Sydney Morning Herald – August 7, 2011

by Jill Stark

”It’s extremely worrying that the government is listening to professional lobbyists who have a massive personal investment in the programs they’re recommending – and they are undoubtedly overstating the evidence. There’s a massive conflict of interest there,” Professor Castle said.

Patrick McGorry Photo: Pat Scala

PSYCHIATRISTS, psychologists and patients’ groups say there is a growing backlash against the federal government’s mental health reforms and have accused its expert adviser, former Australian of the Year Patrick McGorry, of a conflict of interest.

Several mental health specialists have told The Sunday Age the focus on early intervention for adolescents and young adults has been ”massively oversold” by the ”McGorry lobbying machine”.

They claim he used his position on the government’s mental health expert working group to recommend funding for programs he founded.

David Castle, head of psychiatry at Melbourne’s St Vincent’s Hospital, said Professor McGorry, – who founded headspace (Australia’s national youth mental health foundation) and the early psychosis prevention and intervention centres – and Professor Ian Hickie, a headspace board member, had overstated the evidence for early intervention for young people at risk of psychosis.

Headspace is a service for 12 to 25-year-olds with mild to moderate problems such as bullying, stress and relationship difficulties. Patients do not require a GP-referral. The early psychosis prevention and intervention centres provide integrated psychiatric, psychological and social support for 15 to 24-year-olds.

Between them, the two services received almost a quarter of the $2.2 billion mental health package in the May federal budget. Both professors McGorry and Hickie were on the government’s mental health expert working group that advised the Prime Minister.

”It’s extremely worrying that the government is listening to professional lobbyists who have a massive personal investment in the programs they’re recommending – and they are undoubtedly overstating the evidence. There’s a massive conflict of interest there,” Professor Castle said.

The row comes after US psychiatrist Allen Frances – chairman of the committee that produced the Diagnostic and Statistical Manual of Mental Disorders IV, the key psychiatric diagnostic source – described Australia’s investment in early intervention as a ”vast untried public-health experiment”, claiming there was little evidence it had long-term benefits.

The dispute is in part a turf war about where limited funding should go. Some argue traditional GP and psychiatrist-led care has failed teenagers and youths who fall between paediatric and adult services, leading to delays in treatment.

About 14 per cent of children aged four to 17 have mental health problems, with depression and anxiety disorders the most common. About 2 per cent suffer from a psychotic illness.

George Patton, professor of adolescent health research at Melbourne’s Royal Children’s Hospital, praised Professor McGorry’s work but said his faith in early intervention was not shared by everyone. ”There’s a real groundswell of concern amongst the senior psychiatric community that we are running ahead of the evidence,” he said.

Professor McGorry rejected the claims, accusing critics of being a small minority who are ”disaffected, destructive and irresponsible”, and who are misusing scientific evidence to protect their turf and the ailing traditional mental health model.

”The reforms around early psychosis and headspace advantage patients and families, and have 20 years of solid evidence behind them, with successful upscaling in hundreds of communities worldwide,” Professor McGorry said.

He said there was no conflict of interest as he and Professor Hickie headed non-profit organisations, and while ideally all services would have received more funding, young people had the most acute needs.

Peter Birleson, former director of mental health services at Melbourne’s Royal Children’s Hospital, disagreed. ”The McGorry machine is distorting things in Australia. There’s people in the UK who look at what’s happening in adolescent and youth psychiatry here and think that it’s completely mad. While McGorry champions the cause of youth and young adults, actually 50 per cent of lifelong mental disorders appear before the age of 14, so there should be a massive shift towards strengthening services to children,” Dr Birleson said.

Professor Hickie said he and Professor McGorry had long advocated for services outside the youth area, and had no more influence than anyone else on the government’s working group.

”People taking cheap shots is disappointing but it’s characteristic of the mental health area. When there’s been very little investment, people end up fighting over the crumbs,” he said.

Louise Newman, past president of the Royal Australian and New Zealand College of Psychiatrists, said the focus on early intervention was too narrow and could lead to young people being overmedicated, prematurely diagnosed and stigmatised.

However, David Crosbie, chief executive of the Community Council for Australia and former head of the Mental Health Council of Australia, said professors McGorry and Hickie were being targeted for challenging current practice. ”I have nothing but admiration for Pat and for Ian, who are prepared to go well beyond what their roles are to try and make a difference – and it’s a pity that other people in the sector couldn’t support improvements for the greater good of mental health.”

Another supporter, SANE Australia’s executive director, Barbara Hocking, said Professor McGorry had championed services he wasn’t involved with and was instrumental in getting more funding for the sector overall.

Money for the early intervention programs came from cuts to the over-budget Better Access scheme, which provides psychological services through GPs, psychologists and social workers.

The cuts were opposed by the Australian Medical Association, the Royal Australian College of General Practitioners, and the Australian Psychological Society, which claim people with anxiety and depression now will be priced out of treatment.

Professor Hickie and Monsignor David Cappo, who is also on the government’s working group, opposed the Better Access scheme. Prior to the budget they, along with Professor McGorry, released a blueprint to transform mental health. It listed 30 ”best buys” in mental health – Better Access was not among them.

Ben Mullings, head of the Association of Counselling Psychology, said the government’s working group could not claim to be independent when panellists were direct beneficiaries of funds.

Victorian Mental Illness Awareness Council director Isabell Collins said she respected Professor McGorry’s commitment to youth but felt other age groups were being neglected.