The UK's services for adult attention-deficit hyperactivity disorder (ADHD) are in crisis, with demand outstripping capacity and waiting times reaching unprecedented lengths. Recognition of and treatments for ADHD have expanded over the past two decades, increasing clinical demand. This issue has been exacerbated by the COVID-19 pandemic. Despite an increase in specialist services, resource allocation has not kept pace, leading to extended waiting times. Underfunding has encouraged growth in independent providers, leading to fragmentation of service provision. Treatment delays carry a human and financial cost, imposing a burden on health, social care and the criminal justice system. A rethink of service procurement and delivery is needed, with multiple solutions on the table, including increasing funding, improving system efficiency, altering the service provision model and clinical prioritisation. However, the success of these solutions hinges on fiscal capacity and workforce issues.

George Wallett (1775-1845) is generally known only as Haslam's successor at Bethlem who resigned under the cloud of corruption. However, his life proves to have been more eventful. He trained as a lawyer and doctor, enlisted in the army three times and bottled Malvern's first soda water. After bankruptcy, he managed Pembroke House Asylum as it opened, held two jobs in Bethlem and then operated Surrey House Asylum in Battersea. He moved on to help set up the Suffolk and Dorset asylums, and designed the Leicestershire asylum. He finally designed and opened Northampton Asylum, where being a Catholic ended his career.

Dr Pownall was a surgeon, asylum proprietor and one-time mayor of Calne who had bouts of insanity. He had two serious bouts of violence when insane, and later murdered a servant, Louisa Cook, after his discharge from Northwoods Asylum as recovered. He was tried for murder and ended up in Broadmoor, where he died in 1882. There are extensive contemporary public accounts of the case, but detailed examination of the roles of the local chief magistrate, Purnell Barnsby Purnell, and Pownall's brother-in-law and asylum doctor, Dr Ogilvie, reveals severe tensions that adversely influenced events. Everyone defended themselves, and few lessons were learned about cooperation.