Is Patrick McGorry’s and the Independent Mental Health Reform Group’s $3.5b blueprint for Australian mental health the way forward, or a prescription for more ‘psychiatric disorders’, ‘off label’ prescribing and youth suicide?

Former Australian of the Year, Professor Patrick McGorry, and to a lesser extent his close colleague Professor Ian Hickie, have dominated the long overdue debate about the future of mental health service delivery in Australia. Their claims of massive unmet need and proven 21st century solutions are being accepted almost without question by the Gillard Government, the Abbott Opposition, the independents, the media and the public.

In December 2010 Minister for Mental Health & Ageing Mark Butler took the extraordinary step of sidelining his own National Advisory Council on Mental Health and appointing Professors McGorry and Hickie as members of a Mental Health Expert Working Group. Minister Butler said ‘that the creation of the new, time limited, specialist group will allow for targeted advice to be provided directly to the Australian Government on how to achieve the most coordinated, cost-effective and lasting reforms for their investment in mental health care.’[1]

For reasons that are not clear, Professors McGorry and Hickie and fellow member of the Mental Health Expert Working Group, Monsignor David Cappo, subsequently established the Independent Mental Health Reform Group. In March this year the Independent Mental Health Reform Group released its $3.5B blueprint for mental health.[2]

In the following blog I outline my concerns in relation to the blueprint including the:

  • proposal to increase funding to Headspace by $226 million given the advocacy by Professor McGorry and Headspace of ‘off label’ prescribing of SSRI antidepressants to young people. This is despite clinical studies and FDA and TGA advice that the use of SSRI’s increases the risk of suicidal behaviour by young people.
  • proposal to increase funding to EPPIC by $910 million given Professor McGorry advocacy of the recognition of Psychosis Risk Syndrome as a diagnosable psychiatric disorder. This is despite the concerns of numerous high profile psychiatrists including his close colleague Professor Alison Yung who questions; ‘ Is the agenda really to use antipsychotics?…the risk is that instead of getting maybe supportive therapy, they get antipsychotics and they will be diagnosed with the risk syndrome.
  • lack of publicly accesible evidence of patient outcomes and the cost effectiveness of the mental health ‘best buys’ identified in the blueprint.
  • alarmist claim by Professor McGorry that in 2011 four million Australian’s including 1 million young people will have a mental disorder requiring treatment.

Following my blog Professor McGorry takes up my invitation to exercise his right of reply.

So what is in the blueprint?

The blueprint outlines $3.5billion expenditure over 5 years on programs that are identified as mental health ‘best buys’. The most expensive ‘best buy’, at $910m, is for the rollout of 20 new Early Psychosis Prevention Intervention Centres (EPPIC). Australia’s only existing EPPIC clinic is run by Orygen Youth Health, headed up by Professor McGorry.[3] The blueprint states that EPPIC has the largest international evidence base of any mental health model of care demonstrating not only their clinical effectiveness but also their return on financial and social return on investment.’ Despite this bold claim, there is no evidence in the blueprint of EPPIC’s cost effectiveness or patient outcomes compared with outcomes from other mental health services.

The second priority identified is the expansion of the national Headspace program to 90 service sites, at a cost of $226m. Professors McGorry and Hickie are both Board members of Headspace. Again there is no supporting evidence. The blueprint is completely unreferenced. It is merely a $3.5billion consensus wish list of these ‘independent’ mental health experts, completely devoid of supporting verifiable evidence.

That is not to suggest that Headspace and even EPPIC don’t provide some valuable interventions, and there is undoubtedly some merit in the other programs identified. However, the blueprint falls far short of establishing the case that an extra $3.5 billion of taxpayer’s funds would be best spent on the identified ‘best buys’.

How ‘independent’ is the Independent Mental Health Reform Group that developed the blueprint?

Professor McGorry and several organisations he presides over have received considerable financial support from the pharmaceutical industry. In 2008, McGorry disclosed the sources but not the quantum of pharmaceutical company funds he has received in an article he wrote published by the British Medical Journal. To its’ credit the BMJ is one of the few journals that strictly enforces its’ disclosure policy. It stated McGorry, has received unrestricted research grant support from Janssen- Cilag, Eli Lilly, Bristol Myer Squibb, Astra-Zeneca, Pfizer, and Novartis. He has acted as a paid consultant for, and has received speaker’s fees and travel reimbursement from, all or most of these companies’.[4] McGorry is currently Director of Clinical Services at Orygen Youth Health Clinical Program and Executive Director of the Orygen Youth Health Research Centre.[5] Orygen receives support from numerous pharmaceutical companies.[6] In addition, McGorry is Treasurer and former President of the pharmaceutical industry funded International Early Psychosis Association.

Professor Ian Hickiehas received grants totalling $411,000 from pharmaceutical companies, including $10,000 from Roche Pharmaceuticals (1992); $30,000 from Bristol-Myers Squibb (1997); $40,000 from Bristol-Myers Squibb (1998-1999); $250,000 from Pfizer Australia (2009); and $81,000 from Pfizer Australia (n.d.).[7]  Whilst it was not disclosed in the blueprint, Hickie does deserve some credit for disclosing in his online CV that he has received this funding from the pharmaceutical industry.

Along with Professors McGorry and Hickie and Monsignor David Cappo, the other members of the ‘independent’ group are Sebastian Rosenberg, John Moran and Matthew Hamilton. Moran and Hamilton both work for Orygen and therefore are subordinates of McGorry. Rosenberg is the former CEO of the Mental Health Council of Australia and is currently Head of the National Mental Health Policy Unit at Hickie’s Brain and Mind Research Institute[8] and a director of the mental health business ConNetica, whose website lists one of its ‘Private Sector Customers’ as Eli Lilly.[9]

Neither Professors McGorry nor Hickie nor any other member of the Independent Reform Group disclosed their pharmaceutical company connections in the blueprint. Neither did the blueprint identify which mental health ‘best buys’ are based on service delivery models exclusive to organisations they control. These potential conflicts of interest may have been known by the politicians controlling funding, however, it is apparent the media were either ignorant of, or disinterested in them and happily portray McGorry and Hickie as independent advocates.

Why does Professor McGorry think that 4 million Australians will have a ‘mental disorder’ requiring treatment in 2011, and what treatments does he propose?

In March 2010 when appearing on ABC’s Lateline, Professor McGorry said 4 million Australians have mental health problems in any given year. Only one third of them get access to treatment… there are 1 million young Australians aged 12 to 25 with a mental disorder in any given year. It’s the peak period across a lifespan when mental disorders appear. And 750,000 of them have no access to mental health care currently.’[10][11]

Public critics of Professor McGorry are rare; however, not everyone accepts his alarming claims. Jon Jureidini, Adelaide University Professor of Psychiatry and Paediatrics, accused McGorry of disease-mongering when claiming that 750,000 young Australians were ‘locked out’ of care they ‘desperately’ needed: ‘He’s taken the biggest possible figure you can come up with for people who might have any level of distress or unhappiness, which of course needs to be taken seriously and responded to, but he’s assuming they all require … a mental health intervention…It’s the way politicians operate. You look at figures and put a spin on it that suits your point of view. I don’t think that has a place in scientific conversations about the need for health interventions.’[12]

Professor McGorry responded to Professor Jureidini’s criticisms, writing: ‘I have never argued that 1 million young Australians have serious mental illness’. However, he added: ‘late intervention philosophy is associated with risk, preventable damage and stigma and for this reason access to appropriate, staged mental health care for young Australians with mild, moderate and serious mental ill-health is overwhelmingly supported by political parties and the health and social sectors (most recently expressed in a letter co-signed by 65 organisations). To argue that young Australians with mild to moderate mental ill-health do not need access to mental health care applies a standard to mental health that would not be acceptable in physical health. Imagine restricting access to health services to only Australians with severe physical ill-health and locking out all those with milder conditions with the admonition that they should just regard their distress as part of the human condition and suck it up![13]

Professor McGorry is of course correct that there appears to be ‘overwhelming’ support by ‘by political parties and the health and social sectors’ for his calls for early intervention; however, this is evidence of political rather than clinical or scientific success. There is undoubtedly unmet and mis-met mental health need, but Professor Jureidini’s legitimate questions remain. In 2011 will more than one in seven Australians (4 million) have a ‘psychiatric disorder’ requiring a ‘mental health intervention’? Would these millions of Australian’s benefit from, or be stigmatised by being labeled ‘psychiatrically disordered’? And even more worryingly, what are these potential interventions and will they do more harm than good?

