Encouraged by its Managing Director Mark Scott, the ABC has promoted Professors Patrick McGorry and Ian Hickie as independent mental health experts and unquestioningly backed their plans for reforming mental health. However both have significant ties to the pharmaceutical industry[1] and there has been prominent international criticism of their methods – and in Hickie’s case his integrity – which has been substantially ignored by the ABC.

As highlighted by Time magazine in 2006, McGorry has a long and controversial history of promoting the use of life shortening antipsychotics[2] as a means of immunising against schizophrenia in mildly distressed young people.[3] In 2011 McGorry’s plans for the national roll out of his Early Psychosis Prevention and Intervention Centres (EPPIC) prompted influential American psychiatrist Professor Allen Frances to write; ‘McGorry’s intentions are clearly noble, but so were Don Quixote’s. The kindly knight’s delusional good intentions and misguided interventions wreaked havoc and confusion at every turn’.

Frances warned that Australia is in danger of following McGorry blindly down ‘an unknown path that is fraught with dangers’.[4] Domestic critics include Australian professors of psychiatry George Patton, Jon Jureidini, David Castle, and Vaughan Carr, who described McGorry’s claims of the cost effectiveness of his EPPIC model as ‘a utopian fantasy’ based on ‘published evidence that is not credible’.[5] [6] [7] [8]

While critics of McGorry are generally complementary about his motives, the same is not true for Australia’s ‘depression guru’ Hickie. He has been criticised on numerous occasions for allegedly promoting inappropriate antidepressant prescribing and exaggerating the benefits of antidepressants in suicide reduction.[9] [10] [11] Most notably in 2012 the editor of the Lancet, Richard Horton, slammed Hickie for writing an article that Horton concluded exaggerated the benefits of an antidepressant he had been paid to spruik.  Horton tweeted ‘the bias in this paper is very disturbing… it is this kind of complicity that damages any hopes of a positive partnership between medicine and [the pharmaceutical] industry’.[12]

In 2014, driven by Scott, the ABC took the unprecedented step of running a week long Mental As campaign to raise awareness and funds for mental health research.[13] The genesis was a meeting between Scott and McGorry.[14] The ABC ‘worked closely’ with the pharmaceutical industry funded Mental Health Australia in developing the campaign.[15]

Most of the Mental As coverage was uncontroversial and encouraged good mental health habits. However, there was a consistent theme of massive unmet need and promises of safe, effective treatments, including medications, if only troubled Australians sought professional help. The Telethon style coverage concluded with a chorus of circular praise between McGorry, Scott and the ABC.

In April 2015, the ABC’s 7.30 obtained a leaked copy of the National Mental Health Commission report into Australia’s mental health system. Hickie is the only psychiatrist on the Commission whose role it is to ‘provide expert and independent advice to the Government on the performance of our mental health system’.[16] The Commission’s report stated the current system is poorly planned and integrated and is a ‘massive drain on people’s wellbeing’. It urges a ‘radical rethink of responses’ to mentally ill people seeking help and recommends redirecting more than $1 billion in funding from acute hospital care to community-based mental health services.[17]

McGorry and Adjunct Professor John Mendoza (Hickie’s close colleague) were the only two mental health experts interviewed by 730. Mendoza spoke about a recent family tragedy. His nephew was one of two tragic examples of young men suiciding after being turned out of acute mental health services prematurely and without adequate support. The fact that the key recommendation of the report was to strip $1billion out of acute hospital care, which risks many more young men being denied acute care, seems to have been completely lost on the ABC reporters.

On 7.30 McGorry called for ‘evidence based’ suicide prevention strategies and for government to set a national target of a 50% drop in suicides in the ‘next 5 to 10 years’. However, McGorry’s ‘evidence based’ rhetoric on suicide doesn’t match his actions.[18] A 2007 audit of McGorry’s Orygen Youth Mental Health Service 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.’[19]

In addition a 2009 evidence summary produced for Headspace and overseen by McGorry concluded SSRI antidepressants could be used by moderately depressed young people.[20] This is despite the fact that SSRIs are not approved for use in under 18-year-olds because their use increases the risks of ‘suicidal ideation and suicidal behavior’ by about 80%.[21] The nearest thing to a rationale offered in the evidence summary was that many young people who are depressed get no treatment and that it is better to do something than nothing.

