EPPIC

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“Personalities, rhetoric and charisma are driving the direction of mental health rather than science and evidence.” (Martin Whitely MLA, Parliament of Western Australia, 25 September 2012)

Related Media

Sue Dunlevy, News Limited Sunday papers, 7 October 2012, Doubts cast on youth mental health program. Available at  http://www.news.com.au/national/doubts-cast-on-youth-mental-health-program/story-fndo4eg9-1226489760605

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

MARTIN WHITELY (Trancript of speech in the Legislative Assembly, Parliament of Western Australia, 25 September 2012): I want to use this opportunity to talk about some very serious concerns I have about the direction of the mental health policy in Australia. My basic contention is that personalities, rhetoric and charisma are driving the direction of mental health rather than science and evidence.

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Part One – Is Nick Sick?   (11 minutes)

Part Two – Is Nick Sick?   (9 minutes)

Response to the ‘Is Nick Sick?’ video blog

by Professor Jon Jureidini

“Patrick McGorry’s Orygen Youth Health, CAARMS training video[1] on how to diagnose ‘Attenuated Psychosis’ demonstrates how not to carry out a psychiatric interview and interact with young people.”

As identified by Martin Whitely in his commentary about the CAARMS training DVD, describing Nick as being at ultra-high risk of psychosis (UHR) fails the common-sense test. Even more concerning is that Nick is labelled as having Attenuated Psychosis – in ordinary language, he is already mildly mad.

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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

http://www.theage.com.au/national/youth-mental-health-team-too-free-with-drugs-audit-20120707-21o29.html

[2] 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

[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

http://www.theage.com.au/national/youth-mental-health-team-too-free-with-drugs-audit-20120707-21o29.html

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“As opposed to the ‘ongoing disability’ or ‘impending doom’ assumptions inherent in the Americanisation and  Preventative Psychiatry approaches, the Recovery approach is more optimistic about the capacity for recovery and less reliant on pills.  It supports mentally ill patients with housing, educational, employment and psychosocial support – building blocks for a healthy and happy mind that can’t be replaced by drugs.”

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The following is a verbatim copy of a blog by Dr Allen Frances and a response by Professor Patrick McGorry. The original is available at Psychology Today – DSMV In Distress

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The following is an edited excerpt from a speech Martin Whitely MLA made in the Western Australian Legislative Assembly on Wednesday 25 May 2011

Mental Health was a centrepiece of the federal budget, with an additional $2.2 billion being identified over five years for mental health initiatives, of which $419.7 million was split between the Early Psychosis Prevention and Intervention Centre (EPPIC), and Headspace.[1] An additional $2.2 billion for mental health is a good thing and to the extent that people such as Professor Patrick McGorry, Professor Ian Hickie and Professor John Mendoza, have contributed to putting mental health on the agenda, they deserve praise. However, I am concerned that the devil is in the detail. My criticism is not about extra funding but about the lack of an evidence base for the decisions that have been made.

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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.

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Preview to next week’s Blog (Wednesday 4 May 2011)

Next week’s blog details how 2010 Australian of the Year Professor Patrick McGorry and his close colleagues have dominated the long overdue debate about the future of mental health services in Australia. It outlines how their claims of massive unmet need and proven 21st century solutions have been accepted almost without question by the Gillard Government, the Abbott Opposition, the independents, the media and therefore the public.

In March Professor McGorry and fellow members of the Independent Mental Health Reform Group released their blueprint for the future of Australian mental health. The blueprint, Including, Connecting, Contributing: A Blueprint to Transform Mental Health and Social Participation in Australia, outlines $3.5b expenditure over 5 years on ‘transformational’ programs that are identified as mental health ‘best buys’.[1] However, serious questions remain unasked, including:

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