Why do Headspace and Professor McGorry advocate the ‘off label’ (unapproved) use of SSRI antidepressants in even ‘moderately depressed’ young people, despite FDA and TGA warnings about the increased risk of suicidality?

A 2009 evidence summary produced by Orygen Youth Health for Headspace and overseen by Professor McGorry, titled ‘Using SSRI Antidepressants to Treat Depression in Young People: What are the Issues and What is the Evidence?’, correctly identifies that the US Food and Drug Administration has issued the highest possible ‘black box’ warning that the use of SSRI antidepressants increases the risk of suicidality in people under 24.[14] The warning was put on in 2005 after an analysis of clinical trials by the FDA found statistically significant increases in the risks of ‘suicidal ideation and suicidal behavior’ by about 80%, and of agitation and hostility by about 130%.[15]

Headspace’s evidence summary also acknowledged that ‘no antidepressants (including any SSRIs) are currently approved by the Therapeutic Goods Administration (TGA) for the treatment of major depression in children and adolescents aged less than 18 years’.[16] In addition the evidence summary acknowledges that research indicates that in terms of managing the symptoms of depression, ‘the only SSRI with consistent evidence of its effectiveness in young people is fluoxetine (Prozac)….The effectiveness of fluoxetine however is modest…Young people on fluoxetine do not appear to be functioning better in their daily lives at the end of the trials.’[17]

The body of the evidence summary builds a compelling argument for avoiding the use of SSRIs in young people. Despite this, it concludes by recommending: ‘In cases of (even) moderate to severe depression, SSRI medication may be considered within the context of comprehensive management of the patient, which includes regular careful monitoring for the emergence of suicidal ideation or behaviour’.[18] The nearest thing to a rationale offered in the paper is that many young people who are depressed get no treatment and that it is better to do something than nothing.

Through the use of a variety of mechanisms, including candle-light vigils, Professor McGorry has mobilised well intentioned, vocal supporters including Get Up! to highlight the tragedy of youth suicide to advocate for reform of mental health services for the young.[19] Yet the Headspace evidence summary, which is effectively a guideline for the treatement of young Australians, acknowledges and then ignores the clinical trial evidence and FDA and TGA advice on the relationship between SSRI antidepressants and youth suicidality.

If Australia were, as Professor McGorry frequently advocates, to follow ‘evidence based medicine’ on preventing the tragedy of youth suicide, we would not allow the use of SSRIs by young people. However, if Australia follows Headspace and McGorry’s advice on SSRIs, we risk more, not fewer, candles at the next vigil.

Why has Professor McGorry experimented with the use of antipsychotics in non-psychotic adolescents, and why does he advocate the recognition of controversial newly invented psychiatric disorders?

Professor McGorry has a long history of advocating or experimenting with the ‘off label’ use of psychotropic drugs for moderate mental ‘illness’ and for hypothesised psychiatric disorders that are not officially recognised. He is a leading international advocate for the inclusion of psychosis risk syndrome, otherwise known as attenuated psychotic symptoms syndrome, in the next edition of the American Psychiatric Association’s clinically dominant Diagnostic and Statistical Manual of Mental Disorders (DSM-V) (the ‘bible’ of psychiatry) due for publication in 2013.

Professor McGorry hypothesises that that there is ‘prodromal phase’ prior to the onset of a first psychotic episode. He acknowledges that ‘the false positive rate may exceed 50-60%’, but nonetheless he led controversial research that trialled the use of the antipsychotic risperidone (Risperdal®) on young people without psychosis who were suspected of being at risk of developing psychotic disorders such as schizophrenia.[20]

Risperidone is one of the more commonly used ‘atypical’ (newer) antipsychotics and has a range of serious potential side effects including metabolic syndrome, and sudden cardiovascular death.[21][22] There have been more than 500 voluntary adverse event reports made to the TGA, and these are just the tip of the iceberg as the vast majority of adverse events are never reported.[23][24]

Professor Allen Frances, the American psychiatrist who led the 1994 revision of the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), is a fierce critic of the hypothesised psychosis risk syndrome. With the benefit of hindsight, Frances regrets aspects of the 1994 revision for having triggered ‘three false epidemics. One for autistic disorder…another for the childhood diagnosis of Bi-Polar disorder and the third for the wild over-diagnosis of Attention Deficit Disorder.’.[25]

Based on this experience, Professor Frances warns of numerous problems with the drafting of the next edition, DSM-V, recently writing that: ‘Among all the problematic suggestions for DSM-V, the proposal for a “Psychosis Risk Syndrome” stands out as the most ill-conceived and potentially harmful… The whole concept of early intervention rests on three fundamental [flawed] pillars… 1) it would misidentify many teenagers who are not really at risk for psychosis; 2) the treatment they would most often receive (atypical antipsychotic medication) has no proven efficacy; but, 3) it does have definite dangerous complications.”[26] Frances contends that up to 90% of those diagnosed with psychosis risk syndrome would never go on to develop psychosis, and concludes that the it is ‘the prescription for an iatrogenic [adverse effects resulting from treatment] public health disaster’.[27]

Even one of Professor McGorry’s closest colleagues at the Orygen Youth Health Research Centre, Professor Alison Yung, has expressed strong opposition to the inclusion of psychosis risk syndrome in DSM-V, questioning; ‘So why the need for a specific risk syndrome diagnosis? Is the agenda really to use antipsychotics? …….I think there are concerns about validity, especially predictive validity, and this relates to potentially stigmatizing and unjustified treatment for some individuals as well as all the negative social effects of diagnosis. I think including the risk syndrome in the DSM-V is premature…….more people seek help, but the risk is that instead of getting maybe supportive therapy, they get antipsychotics and they will be diagnosed with the risk syndrome.’[28]

Regardless Professor McGorry still advocates for the inclusion of psychosis risk syndrome in DSM-V. However, he recently distanced himself from the use of antipsychotics on patients perceived to be at risk of psychosis. In response to earlier criticism including a blog I authored, he wrote ‘Antipsychotic medications should not be considered unless there is a clear-cut and sustained progression to frank psychotic disorder meeting full DSM 4 criteria’ This appeared to put an end to the debate about whether McGorry currently advocates the use of antipsychotics on the hunch that adolescents will later become psychotic.

However, the statement in his December 2010 blog that ‘our clinical guidelines do not (and have never done so in the past) recommend the use of anti-psychotic medication as the first line or standard treatment for this Ultra High Risk group’ has the potential to mislead.[29] Whilst it is true that Professor McGorry has never produced final endorsed clinical guidelines recommending the use of antipsychotics for his hypothesised ‘ultra high risk group’, the facts are that for well over a decade McGorry experimented with, and advocated, the pre-emptive prescription of antipsychotics to adolescents.

