by Martin Whitely
8 July 2012
An article in today’s Sunday Age, available at http://www.theage.com.au/national/youth-mental-health-team-too-free-with-drugs-audit-20120707-21o29.html, highlights the results of a prescribing audit of Patrick McGorry’s Orygen Youth Mental Health Service. It found the service “prescribed medication to a majority of depressed 15 to 25-year-olds before they had received adequate counselling, despite international guidelines advising against the practice.”[1]
The audit of 150 patients treated in 2007 found “75 per cent of those diagnosed with depression were given the drugs too early. Clinical guidelines recommend that in most cases antidepressants should only be given to young people after they fail to respond to four to six sessions of psychotherapy, which usually takes about six weeks. However, the audit, carried out by Orygen’s own researchers, found on average patients received the drugs after just 27 days. It also showed that fewer than half were followed up to see whether their symptoms had improved or to check for side effects, which can include an increased risk of suicide.”[2]
It is commendable that Orygen[3] published the results of the audit, however the results make a mockery of Professor Patrick McGorry’s often repeated assertion that drugs are not the first-line treatment in any but the most serious cases.
In response Professor George Patton, director of adolescent research at the Centre for Adolescent Health at the Royal Children’s Hospital, told The Age, ”This paper illustrates how much we need to be looking at these new services [EPPIC and headspace] to determine the extent to which we’re following best clinical practice and to ask the questions, are we getting value for money out of these investments, and are we actually seeing better clinical outcomes?”[4]
At the very least there is an obvious need for an independent scientific review of the EPPIC and headspace programs identified for national rollout and for tight real time program wide auditing of medication practice.
Note: The issues raised in today’s Age article reinforce similar concerns I voiced last year about antidepressant prescribing at Professor McGorry’s other favourite project headspace. I raised my concerns in the WA State Parliament and on my blog last year titled “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?” available at http://speedupsitstill.com/patrick-mcgorry%e2%80%99s-independent-mental-health-reform-group%e2%80%99s-3-5b-blueprint-australian-mental-health-forward-prescription-%e2%80%98psychiatric-disorders%e2%80%99-%e2%80%98off-label
[1] Jill Stark, Youth mental health team too free with drugs: audit, The Sunday Age, July 8, 2012
[2] Jill Stark, Youth mental health team too free with drugs: audit, The Sunday Age, July 8, 2012
[3] Orygen runs a range of youth mental health services, including EPPIC (Early Psychosis Prevention and Intervention Centre), PACE (Personal Assessment and Crisis Evaluation), YMC (Youth Mood Clinic) and HYPE (Helping Young People Early, for people with emerging borderline personality disorder). In addition, Orygen is a partner in headspace.
[4] Jill Stark, Youth mental health team too free with drugs: audit, The Sunday Age, July 8, 2012
Tags: antidepressants, depression, EPPIC, headspace, Martin Whitely, off label prescribing, Patrick McGorry
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27 days is an very long time to wait for antidepressants. My friend’s son was offered them within five minutes. Orygen appears awfully slow in comparison. She also did not get the script filled and I advised her to take him to see a psychologist to see how he fared instead. A few years on and he seems well adjusted. At the Richmond ASPAC Conference, Mark Butler did not answer my question as to why psychiatrists have 50 sessions and psychologists have only 10. But I think we all know the answer to that one.
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It is vital that the facts come out. The mental health agenda in this country has been hijacked by those with a particular view of the world and doubters are labeled as not caring about mental health.The reality is that our current policies have no evidence base and are likely doing more harm than good.
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The last paragraph sums up my feelings very well. How on earth they can argue that providing something that will INCREASE the risk of suicide is better than doing nothing is beyond me. We know from ALL the research that doing nothing is better than prescribing SSRI’s, and yet policy is to prescribe them.
I would also love to see the research on the numbers of young people given prescriptions from Headspace. Headspace claims that only about 16% of young people who attend are given a diagnosis. Yet I’ve never heard of anyone who came out of there without a prescription for an SSRI!! And if only 16% are being diagnosed, then what on earth is being done for over 80% of young people who attend the service. Afterall they do not provide funding for psychologists, in order to see a psychologist or the like at headspace they require a GP Mental Health Care Plan, and use Medicare funding for such consultations, and of course that requires a diagnosis. If I am to believe headspace over 80% of young people who attend it turn up, are seen by a GP and then sent away as they have nothing wrong with them!! Why on earth are we putting billions of dollars into a service that is not able to offer any serivces to young people. Any other services offered by headspace also require a diagnosis. Any vocational services are simply Australian Government Centrelink type Job Services Australia (formally Job Network) services. Young people are referred to them from Centrelink they don’t need to go to headspace for such a service. It is not something new!! Social supports are provided by state government mental health psychosocial rehabilitation programs, which require quite severe forms of mental illness. The simple reality is that headspace provides funding for an administration worker, and the rest is taken from elsewhere. And EVERYTHING else requires a diagnosis, with the exception of standard employment services and there is nothing special about what is being offered there. If they were serious about supporting young people supposedly “at risk” although they have not yet said HOW they have determined what “at risk” is, they would be putting more funding into community based youth services which already exist in ALL areas, putting a counsellor/psychologist in each of those services would be much more cost effective than setting up places to employ an administration worker, and then using Medicare rebates, which anyone can already use anyway!!!
