by things like the lights and sounds," she says.
Things weren't perfect but, looking back on that time, Natalia says she had "an idyllic sort of a life".
She had a job at a prestigious university, $120,000 in the bank, a loving partner, a rental in Sydney's east a stone's throw from the beach, and shared custody of her two primary school-aged sons.
But what if she could put an end to her procrastination? Her drifting focus at work?
The number of Australians prescribed medication for attention-deficit/hyperactivity disorder has more than doubled in the last five years to reach 414,000 in 2022.
For many, getting an ADHD diagnosis and the right medication can be a game changer with major, lifelong benefits.
The prevalence of ADHD is contested territory, but it's thought to affect 2–6 per cent of adults in Australia.
Natalia was sceptical about whether she had ADHD for years but, as a diagnosis wave swept the country, the evidence seemed to pile up around her and in February 2022, she acted.
"I thought, look, the responsible thing to do is to get a diagnosis," she says.
She started hunting for a psychiatrist on Google and settled on the one who would see her the fastest.
"I was quite convinced that I had ADHD. So I just wanted somebody who could get me in as quickly as possible," she says.
"They had ADHD in the title so I thought they were perfect."
The earliest appointment was a telehealth session in four weeks' time.
During their session, the clinic's senior psychiatrist interviewed Natalia about her symptoms, stretching back to childhood.
In less than an hour, it was official: she had ADHD.
"I found that it was very easy to get a diagnosis — almost like a drive-through experience," she says.
Natalia was prescribed the stimulant Ritalin and told to take 30mg a day.
'Everything came alive'
The promise contained in her diagnosis and treatment felt palpable.
"I was ecstatic … as if I was about to get on a plane to, you know, some exotic destination," she says.
"It meant a cure to all of the symptoms that I'd been experiencing."
Her doctor's instructions said to start slowly, but the effect was immediate.
"The first few days were blissful. I just felt like life was a music festival," she says.
"Everything came alive, everything popped. I loved this new person that I was and I loved the world."
Within a few days, as she reached her recommended 30mg daily intake, the feeling soured.
"That happiness turned into an acute sense of despair," she says.
She started to have flashbacks to a stressful workplace dispute, which had been resolved a while ago.
"I started to remember these feelings and they were so vivid for me, to the point where I couldn't stop crying … I could barely function," she says.
Natalia started firing off emails to her bosses of the kind you should definitely sleep on and probably never send.
It was out of character, and the university was concerned enough that they put her on six months of leave.
Natalia suspected her new meds were playing a role, so she cut back to 5–10mg a day and emailed her psychiatrist about it in June.
"I was happy to reduce down but I didn't want anyone, especially not my psychiatrist, to tell me to stop taking it," she remembers.
"I always had this weird feeling while I was on the meds that there was some reason that I should continue taking them and that my luck was about to change."
Taking time out to 'heal'
Natalia's psychiatrist had recommended increasing her Ritalin intake to 15mg, but she was taking less after her recent experience at work.
Her plan was to use her six months of leave to recover from whatever it was that caused her to unravel so dramatically.
"That involved me having regular massages, doing lots and lots of yoga, doing painting classes, having acupuncture, having breath work, spiritual chanting sessions," she says.
"The way I perceived it, I was on this quote-unquote healing journey of… I don't even know what it was I was trying to heal."
Natalia started spending money "like it was water".
"Every splurge would give me such a buzz," she says.
There was also a shift in her personality — she'd always been shy with strangers, but now, she couldn't stop meeting them.
"I wanted to talk to everyone all the time about anything and everything, and I wasn't normally like that," she says.
"Going down the street for coffee became this whole adventure where I would just strike up conversations with randoms."
In August she saw her psychiatrist again, who by that point had increased her Ritalin prescription again to 30mg.
Still mindful of how badly things had gone back in March, Natalia decided with her GP to cap her intake at 20mg.
During those months, her transformation further escalated.
"My behaviour started to become more and more outlandish," she says.