Professor McGorry was the lead author of a 2006 article which, as part of a proposed ‘clinical staging framework for psychosis’, identified ‘atypical antipsychotic agents’, as one of the ‘potential interventions’ for individuals who are at ‘ultra-high risk (10% to 40%)’ of developing first episode psychosis.[30] Whilst he has recently adjusted the ‘clinical staging framework’, he was still advocating antipsychotics as a potential pre-psychosis intervention at least as late as October 2007.

A 2007 British Medical Journal article jointly authored by Professor McGorry began by quoting a 1994 paper extolling the potential of pre-psychosis pharmacological interventions: ‘The best hope now for the prevention of schizophrenia lies with indicated preventive interventions targeted at individuals manifesting precursor signs and symptoms who have not yet met full criteria for diagnosis. The identification of individuals at this early stage, coupled with the introduction of pharmacological and psychosocial interventions, may prevent the development of the full-blown disorder.’ McGorry’s article’s opening comment followed: ‘Such sentiment underlines the aim of identifying people in the prodromal phase preceding a first psychotic episode.’[31] The article went on to outline evidence supporting interventions including antipsychotics ‘to delay or even prevent onset of psychosis.’

Furthermore, in 2008, in the British Medical Journal, in an article titled ‘Is early intervention in the major psychiatric disorders justified? Yes’, Professor McGorry wrote: ‘Early intervention covers both early detection and the phase specific treatment of the earlier stages of illness with psychosocial and drug interventions. It should be as central in psychiatry as it is in cancer, diabetes, and cardiovascular disease….. Several randomised controlled trials have shown that it is possible to delay the onset of fully fledged psychotic illness in young people at very high risk of early transition with either low dose antipsychotic drugs or cognitive behavioural therapy.’[32]

These are just a few of numerous similar statements which comment favourably or suggest the use of antipsychotics as part of the treatment for adolescents considered to be at ‘ultra high risk’ of developing psychosis. Whether such comments constitute ‘advocacy’ is open to semantic debate. However, Professor McGorry certainly favoured this highly controversial use and continues to advocate for the official recognition of ‘psychosis risk syndrome’ as a psychiatric disorder. Despite being dircetly asked by me Professor McGorry has not ruled out further experimentation with antipsychotics for psychosis prevention, or the use of antipsychotics as a ‘second line treatment’ for ‘subthreshold psychosis’. These are issues that need a clear resolution before there is any increased funding of EPPIC.

Where are other psychiatrists and the Royal Australian & New Zealand College of Psychiatrists in the national mental health debate?

With the notable exception of Professor Jon Jureidini and Professor Vaughan Carr[33], there has been little public criticism from within the Australian psychiatric profession of Professor McGorry’s plans for the future of Australian mental health. A number of psychiatrists I have spoken to are privately critical of McGorry’s advocacy of ‘off label’ prescribing; however, they are grateful that McGorry’s Australian of the Year status has at last put mental health on the agenda and is likely to result in extra resources.

Whilst I am critical of the unquestioning acceptance of Professors McGorry and Hickie’s claims by politicians and the media, it is not entirely their fault. Mental health is a confusing and mysterious field clouded by personal and commercial agendas and politicians, and the media have not been offered an attractive alternative – mainly because there are few simple solutions for complex problems.

The Australian psychiatric profession needs to start acting like a profession interested in cautious, first-do-no-harm, evidence-based approaches to addressing unmet and mis-met mental health needs. The Royal Australian & New Zealand College of Psychiatrists needs to stop being so timid. The Australian public needs a vigorous debate within the College, the psychiatric profession, the wider medical and therapeutic community and the public to drive the future of Australian mental health.

Isn’t it time to ask Professor McGorry a few tough questions?

I think that unquestioningly following Professor McGorry’s prescription for Australian mental health risks more harm – more ‘psychiatric disorders’, youth suicides and an epidemic of iatrogenic (adverse prescription drug event) suffering – than good. I am particularly concerned that a McGorry endorsed and Headspace driven increase in the ‘off label’ prescription of SSRI antidepressants to children and young people may cost lives. And I think McGorry’s pharmaceutical company ties and obvious conflicts of interest in advocating for well over $1billion increased funding for EPPIC and Headspace need to be understood and considered.

Professor McGorry needs to show that his claim that four million Australians will suffer a mental health disorder warranting treatment this year is not disease-mongering. He needs to detail what these psychiatric disorders are and exactly what appropriate treatments would involve. And McGorry needs to explain why the FDA and TGA are wrong and why giving SSRIs to depressed children and adolescents doesn’t increase their chances of suicidality.

And Professor McGorry needs to explain why he has experimented with antipsychotics on adolescents who had never been, and by his own admission probably never will be, psychotic. McGorry also needs to explain why Professor Allen Frances and even McGorry’s close ally Professor Alison Yung are wrong to be concerned that his push for the recognition of ‘psychosis risk syndrome’ as a new psychiatric disorder may be all about promoting the use of antipsychotics and may lead to an ‘iatrogenic health disaster’.

Perhaps Professor McGorry really does have insights that make him uniquely placed to design Australia’s 21st century mental health system. However, now that the Gillard Government is on the verge of committing massive resources to aspects of McGorry’s mental health blueprint, it is time the Canberra politicians, the media and the Australian psychiatric profession and other health and welfare professionals got beyond his former ‘Australian of the Year’ status and asked him a few hard questions.


[1] Advisory Group to Guide Mental Health Reforms (23 December 2010), Pro Bono News http://www.probonoaustralia.com.au/news/2010/12/advisory-group-guide-mental-health-reforms (accessed 26 April 2011)

[2] Including, Connecting, Contributing: A Blueprint to Transform Mental Health and Social Participation in Australia, March 2011. Prepared by the Independent Mental Health Reform Group: Monsignor David Cappo, Professor Patrick McGorry, Professor Ian Hickie, Sebastian Rosenberg, John Moran, Matthew Hamilton http://sydney.edu.au/bmri/docs/260311-BLUEPRINT.pdf (accessed 26 April 2011)

[3] Orygen Youth Health – Early Psychosis Prevention Intervention Centre website http://www.eppic.org.au/about-us (accessed 26 April 2011)

[4] McGorry P.D. (2008) Is early intervention in the major psychiatric disorders justified? Yes, BMJ 337:a695 http://www.bmj.com/cgi/content/full/337/aug04_1/a695 (accessed 3 August 2010)

[5] McGorry is the former President and the current Treasurer (http://www.iepa.org.au/ContentPage.aspx?pageID=40) of the International Early Psychosis Association which is funded by antipsychotic manufacturers Astra Zeneca, Lilly and Janssen-Cilag (http://www.iepa.org.au/2010/)

[6]McGorry is currently Director of Clinical Services at Orygen Youth Health Clinical Program and Executive Director of the Orygen Youth Health Research Centre. Orygen receives support from AstraZeneca, Bristol Myer Squibb, Eli Lilly, and Janssen-Cilag. Orygen Youth Health, Research Centre – Other Funding http://rc.oyh.org.au/ResearchCentreStructure/otherfunding (accessed 3 August 2010)