As an advocate who on a daily basis helps mental health service consumers let down by the mental health system, I agree with the National Mental Health Commission report’s bleak assessment of the current state of care. The reality for most Australians seeking mental health help is a visit to the GP, a script of antidepressants, and a bit of a chat if you lucky. Resources are spread too thinly and there is far too much reliance on quick diagnosis backed up by indiscriminate (frequently off-label) prescribing of drugs that messily interfere with a patient’s biochemistry without addressing their underlying problems. Diagnostic labels and drugs are used as a poor substitute for individualised ‘person centered’ support.  

The need for a radical rethink is obvious but the danger is the recipe for reform offered by Hickie and McGorry will make this very bad situation considerably worse. The fundamental problem is they dangerously overstate what a mental health system can achieve. They argue for a system that targets everyone from the severely psychotic to the moderately depressed and even those perceived to be at mildly elevated risk of future mental illness. According to both the report and McGorry, this represents about 4 million Australian’s in any given year.[22]  

The ‘21^st Century…proven approaches’ that McGorry repeatedly claims are readily available if only government would urgently fund them are substantially based on models of care he has developed.[23]  I believe this is a product of his heartfelt ‘crusader’s desire’ to help millions of Australians, and not simply a cynical attempt to expand his mental health empire but ultimately his motivation doesn’t matter. What matters is that these claims are not supported by robust independent evidence.

Although the ‘stitch in time’ philosophy inherent in his approach is intuitively appealing, independent evidence indicates two fundamental problems. Firstly the predictions of future mental illness in mildly troubled individuals are wildly inaccurate.[24] Secondly the preventive measures they employ have very modest sustained benefits.[25]  

McGorry and Hickie not only massively overstate the benefits of their own pet interventions; they also massively overstate the capacity of government to help. Government can’t stop people becoming depressed. Government can’t address the concerns of the socially anxious. What government can do is foster a tolerant and inclusive society, and do their best to ensure housing, employment and educational opportunity – the social determinants of mental health.  

The first priority for Australia’s mental health system must be properly addressing the needs of the acutely unwell by supporting their recovery. A secondary focus can be prevention through programs like Act- Belong-Commit that promote resilience and encourage moderately distressed people to seek help from family and expand friendship networks.

However, despite their overblown claims, the brand of preventive psychiatry developed by McGorry, and to a lesser extent Hickie, is potentially very harmful.  Their approach is wasteful of resources and can create a self-fulfilling prophecy of impending serious mental illness and iatrogenic harm from unnecessary treatments.[26]   

McGorry and Hickie are repeating the pattern of over-promising and under-delivering that has caused much of the current mess in mental health. Historically extremely bad psychiatric practices like lobotomies, deep sleep therapy and ADHD child prescribing[27] have all been justified by grossly exaggerated claims of breakthroughs in brain science and treatment technology. Although less dramatic, much of current psychiatric practice risks trading long term welfare of patients for perceived short term benefits, some of which are external to the patient (e.g. increased compliance from agitated geriatric patients).

In contrast cautious psychiatrists realise the limitations of their profession and diagnose and medicate with great care. They resist incentives from industry and the pressure from ‘the system’ and in some cases from patients and carers, to concentrate primarily on short term symptom management.

A major potential driver towards cautious psychiatry is the patient-led psychiatric ‘recovery’ movement. Proponents of recovery contend that many patients are prevented from recovering by being labeled as permanently disabled and by being numbed by ‘medications’ on the assumption that without them they are biochemically imbalanced.

Although McGorry and Hickie have appropriated the language of the recovery movement, in reality their approach is the very antithesis of recovery. They seek to extend the American Psychiatric Association’s permanent disability model by adding new categories of impending disability to individuals perceived to have an elevated risk of being mentally ill.