A transformation
Natalia was living with her partner of five years, Paul, who she describes as calm, focused and the love of her life.
He'd noticed the changes and tentatively expressed some concern, but the way she saw it, she'd never been better and by September, she began to feel as if Paul wasn't keeping up.
"I wanted more excitement in my life and he wasn't at the pace that I needed him to be at," she says.
She decided to end things and she broke the news abruptly.
"I said, 'it's over, buddy', and I told him he had three weeks to leave," she recalls.
"I put on some hot pants and I went down to the local pub, had a couple of wines.
"Apparently, I was slurping a smoothie when I came back and said something else flippant along the lines of 'What are you still doing here?'"
Paul was devastated.
By October, Natalia was running out of money and needed to return to work.
The university had her take an independent psychiatric assessment, and she was cleared to go back to the office.
But the Natalia who showed up was not the Natalia her colleagues remembered
"I would come In when I felt like it, dressed in a combination of yoga gear and office attire," she says.
"I was talking non-stop about my love life very loudly and just being very eccentric. I don't know that I got a lot of work done.
"I'd just get up and go out for a cigarette every few minutes."
Things start to unravel
Smoking was the least of Natalia's transformations but, in all the whirlwind change, her kids had been a constant.
Eventually, though, a turning point came in November, during a day out at a local water park.
"They started offloading about the fact that their stepmother assigns them lots of chores around the house," Natalia says.
Natalia had always had a good relationship with her ex-husband's partner.
She describes her as someone she'd always trusted and appreciated, but hearing her kids complain at the water park, she reconsidered.
"She just became like the most horrendous creature imaginable in my mind," she says.
Speaking with her sons, Natalia became more and more wound up about what she saw as the injustice of the scenario.
In the days that followed, Natalia sent an email to the extended family implying that her kids were being abused by their stepmother.
It prompted a furious phone call from their father, but Natalia wasn't deterred.
"I went over and stood in front of the house and called the police, saying that they were, you know, they were being abused," she says.
"[It was] this mama bear instinct, just gone over the top."
Around this time, Natalia's erratic behaviour also led to a fallout with her sister and best friend.
She was increasingly isolated but doesn't remember feeling lonely.
"I took real pride in the fact that I could go out on a Saturday night by myself and just strike up conversations," she says.
Natalia was still seeing the same psychiatrist from the ADHD clinic.
They had an appointment in mid-December and he left her ADHD treatment plan unchanged.
Then, a few days before Christmas, while she had the kids to stay, she did something she couldn't undo.
"I won't go into all the details, but I was being a smart alec and I said something which sounded like a horrendous threat," she says.
"My oldest was on the phone to his Dad at the time, and his Dad said, 'call the police.'"
The police issued Natalia with an AVO, which stopped short of forbidding her from seeing her children but did impose strict conditions.
After that, Natalia knew she wasn't well and agreed to limit her time with the kids to a few hours, once a fortnight.
She checked herself into a psych ward, where she had to beg to be admitted.
"I got down on the floor and started howling until they let me in," she says.
She left the ward again after a couple of days.
An unrecognisable life
Natalia was back at work, but every other aspect of her life was unrecognisable.
By March, a year after her first appointment with the ADHD clinic, Natalia had developed a romantic obsession with her yoga teacher, who was gay and had declined her advances.
"I would stay up all night just writing poems for him and things like that," she says.
"It's not that I necessarily believed we would be together. I just was overwhelmed with a sense of affection."
She was listening to certain songs and watching certain shows on endless repeat.
Natalia also remembers sending a lot of long emails, including to senior management at the university where she worked.
Natalia's delusions had escalated to the point where she was convinced she was about to become the new chancellor.
The next time she saw her kids, she told them about a plan to move the three of them to a desert island, where they would reinvent language together.
When she explained their Dad wasn't coming, they screamed and ran out.
It was the last time she saw them for months.
But Natalia wasn't perturbed.
"I just went on to the next thought process. I had to go into the university. So I went out and hopped on a bus," she says.