[7] Cited in Ian Hickie, Curriculum Vitae, last updated 23 August 2009 http://sydney.edu.au/bmri/about/Hickie_CV.pdf (3 August 2010). In addition Professor Hickie and colleagues created ‘SPHERE: A National Depression Project’ (http://sydney.edu.au/bmri/about/Hickie_CV.pdf). As was reported in The Australian, Pfizer works in conjunction with SPHERE through a company called Lifeblood, which is based at Hickie’s Brain and Mind Research Institute. BMRI staff are paid to review SPHERE. According to Lifeblood, SPHERE ‘assisted in restoring the market share and growth of the Pfizer antidepressant Zoloft, restoring it to the No 1 product in this market’. Davies J. (10 July 2010) GP jaunts ‘boosted’ drug sales, The Australian. http://www.theaustralian.com.au/news/nation/gp-jaunts-boosted-drug-sales/story-e6frg6nf-1225890003658 (accessed 30 April 2011)

[8] Brain and Mind Research Institute website http://sydney.edu.au/bmri/research/mental-health-policy/index.php (accessed 30 April 2011)

[9] ConNetica website http://connetica.com.au/about (accessed 26 April 2011)

[10] ABC (11 March 2010) Mental health system in crisis: McGorry, Lateline, Australian Broadcasting Corporation. Reporter: Tony Jones http://www.abc.net.au/lateline/content/2010/s2843609.htm (accessed 26 April 2011)

[11] In a presentation on behalf of beyondblue, Professor Ian Hickie claimed the 12 month prevalence of mental disorders for Australia men is 17.4% and woman 18.0%. Responding to the challenge of brain and mind disorders in Australia, Ian Hickie MD FRANZCP Professor of Psychiatry, Brain and Mind Research Institute, University of Sydney& Clinical Advisor, beyondblue: the national depression initiative http://www.gptt.com.au/Exam%20preparation%20CK%20Khong/Mental%20Health/Depression%20adults%20hickie_slides.pdf

[12] Medew, J. (9 August 2010) McGorry ‘misleading the public’, The Age http://www.theage.com.au/national/mcgorry-misleading-the-public-20100808-11qes.html

[13] Sweet, M. (17 August 2010) Patrick McGorry defends early intervention on youth mental health, Croakey: the Crikey Health Blog http://blogs.crikey.com.au/croakey/2010/08/17/patrick-mcgorry-defends-early-intervention-on-youth-mental-health/ (accessed 26 April 2011)

[14] Evidence Summary: Using SSRI Antidepressants to Treat Depression in Young People: What are the Issues and What is the Evidence? Headspace, Evidence Summary Writers Dr Sarah Hetrick, Dr Rosemary Purcell, Clinical Consultants Prof Patrick McGorry, Prof Alison Yung, Dr Andrew Chanen http://www.headspace.org.au/core/Handlers/MediaHandler.ashx?mediaId=4896 (accessed 26 April 2011)

[15] Hammad T.A. (16 August 2004). Review and evaluation of clinical data. Relationship between psychiatric drugs and pediatric suicidal behavior, Food and Drug Administration. pp. 42; 115. http://www.fda.gov/OHRMS/DOCKETS/ac/04/briefing/2004-4065b1-10-TAB08-Hammads-Review.pdf (accessed 29 May 2008)

[16] Evidence Summary: Using SSRI Antidepressants to Treat Depression in Young People: What are the Issues and What is the Evidence? Headspace, Evidence Summary Writers Dr Sarah Hetrick, Dr Rosemary Purcell, Clinical Consultants Prof Patrick McGorry, Prof Alison Yung, Dr Andrew Chanen http://www.headspace.org.au/core/Handlers/MediaHandler.ashx?mediaId=4896 (accessed 26 April 2011)

[17] Evidence Summary: Using SSRI Antidepressants to Treat Depression in Young People: What are the Issues and What is the Evidence? Headspace, Evidence Summary Writers Dr Sarah Hetrick, Dr Rosemary Purcell, Clinical Consultants Prof Patrick McGorry, Prof Alison Yung, Dr Andrew Chanen http://www.headspace.org.au/core/Handlers/MediaHandler.ashx?mediaId=4896 (accessed 26 April 2011)

[18] Evidence Summary: Using SSRI Antidepressants to Treat Depression in Young People: What are the Issues and What is the Evidence? Headspace, Evidence Summary Writers Dr Sarah Hetrick, Dr Rosemary Purcell, Clinical Consultants Prof Patrick McGorry, Prof Alison Yung, Dr Andrew Chanen http://www.headspace.org.au/core/Handlers/MediaHandler.ashx?mediaId=4896 (accessed 26 April 2011)

[19] Hagan, K. (29 July 2010) GetUp! calls for urgent reform to mental health policy, The Age http://www.theage.com.au/victoria/getup-calls-for-urgent-reform-to-mental-health-policy-20100728-10w74.html#ixzz1Ka5lGSDj (accessed 26 April 2011)

[20] Williams, D. (18 June 2006) Drugs before diagnosis? Time Magazine http://www.time.com/time/magazine/article/0,9171,1205408,00.html (accessed 18 November 2010)  

[21] Consumer Medicine Information: Risperidone http://www.racgp.org.au/cmi/jccrispe.pdf (accessed 3 August 2010)

[22] Webb, D. & Raven, M. (6 April 2010) McGorry’s ‘early intervention’ in mental health: a prescription for disaster, Online Opinion http://www.onlineopinion.com.au/view.asp?article=10267 (accessed 18 November 2010)

[23] Adverse events information related to risperidone obtained from the Therapeutic Goods Administration’s Public Case Detail reports

[24] As reporting is voluntary, there is no way of knowing what proportion of actual adverse events gets reported. A 2008 study by Curtin University pharmacologist Con Berbatis indentified that only a tiny fraction (for general practitioners only 2 per cent) of adverse events are reported. (Con Berbatis, (2008), Primary care and Pharmacy: 4. Large contributions to national adverse reaction reporting by pharmacists in Australia, i2P E-Magazine, Issue 72, p. 1)

[25]Frances, A. (2010), in M. Whitely, Speed Up and Sit Still: The Controversies of ADHD Diagnosis and Treatment, p.18. UWA Publishing, Crawley, Western Australia. Also: Frances, A. (8 April 2010) Psychiatric diagnosis gone wild: The “epidemic” of childhood bipolar disorder, Psychiatric Times http://www.psychiatrictimes.com/bipolar-disorder/content/article/10168/1551005 (accessed 30 April 2011)

[26] Frances, A. (2010) DSM5 ‘Psychosis risk syndrome’—Far too risky, Psychology Today http://www.psychologytoday.com/blog/dsm5-in-distress/201003/dsm5-psychosis-risk-syndrome-far-too-risky

[27] Frances, A. (2010) DSM5 ‘Psychosis risk syndrome’—Far too risky, Psychology Today http://www.psychologytoday.com/blog/dsm5-in-distress/201003/dsm5-psychosis-risk-syndrome-far-too-risky

[28] Schizophrenia Research Forum (4 October 2009) Live Discussion: Is the risk syndrome for psychosis risky business http://www.schizophreniaforum.org/for/live/transcript.asp?liveID=68

[29] Refer http://speedupsitstill.com/reply-patrick-mcgorry-early-intervention-psychosis

[30] McGorry, P., Purcell, R., Hickie, I. B., Yung, A. R., Pantelis, C., & Jackson, H.J. (2006) Clinical staging of psychiatric disorders: a heuristic framework for choosing earlier safer and more effective interventions. Australian and New Zealand Journal of Psychiatry, 40:616-622. Note: A similar article is available online at http://www.mja.com.au/public/issues/187_07_011007/mcg10315_fm.html (accessed 26 April 2011)

[31] Yung, A.R. & McGorry, P.(2007) Prediction of psychosis: setting the stage, British Journal of Psychiatry, 191: s1-s8.  http://bjp.rcpsych.org/cgi/content/full/191/51/s1  (accessed 7 December 2010)

[32] McGorry P.D. (2008) Is early intervention in the major psychiatric disorders justified? Yes, BMJ, 337:a695 http://www.bmj.com/cgi/content/full/337/aug04_1/a695 (accessed 3 August 2010)

[33]Carr V. (8 July 2010) Mentally ill of all ages need services. The Australian. http://www.theaustralian.com.au/news/opinion/mentally-ill-of-all-ages-need-services/story-e6frg6zo-1225889141003 (accessed 30 April 2011)


Right of Reply – Professor Patrick McGorry

Martin Whitely suggests that the Independent Mental Health Reform Group’s Blueprint may be a template for more psychiatric disorders, more off label prescribing and more youth suicide. In support of this improbable claim Mr. Whitely questions the integrity of the authors of the Blueprint, casts doubt about the wisdom of the Australian community’s desire for major mental health reform and suggests that early intervention models headspace and EPPIC may do more harm than good. I therefore welcome the opportunity to respond to each of these themes.