In addition to promoting the views of McGorry and Hickie, the ABC has selectively ignored important revelations about the safety and efficacy of mental health drugs. Most notably, in late 2014, management at the ABC intervened to prevent a story, already in production, that highlighted significant concerns about the safety and efficacy of antidepressants, from going to air.

We need a vigorous national debate about the future of mental health, but our taxpayer funded national broadcaster is stifling debate and promoting the unchallenged views of a few gurus. It is not that McGorry and Hickie are wrong about everything – they have put mental health on the national political agenda and many of their criticisms of the current system are indisputable. However, just because you can point at a problem doesn’t mean you know the solution, and if you are paid to promote pharmaceuticals you are not independent.

When the ABC picks favorites and ignores contradictory evidence, our national debate dumbs down. Other contradictory voices need to be heard on ‘our’ ABC. Given the current dearth of national political leadership, we need an ABC that elevates debate and deals with big issues without fear or favour.

The future of Australia’s mental health system is a crucial and complex issue. Millions of Australians, either directly, or indirectly as family and friends, have the potential to be either helped or harmed. It requires better coverage than the black and white bumper sticker campaign currently being run at the ABC.

 References

[1] The information below on the commercial ties of Professor’s McGorry and Hickie to the pharmaceutical industry was current in August 2010 and does not list subsequent funding.

Professor McGorry was the former President and is 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/) McGorry is currently Director of Clinical Services at Orygen Youth Health Clinical Program and Executive Director of the Orygen Youth Health Research Centre. Orygen Youth Health 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) McGorry individually has received unrestricted grants from Janssen-Cilag, Eli Lilly, Bristol Myer Squibb, Astra-Zeneca, Pfizer, and Novartis and has acted as a paid consultant or speaker for most of these companies McGorry P.D. ‘Is early intervention in the major psychiatric disorders justified? Yes’, BMJ 2008;337:a695 http://www.bmj.com/cgi/content/full/337/aug04_1/a695 (accessed 3 August 2010)

Professor Hickie and colleagues created the ‘SPHERE: A National Depression Project’ (http://sydney.edu.au/bmri/about/Hickie_CV.pdf). As was reported in The Australian Pfizer work in conjunction with SPHERE through a company called Lifeblood who are paid to review SPHERE. Through the use of SPHERE Pfizer have restored Zoloft to the number one antidepressant in Australia. (http://www.theaustralian.com.au/news/health-science/gp-jaunts-boosted-drug-sales/story-e6frg8y6-1225890003658). Professor Hickie received the following grants totalling $411,00 from pharmaceutical companies: $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); $81,000 from Pfizer Australia (n.d.) Cited in Ian Hickie, Curriculum Vitae, last updated 23 August 2009 http://sydney.edu.au/bmri/about/Hickie_CV.pdf   (accessed 3 August 2010)

[2] Joukmaa, M.; Heliovaara, M.; Knekt, P.; Aromaa, A.; Raitasalo, R.; & Lehtinen, V. (2006). Schizophrenia, neuroleptic medication and mortality. The British Journal of Psychiatry 188: 122-127 http://bjp.rcpsych.org/content/188/2/122.full (link is external)

[3] 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)

[4] Australia’s Reckless Experiment In Early Intervention – prevention that will do more harm than good by Allen J. Frances, M.D. at http://www.psychologytoday.com/blog/dsm5-in-distress/201105/australias-reckless-experiment-in-early-intervention ↩

[5] Professor George Patton quoted in The Age, ”This paper illustrates how much we need to be looking at these new services (EPPIC) 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?” Jill Stark, Youth mental health team too free with drugs: audit, The Sunday Age, July 8, 2012 http://www.theage.com.au/national/youth-mental-health-team-too-free-with-drugs-audit-20120707-21o29.html ↩

[6] http://speedupsitstill.com/patrick-mcgorrys-ultra-high-risk-psychosis-theory-fails-common-sense-test Patrick McGorry’s ‘Ultra High Risk of Psychosis’ training DVD fails the common sense test

[7] David Castle (St Vincents Melbourne) Medical Journal of Australia 21 May 2012- Is it appropriate to treat people at high risk of psychosis before first onset? NO ↩