It was the evening and the campus was quiet, but Natalia could hear music coming from the trees. She started dancing and singing along.
She discovered an auditorium, where the microphone was still turned on.
"I went up to the lectern and I sat and I gave a speech about all the changes that I would implement as the new chancellor," she says.
After the speech, she couldn't understand why senior management wasn't there to congratulate her.
She went to the chancellery to find them and found it locked.
Believing it was part of a media stunt to publicise her new promotion, she ran at the door and kicked it, causing a little damage but not enough to get inside.
More confused than ever, Natalia eventually wandered away.
That's when the police turned up.
They arrested her, then transferred her to an ambulance, where she was injected with a sedative.
When she eventually woke up in a psychiatric hospital, she'd been taken off the Ritalin and put on an antipsychotic and a mood stabiliser.
The doctors at the hospital told her she was experiencing what's known as stimulant-induced psychosis. It had been triggered by her Ritalin.
They also told her it was likely that she had bipolar.
Just over a year after being diagnosed with ADHD, Natalia's life had been comprehensively derailed.
Her career was on hold, her $120,000 in savings was gone, her partner was seeing someone else, she had to move home with her parents and she'd lost access to her kids.
'It was all too easy'
Natalia believes the care she received at the ADHD clinic played a big role in how her life unravelled.
"It is a fast food sort of a type of operation".
"It's very quick, it's not very thorough. It was all too easy.
"It was almost a fait accompli that as soon as I engaged with him, that I would come out with a script for stimulants.
In the hour it had taken her psychiatrist to diagnose Natalia with ADHD, he had missed her bipolar.
Natalia says she mentioned during the first appointment that she'd been hospitalised before for a depressive episode and that bipolar had been suggested at the time, but she was resistant to the idea, so she played it down with the ADHD clinic.
In a written response to Background Briefing, Natalia's psychiatrist said that a one-hour telehealth session is usually enough for an experienced psychiatrist to assess for both those conditions and more.
He also says that she "denied previous manic/hypomanic and clinical depressive episodes" in their first meeting.
He says it might have been possible to diagnose her sooner "if she had admitted to having had BAD (Bipolar Affective Disorder)".
Natalia's psychiatrist says up until her hospitalisation in April 2023, she had been "doing well".
Having bipolar doesn't necessarily preclude the use of stimulants, but it carries extra risks, such as a higher likelihood of manic episodes or occasionally, psychosis.
Natalia's psychiatrist says she told doctors that she'd taken more Ritalin than he'd prescribed, and that might have contributed to her psychosis.
Natalia admits she said that, but only during the peak of her psychosis as part of a misguided attempt to avoid being diagnosed with bipolar.
She's adamant now she never took more than she was prescribed, and frequently took less.
The psychiatrist says he saw Natalia on average once every two and a half months up until her three weeks in the psychiatric ward.
But the way Natalia remembers it, she didn't see him once between December 2022 and May of 2023.
She says booking follow-up appointments was a nightmare.
"Three to four months [was] the wait".
"After I'd had the psychosis and I contacted them, they gave me an emergency slot, which was three weeks after my call."
'A conveyor belt of faces'
Psychiatrist Dr Killian Ashe has seen cases like Natalia's become more common as the ADHD wave has picked up steam.
Dr Ashe works at the Royal Melbourne Hospital's Acute Psychiatric Unit.
"From mine and from my colleagues' anecdotal experience in a busy inner-city public emergency department and psychiatric unit, there is a consistent increase in the amount of stimulant-related presentations," he says.
"I'm seeing a conveyor belt of faces go through my mind now of the last few years where we've had young people, some of them attending over and over again because their prescribers would not stop prescribing," he says.
The clinic Natalia went to is part of a subset of psychiatry that's been booming since the pandemic: telehealth ADHD clinics.
No two are the same, but they tend to share some key characteristics.
They're often marketed as ADHD specialists and many have unusually high fees.
In extreme cases, they'll charge up to $3,000 for an assessment.
The psychiatrists working there are sometimes paid very high salaries. A recruitment ad for one clinic offers $900,000 a year.