1. Integrity of the Blueprint’s authors

Mr.Whitely raises numerous doubts about the integrity of the authors (and in particular of myself) – in terms of motive, independence and process. Specifically, Mr. Whitely questions what motivated the authors to convene to write the Blueprint in the first place, states that the authors have undisclosed conflicts of interest and suggests that we have made claims without being able to substantiate them with evidence. It is disappointing that Mr. Whitely should impute such bad faith to our group and should have been prompted to do so in the absence of supporting evidence. In terms of the issues of integrity that he raises:

  • The motive of the authors was to produce a credible investment action plan to advance mental health reform across the lifespan that could be adopted by Government (and by Opposition and Cross-Bench Parties). We felt that the momentum for mental health reform might temporarily stall in the absence of such a plan. We therefore convened a group to produce the Blueprint document and chose the name Independent Mental Health Reform Group to make it clear that our work reflected only the views of the six authors made no claims of wider representation or linkage to Government and/or other third parties.
  • The suggestion that the authors are dishonestly trying to secure over $1b of public funding for projects (specifically headspace and EPPIC) to which they conceal their links is completely at variance with the truth. The target audience for this Blueprint (political leaders and public servants responsible for mental health policy) are unambiguously clear about my leadership role in EPPIC and the participation of Ian Hickie and myself on the headspace board. I have hosted both Julia Gillard and Tony Abbott at EPPIC, as well as Minister for Mental Health Mark Butler and a diverse range of current and past parliamentarians – including a visit last month by members of the House of Representatives Education and Employment Standing Committee. Likewise, officials from the Department of Health and Ageing have also visited our EPPIC service and both Ian Hickie and myself have longstanding relationships with political and public service leaders arising directly from our role with headspace. Furthermore the proposal we have made is that the public in other parts of Australia beyond the EPPIC service I lead should reap the considerable benefits of this model of care.  There is no request or expectation of any personal benefit to me or any of my colleagues flowing from any Federal government decision to scale up the EPPIC model, as other countries have already done in response to my prior support and advocacy.
  • Similarly, the implication that the content of the Blueprint may have been inappropriately influenced by the pharmaceutical industry is also false. In my case, Mr. Whitely perversely uses my own declaration of previous pharmaceutical industry funding as supporting evidence for his claim that I am actively concealing this funding. To put this in context, pharmaceutical funding currently plays a very minor roll (less than 5%) in funding Orygen Youth Health Research Centre projects – all of which have been designed and conducted independently of pharmaceutical company input. Furthermore, its unclear which, if any, of the Blueprint’s 30 recommendations would be core commercial concerns of any of the pharmaceutical companies – for example it is notable none of these recommendations call for the MBS listing of any drug.

2. Wisdom of the Australian community’s desire for major mental health reform

Mr. Whitely acknowledges that the Australian public and elected representatives from all sides of politics accept that there is a major need to act on mental health reform. Mr. Whitely appears not to believe that this national consensus for action is the result of tens of thousands Australians sharing their stories of unmet serious mental distress to finally break through to our national conversation. Instead, Mr. Whitely chooses to believe it is more likely the product of a gullible public falling for some clever sophistry. Mr.Whitely appears to believe that the case for mental health reform remains unproven. This is a disappointing approach from an elected representative. The facts are clear that access and quality in mental health care are well below the standards that exist in the rest of health care.  National Mental Health survey data clearly backs this up and it is freely acknowledged by the department of health and ageing and the current government.  Most of his peers and indeed all sides of politics have listened to the Australian community and concluded that it is time to act – it is unclear what new evidence he is waiting for before he joins them. It is notable that he has not chosen not to state in his article his own views about the appropriate level of expenditure on mental health care (an increase? a cut?) or where he feels resources should be directed.

3. Early intervention models headspace and EPPIC

Mr. Whitely only specifically mentions two investment recommendations contained in the Blueprint – the early intervention youth mental health models headspace and EPPIC. It is not clear why he has chosen just these two recommendations or what he thinks about the other 28 recommendations. For the record, the other 28 recommendations include family based interventions for children, social and economic participation supports for middle and older years Australians and a range of measures to improve accountability, innovation and practice across the mental health system.

Mr. Whitely wrongly concludes that because we wrote the Blueprint as an action plan rather than a referenced review of the evidence, that there is no evidence for our recommendations. It is based on the best available scientific evidence.  In fact, we had already supplied much of that evidence to the policy making audience for the Blueprint over the previous months. The National Health and Hospitals Reform Commission chaired by Dr Christine Bennett reviewed all the evidence for the Rudd government and came up with very similar recommendations and carefully referenced their findings.   Mr. Whitely surely is aware of the NHHRC’s unequivocal support for headspace and EPPIC.  For example, cost-effectiveness data for Early Intervention in Psychosis (EPPIC or EPPIC derived models of care) indicate that:

– Health costs are less under EIP than under standard care. The first year health costs through providing the full EPPIC model to young people experiencing a first episode psychosis have been estimated to be $25,955 compared to $36,833 under standard care [1 – updated to 2009 prices]. Over the long term, mean annual costs under the EPPIC model are estimated to drop to approximately 1/3 of those under standard care [2].

– Employment costs are likely to be less under EIP than under standard care. Long term follow up of EPPIC clients indicates they are twice as likely to be currently in employment than people receiving standard mental health care [2].

– Suicide costs are likely to be less under EIP than under standard care. Most suicides associated with schizophrenia are thought to occur near the beginning of the illness [3]. A recent study suggested that the number of suicide attempts amongst this group in areas with EIP teams is one third that in areas without them [4].

– Homicide costs are likely to be less under EIP than under standard care. People with untreated psychosis are estimated to be ten times more likely to engage in acts of homicide than people with treated psychosis [5]. There is a significant association between homicide and the duration of untreated psychosis [6]. A core goal of EIP services is reducing the duration of untreated psychosis.

This cost-effectiveness data for the EPPIC model is significantly enhanced when including studies that focus specifically on clinical outcomes and functional recovery. Up to 85% of young people with vocational interventions achieve functional recovery, levels which are unprecedented. Furthermore, the recent independent evaluation of headspace was extremely positive, showing that  headspace was meeting the goals set of it by the Australian Government.

Mr. Whitely raises concerns about the use of medication in headspace and EPPIC which are also unwarranted. There are acknowledged risks with medications of all kinds in healthcare so the risk benefit ratio always has to be the guide for timing and need for use of such interventions.  In these programs the Centre for Excellence at Orygen Youth Health and headspace guides evidence based practice within these programs and care is strictly tailored to clinical practice guidelines which are published. We follow the International CPGs for early psychosis in EPPIC and beyondblue CPGs for the treatment of depression in young people recently published by beyondblue.  Of course CPGs are guidelines and individual clinicians must make their own decisions in individual cases since every patient is different in some respects. There are also areas where the evidence is incomplete and clinicians need to act on the best available evidence recognising that further evidence is required through further research.