[8] Carr, Vaughan. (2010, July 10). Letter to the Editor, Mental health funding. The Australian. http://www.theaustralian.com.au/news/opinion/mental-health-funding/story-fn558imw-1225890005936 ↩

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)

[9] http://www.theaustralian.com.au/news/health-science/campaign-targets-depression-guru/story-e6frg8y6-1226269135293

[10] Phillips, N., Oldmeadow, M. J., & Krapivensky, N. (2002, February 18). SPHERE: A National Depression Project. Medical Journal of Australia, 176(4), 193-194.

[11] http://www.bmj.com/content/326/7397/1008?tab=responses

[12] For more detail see  Professor Ian Hickie – Visionary Mental Health Reformer or Paid Pharmaceutical Industry Opinion Leader? Available at http://speedupsitstill.com/professor-ian-hickie-visionary-mental-health-reformer-paid-pharmaceutical-industry-opinion-leader

[13] https://twitter.com/mscott/status/532811349391585280 Mental As http://blogs.abc.net.au/nsw/2014/08/mental-as.html http://mhaustralia.org/newsletters-bulletins/mhca-ceos-weekly-update-15-august

http://blogs.abc.net.au/nsw/2014/08/mental-as.html

[14] http://mhaustralia.org/newsletters-bulletins/mhca-ceos-weekly-update-15-august

[15] http://mhaustralia.org/about-us/pharma-collaboration

[16] http://www.health.gov.au/internet/ministers/publishing.nsf/Content/7B43BA089E706CD8CA2579640010F23B/$File/MB223.pdf ↩

[17] http://www.abc.net.au/news/2015-04-14/mental-health-services-report-recommends-funds-redirection/6391028

‘National Mental Health Commission, 2014: The National Review of Mental Health Programmes and Services. Sydney: NMHC Published by: National Mental Health Commission, Sydney.

http://www.abc.net.au/news/2015-04-14/mental-health-services-report-recommends-funds-redirection/6391028

[18] Jill Stark, Youth mental health team too free with drugs: audit, The Sunday Age, July 8, 2012 http://www.theage.com.au/national/youth-mental-health-team-too-free-with-drugs-audit-20120707-21o29.html ↩

[19] Jill Stark, Youth mental health team too free with drugs: audit, The Sunday Age, July 8, 2012http://www.theage.com.au/national/youth-mental-health-team-too-free-with-drugs-audit-20120707-21o29.html ↩

[20] 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) ↩

[21] 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) ↩

[22] 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) ↩

And ‘National Mental Health Commission, 2014: The National Review of Mental Health Programmes and Services. Sydney: NMHC Published by: National Mental Health Commission, Sydney.

http://www.abc.net.au/news/2015-04-14/mental-health-services-report-recommends-funds-redirection/6391028

[23] Address to the National Press Club Canberra by Prof. Patrick McGorry July 7, 2010 ↩

[24] Professor David Castle Medical Journal of Australia 21 May 2012 Is it appropriate to treat people at high-risk of psychosis before first onset — No Available at https://www.mja.com.au/journal/2012/196/9/it-appropriate-treat-people-high-risk-psychosis-first-onset-no ↩

[25] Marshall M, Rathbone J. Early intervention for psychosis. Cochrane Database of Systematic Reviews 2011, Issue 6. Art. No.: CD004718. DOI: 10.1002/14651858.CD004718.pub3 June 15, 2011 http://summaries.cochrane.org/CD004718/early-intervention-for-psychosis

[26] Whitely M and Raven M, 2012. The risk that DSM-5 will result in a misallocation of scarce resources, Current Psychiatry Reviews, Bentham Science. http://www.eurekaselect.com/103772/article

[27] Whitely M, ‘Chapter 9 – ADHD: How a Lie ‘Medicated’ Often Enough Became the Truth’ in Ewen Speed, Joanna Moncrieff and Mark Rapley, eds., De-Medicalizing Misery II: Society, Politics and the Mental Health Industry, Palgrave Macmillan (2014).