They mostly see patients on telehealth and at some clinics, it's the only option available.
Natalia's psychiatrist estimates that 90 per cent of patients who come for an assessment, leave with an ADHD diagnosis.
Plenty of clinics practise responsibly but a number of doctors who've spoken to Background Briefing say there are too many that don't.
Psychiatrist Dr Jackie Rakov works both in custodial settings and private practice and is also witnessing a new wave of patients presenting with prescribed drug-induced psychosis.
"The prevalence is unquestionably higher," she says.
"I have colleagues who work in custodial settings and they are just sort of exhausted by it, like 'yet another person admitted with a prescribed drug-induced psychosis.'"
Dr Rakov blames ADHD clinics like Natalia's.
"There's a lot of capitalising on people's worry and sense of urgency about needing this diagnosis," she says.
"It's almost like a fait accompli where you hand over your $2,000 and you get your diagnosis. End of story."
She believes many ADHD specialist clinics are failing in their responsibility to their patients.
"I've sat with patients in my consulting suite helping them word their concerns to the Health Complaints Commissioner because they've developed essentially trauma disorders from their experience being involuntarily detained for a psychosis caused by their prescribed stimulant," she says.
"I've dealt with people facing criminal charges because of the consequences.
"And I think it's actually abhorrent that the people who sit in those very nice, probably very profitable clinics are not accountable for that."
Neither Dr Jackie Rakov nor Dr Killian Ashe are against the use of stimulants to treat ADHD.
"Some of the most gratifying work I've done as a doctor is the prescribing of stimulants to people who had missed out, and many of them were women and girls," Dr Ashe says.
"This is not about dismissing you, this is about acknowledging you and acknowledging our responsibility to you."
There's a mood for change at the moment when it comes to how ADHD is treated in Australia.
A Senate inquiry into ADHD care delivered its report in November, making 15 recommendations, including that the government consider reviewing Medicare and bulk billing for ADHD.
There are hopes that such a move might diminish the market for high-fee private clinics.
For now, they're the only option for the vast majority of Australian adults seeking an ADHD assessment.
The government is due to respond by February.
Loading...'When the shame kicked in'
It took Natalia about a month after being admitted to hospital for her to return to herself.
"I can almost remember the day when the penny dropped," she says.
"I felt alone and scared, and suddenly I didn't know what to do with myself.
"That's when the shame kicked in — recognising all of the mistakes that I'd made and being hugely embarrassed and ashamed of everything that I'd done."
Natalia was also facing criminal charges — that included assaulting a police officer — over that night at the chancellery.
If she was convicted, she could have gone to prison
She had to get her treating psychiatrist — the doctor who'd originally diagnosed her with ADHD — to write to the court in order for the charges to be dismissed under the Mental Health Act.
The letter he wrote worked but, as part of her ongoing treatment plan, he recommended she continue using stimulants, once she had stabilised.
"[It was] unbelievable to me that he would do that after I've just had a psychosis … I thought it was ludicrous," she says.
At Natalia's request, he revised the plan to exclude Ritalin.
Natalia is required to continue seeing her psychiatrist every two months until July next year, under the conditions of her release.
She's now moved back to Sydney and is starting to rebuild her old life.
She's mended her relationship with her partner, Paul, and they're back together.
She was nervous to see her kids again, but it went better than she dared to hope.
"They couldn't stop hugging me," she says.
"They kept insisting that I sleep in the bed with them, which I couldn't because I wriggle so much, but it was lovely".
Natalia is rebuilding the rest of her relationships slowly, but the shame she feels is persistent.
"I do sometimes feel like the lowest creature on Earth for having been in this situation where I can't care for my children," she says.
"It's really hard to shake".
She says what helps the most, is seeing her life return to normal, even if it is in small increments.
"For example, the recent conversation with my ex-husband where that trust is starting to come back and my oldest is talking to his Dad about how often he wants to be able to stay at my place," she says.
"I believe it will all come back together. And as it slowly does, that's when the shame goes."