In closing I appreciate the opportunity to respond to Mr Whitely’s communications.

Patrick McGorry

AO MD PhD FRCP FRANZCP

Professor of Youth Mental Health

University of Melbourne  


[1] Mihalopoulos, C., P.D. McGorry, and R.C. Carter, Is phase-specific, community-oriented treatment of early psychosis an economically viable method of improving outcome? Acta Psychiatr Scand, 1999. 100(1): p. 47-55.

[2] Mihalopoulos, C., et al., Is early intervention in psychosis cost-effective over the long term? Schizophr Bull, 2009. 35(5): p. 909-918.

[3] Robinson, J., et al., Suicide attempt in first-episode psychosis: a 7.4 year follow-up study. Schizophr Res, 2010. 116(1): p. 1-8.

[4] Melle, I., et al., Early detection of the first episode of schizophrenia and suicidal behavior. Am J Psychiatry, 2006. 163(5): p. 800-804.

[5] Nielssen, O. and M. Large, Rates of homicide during the first episode of psychosis and after treatment: a systematic review and meta-analysis. Schizophr Bull, 2010. 36(4): p. 702-712.

[6] Large M, Nielssen O. Evidence for a relationship between the duration of untreated psychosis and the proportion of psychotic homicides prior to treatment. Social Psychiatry and Psychiatric Epidemiology 2008, 43:37‐44;


The Last Word – Professor McGorry leaves key questions unanswered – by Martin Whitely

I welcome Professor McGorry’s response and to the limited extent that it identifies the evidence base of the recommendations in the blueprint it is useful. I will examine in detail the evidence provided, however, it leaves most of the questions I raised unanswered.

In particular I believe the key questions that must be answered before EPPIC and Headspace are considered for extra funding are:

1 – EPPIC and the ‘off label” use of antipsychotics– Does Professor McGorry now agree with his colleague at EPPIC Prof Alison Yung and oppose the recognition of Psychosis Risk Syndrome in the next edition of the DSM? And if not, what is EPPIC’s position on the recognition of Psychosis Risk Syndrome (PSR)? And under what circumstances, if any, would Professor McGorry and EPPIC recommend the use of antipsychotics for the treatment of patients considered to be at risk of developing psychosis? Has Professor McGorry finished experimenting on young people with the use of antipsychotics for the treatment of Psychosis Risk Syndrome?

2 – HEADSPACE and the ‘off label’ use of SSRI antidepressants– Why do Professor McGorry and Headspace acknowledge and then ignore the clinical trial evidence, and FDA and TGA warnings, on the increased suicidality risk for young people using SSRI antidepressants and advocate the ‘off label’ use of SSRIs by even moderately depressed young people? Won’t this result in more, not less, youth suicide?

In response to specific comments in Professor McGorry’s right of reply I offer the following:

‘Mr. Whitely… casts doubt about the wisdom of the Australian community’s desire for major mental health reform’ and ‘Mr.Whitely appears to believe that the case for mental health reform remains unproven. This is a disappointing approach from an elected representative…It is notable that he has not chosen not to state in his article his own views about the appropriate level of expenditure on mental health care (an increase? a cut?) or where he feels resources should be directed.’

I support a massive injection of funds into mental health but believe there are far too many unanswered questions to support the ‘best buys’ identified in Professor McGorry’s and the Independent Mental Health Reform Group’s $3.5 billion blueprint. I believe as an elected representative it is not my job to go with the flow but rather to ask difficult questions and ensure taxpayers funds are spent on programs that help not harm.

Mr. Whitely perversely uses my own declaration of previous pharmaceutical industry funding as supporting evidence for his claim that I am actively concealing this funding.

I do not suggest that Professor McGorry or any member of the Independent Mental Health Reform Group dishonestly ‘actively conceal’ their potential conflicts of interest. Rather, I am critical of them for not ‘actively disclosing’ potential conflicts of interest particularly when they badged themselves as an ‘independent’ and asked for $3,500,000,000 of taxpayer’s funds to be directed to programs, several of which they have significant influence over. I accept that senior decision makers would be aware at least of Professors McGorry and Hickies connections to EPPIC and Headspace but I am not so sure about the media and the public.  I became aware of Professor McGorry commercial ties to the pharmaceutical industry from a 2008 article in the British Medical Journal (BMJ). As is required by the BMJ Professor McGorry disclosed the sources but not the quantum of pharmaceutical company funding he had received.

In fairness to Professor Ian Hickie, whilst it was not disclosed in the blueprint, he does deserve credit for disclosing online via his CV that he has received $411,000 from various pharmaceutical companies. Whilst this was acknoweledged in my reference I should have acknowledged this self disclosure in the text of my blog when I originally wrote it (and I now have).

‘Mr. Whitely only specifically mentions two investment recommendations contained in the Blueprint – the early intervention youth mental health models headspace and EPPIC…Mr. Whitely raises concerns about the use of medication in headspace and EPPIC which are also unwarranted… We follow the International CPGs for early psychosis in EPPIC and beyondblue CPGs for the treatment of depression in young people recently published by beyondblue.’

As identified at 1 and 2 above I am very concerned that through the expansion of the EPPIC and Headspace networks we risk more ‘off label’ prescribing of antipsychotics and SSRI antidepressants to young people including children. I would be much more comfortable if EPPIC and Headspace followed the advice of the independent regulators i.e. the TGA and the FDA (and even the drug manufacturers) and stuck to recommending and practising ‘on label’ prescribing.

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  1. Linda Kimber’s avatar

    While Martin Whitely may be concerned that “off-label” prescribing of medications to treat mental health disorders in young people is a major concern, our family is enormously relieved that psychiatrists are not restricted to ‘on label’ medications recommended by the TGA and FDA. Our 15 year old daughter may not still be with us if her Bipolar Disorder could not be treated with an “off-label” medication. Her future looked bleak, if not limited, as she had negligible improvement (and often significant negative side effects) on medications recommended in Australia for this disorder. The medication that has enabled her to lead a normal life for the past 9 months is recognised in the US as effective for the treatment of Bipolar Disorder. Many patients describe it as the most effective medication they have used to treat their illness. However, many Australians who suffer from Bipolar Disorder are unlikely to benefit from this medication as funding limitations and politics prevent it from being subsidised for treatment.

    For many sufferers whose financial circumstances are already compromised by their illness, paying for effective medications is a huge concern. It is shameful that anyone in Australia who suffers from chronic mental illness should be denied effective treatments because governments think they are saving money. Patrick McGorry is correct in highlighting the costs of unemployment, suicide and homicide that are the product of ineffective treatment.

    Until there is a better understanding of exactly what goes wrong in the brains of people with mental illness and that knowledge leads to more efficient and effective diagnosis, the treatment of mental illnesses is reliant on the expertise and experience of mental health experts who should not be at the mercy of government funding and policy limiting their access to treatments.

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    1. Matt Dent’s avatar

      I’ve researched psychiatric meds for over 15 years. I’ve also worked within a psychiatric facility and had to deal with people who were on heavy doses of such meds. For a reference I use MIMS (Australia’s medical information guide which doctors use) and I’ve studied the TGA’s adverse reaction reports on such meds as well as data from the FDA. I’ve found that the public is to a large degree ignorant of the short and long term effects of these substances. Please please make sure you check ALL the adverse reactions to the drug. Read the fine print etc. All pschotropic meds are used to manage not cure. Often they are highly addictive and all of them have very very serious side effects.