What also amazes me is the fact that despite the TGA not approving the use of SSRI’s in people under the age of 18 in this country, they are covered by the PBS. How on earth is government funding being used to fund a drug that is not even approved for use in this country? The fact that no one cares about that is beyond me. The fact that government figures show that we have a number of PBS prescriptions for antidepressents for infants under the age of 12 months is beyond me. How on earth can an infant be diagnosed as depressed, and surely a few extra hugs would have solved the problem!!
Further Headspace discourages family involvement and has no hesitation at all in prescribing off label to 12 year olds. How can a 12 year old possibly make the decision to take an off label medication, and how can a child who is then placed at high risk of suicidiality/ and voilence then not have the family told about the fact that the child is placed on that medication. At an absolute minimum those living with the young person MUST be informed if they are to be placed on these medications, the fact that government funding discourages that is even more damming. It only places them at even more risk as those around them can’t even monitor them. But of course that would then mean telling the truth to the population about the risks these medications pose, and then they would have to explain WHY they are on the PBS for ALL age groups!!!
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bjcirceleb has asked two obvious questions that also trouble me: 1- Why is it superior to do something that increases suicide risk (i.e. prescribe SSRI antidepressants to young people) than to do nothing? (I am not advocating doing nothing but must ask why do something that clearly increases suicidality) And 2- Why subsidise via the PBS SSRI’s for under 18’s when they are not approved for use in under 18’s?
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It should be noted that NO antidepressents are approved for use in those under the age of 18, not just SSRI’s.
I have had people say its not a problem, my child was put on an SNRI, which is in many regards known to be worse than SSRI’s, but as it is not public they are not admitting that.
At an absolute minimum they should have to be started in hospital and monitored in a hospital environment for at least 4 weeks, which is when we know if they are going to have an adverse inpact. The amount of these drugs being prescribed by GP’s is also highly concerning. If a child is so profoundly depressed as to warrant one even considering medication, they need to be seen by a psychiatrist and one would think for children and adolescents, hospitalisations.
I also do not agree with doing nothing, but equally the push by most for CBT instead is not going to solve the problems. Personally CBT made me a thousand times more suicidal than anything else. It was and remains for me the most abusive treatment and at times I feel as though it ought to be outlawed. This was with over 20 different therapists, some of the top in the country. It is not as though it was a one of thing for me.
Above all else we need to understand and remember that NO ONE is depressed or suicidal for no reason. Unless you address those reasons then nothing can change for them. It may not be of any real issue to you, it may seem stupid to you that it worries them, but the fact is it is very very real for them. None of our current policies and treatment options do any such thing.
We also have the issue of making out every day sadness into a brain disease and this has been proven to make people worse not better.
IF these treatments were so effective then why do we have an epidemic of sadness in the country. We currently have one in every 12 people on antidepressents, we have millions of people seeing psychologists, WHY are these people not getting better?!! We talk about them not getting treatment, but the fact is we have more people than ever before getting treatment, and more treatment than ever before, and yet the outcomes are getting worse not better. The simple fact is there is NO evidence that a trillion dollars of our current policies and programs would produce any better outcomes than we currently have. At an absolute minimum these services SHOULD be stabilising people, but instead we have more and more people who are becoming more and more disabled and ending up on a disability pension, all becuase they became sad?
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Of course one should also be asking why it is that over 80% of prescriptions for ALL types of antidepressents are for people on concession cards. IF these drugs are as effective as they claim, then why are people still on beneifts. Surely the drugs would cure you as well as insulin for diabetes and so people would be back working. As for the statistics on other types of psychopharmecuticals, well then even more people on benefits are on them. Since we do not have 80% of the population on health care cards or pensions we should be asking what doctors are doing, and of course IF the drugs are even helping.
Add to that that one of the primary things being studied in relation to adverse drugs interactions/issues at present by the AUSTRALIAN GOVERNMENT is Serotonin Syndrome, which is when people have an excess of serotonin in there body that can end up killing them??!! How can something that simply corrects a chemical imbalance possibly result in someone having too much in there system??
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When I initially commented I clicked the “Notify me when new comments are added”
checkbox and now each time a comment is added I get three emails with the same comment.
Is there any way you can remove people from that service?
Thank you!
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