      Suicide, as mentioned by Whitely, is one of the most common adverse event related to such drugs (in the case of antidepressants) however a whole list of serious events can be found in the pharmaceutical literature on such drugs (look in MIMS). The main concern with such drugs is that they are not like normal medicines such as insulin in that they are not naturally occuring substances which the body lacks and needs to function.

      What most people don’t understand is that psychotropic (meaning mind altering) drugs are in fact chemical substances which affect the central nervous system generally. Nearly all illegal street drugs were once legal “psychotropic” meds: speed, LSD, angel dust, heroin, ecstacy, MDMA and Ice to name a few. They can mask symptoms and make a person feel better for the short term but they don’t cure anything.

      Another often unknown point regards these drugs is that they often cause irreversible nervous system damage such as tardive dyskonesia and tics (in the case of anti psychotics — also mentioned in MIMS).

      Other psychotropic drugs such as Ritalin and other amphetamine type drugs used for ADHD are severly addictive and listed as Schedule 8 drugs by the TGA which indicates the highest potential for addiction in a drug. Cocaine and heroin are schedule 8 substances.

      The key thing to remember is that these drugs cause extreme damage to the body and eventually the mind due to their highly toxic nature. Many of these substances have been banned in countries around the world for the fact that the adverse events are so common and so horrible (Zyban which used to be an antidepressant) in the UK and Canada for example.

      Pyschotropic drugs are only used to blanket symptoms much the same way that people use illegal drugs to blanket symptoms. Psychotropic (mind altering) drugs drugs are used to block out painfull emotion. Heroin does this too and has been used for this by the psychitric industry in the past as a psychotropic. This is not new, people have used psychotropic drugs to mask symptoms for thousands of years. The main thing to remember is that such drugs often are addictive and often keep the person stuck having to use them to feel better rather than being pro-active in dealing with the issues which are actually causing their troubles. On top of this such drugs end up adding, eventually, to the individual’s suffering by destroying their bodies and nervous systems.

      Psychiatry has yet to produce any evidence or test to show that mental illness is a brain disorder. This is serious because they have been claiming this for years. Ask a psych to produce a blood test or brain scan which shows a chemical imbalance and they can’t. Go to any pathology lab of any hospital and ask them for such test and they will say they don’t exist (try this I’ve done it at Canberra Hospital). So, to give people drugs which act on the central nervous system and don’t cure anything but only mask symptoms, while telling the person they have a brain problem but not providing any physical evidence of such a problem is a very dodgy and non-scientific aproach. Most people want a quick fix and when they get drugs which help mask over their problems, they are relieved. However, the cost in terms of severe nervous system damage and other complications is just not worth it.

      Matt D (Researcher into psychiatric treatments and history)

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    2. Sandra Black’s avatar

      McGorry is a pseudoscientist not worthy of taking seriously. Kids who have a crisis and have unwanted feelings and behaviors do not deserve to be drugged with brain damaging drugs. It’s not ‘shameful’ that the taxpayer isn’t subsidising your snake oil, it is shameful when the taxpayer does finance this snake oil.

      Psychiatrists don’t examine anyone’s brain when they ‘diagnose’ them. They are all taking money hand over fist from the drug companies. They do not serve anyone’s interest but themselves, the drug companies, and parents who want to drug their kids into submission.

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    3. Dr Joe’s avatar

      The use of anti-psychotic medications has exploded over the last decade.Is our collective mental health better for this? The answer is no. It is driven by pharmaceutical marketing and in-particular the use or “key opinion leaders”.These are doctors who are “courted” and financed by big pharama and who in turn promote the use of drugs and expand markets by finding new ways to convert healthy people into people with illness or better still people with “risk factors”.
      The worst examples of this are in psychiatry where everything is subjective. I recommend the book Unhinged by Dr Daniel Carlat who is a psychiatrist who used to give talks for pharma.
      Off label marketing has led to huge fines in the USA but the firms just see these fines (hundreds of millions) as a cost of doing business.
      Most people have issues and most people feel down at times.This is the human condition and it is not an illness and does not require medication or “early intervention”.
      If resources were used only for people who actually have psychiatric illness rather than those having a bad hair day there would be neither a shortage of funding or resources to help them.

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    4. Sheaajem’s avatar

      Why not make your scientific evidence public Mr McGorry?, so we can all see where our taxes are going and if you are actually getting results! Martin Whitely has stated facts and Mr McGorry has tiptoed around answering them.

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    5. Dr James Alexander, PhD’s avatar

      Mr Whitely is a courageous man who is tackling the hard issues which no one else wants to. As per the treatment guidelines, adolescents should not be prescribed antidepressants- the evidence clearly demonstrates that they are dangerous substances to young people, however Professors McGorry and Hickie somehow manage to side-step the factual evidence and advocate the use of them for young people. Knowing what they do, would they be willing to place their own adolescents on them? (perhaps they would! even knowing what they do). The evidence is clear and there for all to read. Antidepressants are much more likely to make young people become more suicidal than make them better. Where is the room for debate in this? The pharmaceutical push in the psychiatric profession have done more to harm the mental health and well being of the community than any other factor. People’s brains suffer as a result of dangerous drugs, wether they be illicit or prescribed. With the deterioration of brain health from the drugs comes psychological symptoms (either new additional ones, or an exacerbation of existing ones) and a reduced ability to function. Clearly, not everyone is equally adversely effected. Some people suffer catastrophic results, while others barely suffer adverse side effects. The field of pharmacogenetics is able to explain this variation, and provides clear evidence based guidelines in terms of who these drugs are most likely to be dangerous to. Surely, mental health funds should be taken away from dangerous psychiatric practices (which have spurious bases in evidence) and put into mental health interventions which are i) harmless at worse, and ii) beneficial at best. Also, funds should be put into genetic tests which alert a person before they take a psychiatric drug as to whether they are likely to suffer from adverse side effects. The technology is there now- the research evidence is there now. We just need politicians who are well enough informed to push in the right directions. Well done Mr Whitely- you are doing a fantastic job, and i would like to help you in any way i can.

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    6. Linda’s avatar

      I did not realise when I decided to comment in this forum that fellow contributors liken severe mental health disorders to “a bad hair day”, “having issues’ and “feeling down”. Perhaps they don’t know, or more importantly, live with anyone who suffers from a severe mental illness. I would love to be able to reassure my sister that she was doing the right thing when she decided to manage her Bipolar Disorder without medication. She continued, unsuccessfully, to access non-pharmaceutical therapies for a year before she took her own life. I certainly don’t have the courage or the inclination to tell my own daughter, who has the same condition, that she should cease taking the “snake oil” that has given her a normal life so that we can all return to the living hell that is the life for individuals and their families who live with a genuine mental illness. Maybe I’m being selfish in enjoying the fact that I am no longer constantly on suicide watch to keep my daughter alive despite accessing all the mental health interventions available but ineffective for her.

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      1. Matt Dent’s avatar

        I’ve had to work with such cases in the Canberra Hospital. What I found is that they still don’t advocate a thorough physical exam of such patients. Recent data from California shows that 80% of all mental illness was contributed to by an underlying physical ailment which was unknown and untreated and when treated, either handled the metnal illness or eased it.

        Often people need various complex handlings and yes it is stressfull to be involved in managing such cases. However, to use psychotropic drugs which have suicide as one of the major complications and side effects, and which can be addictive and which are known to only blanket emotional issues and are not a cure and can cause irreversible nervous system and organ damage, are not to be considered as a viable treament. It is not worth destroying the patient as part of the cure. Yes the person may now feel emotionally numb (a common reaction) but when they come off the drug they go right back into the situation but now in a worse off condition due to the drug, so how is this helping except for on a very short term, management basis? Please look at all alternatives possible before using such dangerous drugs.

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      2. anupriya’s avatar

        Iam currently suing certain psychiatrists for making my family call the CATT team which then forcibly and falsely diagnosed me for “psychosis” and then forcibly gave me depot injections of antipsychotics-specifically risperdal for a year, under involuntary provisions of the Victorian Mental Health Act 1986. The effect of the antipsychotics made me get fall into clinical depression(which I have recovered from). It is almost certain that the psychiatrists were organised and influenced by my ex employer among others. Basically it is not understood by the public and the media that psychiatric diagnosis is not objective, there is no brain scans etc and that the risk of misdiagnoses(for which misdiagnosed patients can be forced to take anti psychotics such as Professor McGorry’s favorite ones) is far higer than in other areas of medicine.

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      3. bj2circeleb’s avatar

        This is not about totally banning medications. For a very small percentage of people they can do some good. What is wrong is that we have been made to believe that these medications are like insulin for diabetes which is simply false. There are NO chemical imbalances in the brain and all psychaitrists and mental health experts knew that decades ago. These drugs cause chemical imbalances and do not solve them. These drugs and they are drugs and not medications, do not cure anything, at most they provide tempory symptom relief. The fact that we have growing rates of mental illness despite the widespread use of these drugs is proof of that. GP’s hand out prescriptions for psychotropics like there is no tomorrow and half the population is on them. People are on the whole forced to take these medicaitons, via injections and yet these are the same people going in and out of hospital and who remain unemployed and on disability pensions. The vast majority of people in psychiatric wards are not first time patients and they are in 99% of cases medication compliant as the med’s are being forcibly injected. To pretend that the only reason people relapse is becasue they do not take med’s is a total joke and yet this is what people are told.

        Biplor had until 30 years ago, never been seen in children or teenagers, it is now an epidemic. It is also known that in over 98% of cases children and teenagers had been on some form of psychotropic medication, usually for ADHD or depression before being diagnosed as biplor. WHY if they are so good at diagnosing do they get it so wrong and medicate children wrongly for so many years.

        Whenever anyone is put on new psychotropic medications they go through a honeymoon period in which they are suddenly brilliant and everything is going fine. Then sooner or later the effects of the medication start to wear off and they are left back where they started from.

        I have no doubt that some people do gain from very low doses of some of these medications short term while they seek to deal with the underlying problems that resulted in them becoming sick in the first place. But we do not do that. We do not provide them with any other support at all, and we tell them that these drugs cure chemical imbalances in the brain, which is impossible.

        I am not aware of anyone who is saying that these drugs should be outlawed, what they are saying is that we need to be very very careful of what we are doing and when and how they are being prescribe. We do not and never will give people chemotherapy on the basis that it may prevent them from getting cancer, that if they take it for life, they will never get cancer again, etc. We use it when it is needed for short periods of time and only when it is expected to be on some clincial use.

        The aim of all medicine is to have people on the lowest doses of medication for the shortest period possible. If people have asthma they take preventatives and relievers. The aim is to have enough preventative to minimise the use of the reliever, but not to totally stop it, as they are not good for people. If people do not use their reliever for a period of time, then we lower the dose of the preventative. People who have organ transplants need anti rejection medications, but again, at all times we aim to reduce the level of that medicaiton and even if it is 20 years before it can be done it is done then. This is not something that is done with psychaitry. Instead people are drugged to the hilt and told they need to take that dose for life, even though there is no evidence of this and nor is there any proof that it is preventing anything.

        No one has said that being severly mentally ill is simply feeling sad, what they have said is that minor and moderate mental illness is in most cases feeling sad and does not need harmful drugs as the first line of treatment.

        This is not anti psychiatry or anti medication it is about being critical of psychiatry and critical of psychotropic medications. There are a small but growing number of psychiatrists that are forming a critical psychiatry network, the problem is that they are so small.

        Reply

      4. bj2circeleb’s avatar

        In this 2011 article, some say that we need to be cautious of giving antipsychotics to people without clear evidence of psychosis. McGorry says that doing so is denying people who need treatment, treatment. To me he is saying that we should still be giving these medications to people who are not psychotic!!

        http://sswahsandbowralhealth.blogspot.com/2011/04/sswahs-swslhn-and-mental-health-in_09.html

        If these medications are as harmless and safe as McGorry claims, then one wonders why he is not advocating for them to be put in the water supply like we do with flouride. The simple answer is that they would not be willing to take these medications themselves.

        There is also a growing and even more disturbing use of giving antipsychotic medications to children who have parents who have ever experienced psychosis from birth. The fact that most of these children to live to be teenagers does not appear to be of any relevance, just a slight loss of life, but not of interest to those advocating their use.

        Every single one of us is at risk of experiencing psychosis and there are people who experience their first episode of psychosis in their 40’s, 60’s and so on. There is no way that McGorry or anyone else is exempted from every experiencing psychosis and I for one would like to know why he himself does not take these medications?

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      5. Fid’s avatar

        Linda,

        Your daughter is being treated because she has been diagnosed with BD. McGorry’s early intervention program diagnoses children before they actually get the illness. It’s guess work based on box ticking forms.

        Let’s assume for one minute that McGorry’s early intervention program is flawed and healthy subjects are given antipsychotics and/or antidepressants. Are we to assume that these subjects will be okay on these addictive medications?

        It’s impossible to pre-determine if a child will fall foul of a mental disorder. Furthermore, there is no structure to diagnosing “illnesses” in the ‘now’ – no urine samples, no blood tests, no X-rays, no MRI scans.

        It’s all based on theory.

        When SSRi’s, for example, first came to market, they were promoted to correct a “chemical imbalance” – This has never been scientifically proven. Today we see a huge U-Turn with the pharmaceutical industry. Look at the patient information leaflets that accompany the boxes of SSRi type medication. There is no bold statement any more – they [pharma] throw in the word “may” correct a chemical imbalance.

        Why?

        Because they themselves do not know.

        Ask for the scientific proof of a chemical imbalance.

        In the meantime, McGorry and co will make claims that they can predict if a child will fall foul of a mental disorder. I’d love to be able to get my hands on the DeLorean that he drives around in!

        All that said, I wish your daughter well and am sorry for your loss.

        Reply

      6. bj2circeleb’s avatar

        People are diagnosed with these conditions based on a pen and paper test with someone sitting 5 feet away from them. And then they call them illnesses. You do not diagnose diabetes, cancer, heart disease, asthma or the like with a pen and paper sitting five feet away from someone. Put two psychiatrists in the same room with someone at the same time and allow them to ask all the questions they want. Then take them out two seperate doors and ask them to write down what illness the person has and what treatments they need and they will NEVER give the same answer. In less than 20% of cases would they even say the same condition and they would NEVER say the same treatment. Ask for a brain scan BEFORE they medicate you, even offer to pay for it yourself and it is refused. The simple fact is the ONLY changes found in the brains of people with any of these so called conditions are based on medication effects and they are purely the result of the dosages of the medication and the length of time people have been on them. When people wean themselves off medication the changes stop happening. Medications can provide some level of symptom relief for some people, but they cannot and will not ever cure or even treat any condition!!

        Reply

      7. Clive’s avatar

        I bet they want to increase suicide for there water excuse so your passive for future death camps, police state, one global currency and policy. Has anyone even looked how they class a psychiatric disorder. Why is drinking coffee allways in the questionires. What makes me laugh is there science explaination: It’s in the brain and it’s Organic!

        Reply

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