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Mental health system in crisis: McGorry -

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Mental health expert and Australian of the Year professor Patrick McGorry tells Lateline why he has
asked the Government to implement a massive overhaul of the mental health system.

Transcript

TONY JONES, PRESENTER: And now to our guest, the 2010 Australian of the Year professor Patrick
McGorry.

Professor McGorry is an internationally renowned expert in the mental disorders of young people.

He's best known for his pioneering work on early intervention in the treatment of psychosis, which
was done at Melbourne's Orygen Youth Health, Australia's largest youth-focused mental health
organisation.

Key parts of his team's research and their treatment models were adopted in the UK, Canada and
Western Europe, but not nationally in Australia. That, however, may be about to change.

Professor McGorry is now calling for a massive overhaul of the mental health system and the Federal
Government appears to be listening.

Patrick McGorry joins us now in the studio. Thanks for being there.

PROFESSOR PATRICK MCGORRY, CENTRE FOR YOUTH MENTAL HEALTH, UNI OF MELBOURNE: Thanks, Tony.

TONY JONES: Since you were named Australian of the Year, as I understand it, you have been flooded
with horror stories about the mental health system from all over the country.

Do you get the impression that we are facing a crisis beyond what you had imagined?

PATRICK MCGORRY: Well, Tony, I was aware of this myself but it certainly gives graphic relief to
this-this problem all around Australia.

The figures underpinning this are quite stark. 65 per cent of those in Australia with mental health
problems have no treatment at all, no treatment access whatsoever.

So when we talk about delays for elective surgery, we know that 90 per cent of people with physical
health problems do get good access to care, so the lopsided nature of investment in our system's
really revealed by this.

4 million Australians have mental health problems in any given year. Only one third of them get
access to treatment.

TONY JONES: That's a staggering figure. I mean, are you getting personal accounts coming to you? It
was obvious you'd become a lightning rod, I suppose, but are these flooding your office?

PATRICK MCGORRY: These are graphic in very large numbers - emails, letters - quite distressing
stories. Now, I'm familiar with that myself anyway on a day to day basis from working from within
the mental health system, but I think the scale of it is now coming to the fore.

And I think Australians are starting to realise that their mental health needs are as important as
physical health needs and I don't think politicians have caught up with that yet.

TONY JONES: Here's one astonishing figure, 500,000 people presenting, apparently, with mental
illness have been turned away from hospital emergency wards.

PATRICK MCGORRY: Well, unfortunately the acute end of the system, the hospital emergency
departments, have become the lightning rod, the place, the destination where all of this
desperation actually presents and they can't cope. So many people are discharged to other forms of
care or really to what people aren't really sure the next day.

TONY JONES: We don't know what is happening to these people. It's an incredible number of people to
have been turned away from hospitals.

PATRICK MCGORRY: It is, and it shows that the system is lopsided and the lack of upstream
investment in community based services - community beds, mobile outreach teams, housing services,
vocational recovery programs, all the community elements of care - have been disinvested in,
really.

The states and the Federal Government's quite appropriately looking at supporting that health
system and the reform process is very, very welcome. We want to be a part of it.

The mental health system needs that kind of additional support to help the states deal with this
problem, particularly on the community side.

TONY JONES: Is what we're seeing the inevitable side of shutting down mental institutions in the
first place? That people would have to present somewhere, but unfortunately, when they have acute
mental illness, there's really nowhere to take them properly.

There are a few acute facilities, but those are overstressed, understaffed and in serious trouble
themselves.

PATRICK MCGORRY: Yeah, we need to take the pressure off the acute end of the system by investing
upstream.

And as you say, it's only 15 years or so ago when we started to really leave the asylum system of
the 19th century behind, and our first attempt at it has really struggled because of this failure
to invest at the appropriate level and in the right way.

TONY JONES: Is it because governments thought they could actually save money by shutting these
institutions, the asylums, which, if you think of the word "asylum", it's meant to be a place where
you can find care. Of course, there's a pejorative tone to that now.

I mean, is there something else you could put in their place for people with acute problems?

PATRICK MCGORRY: I think we do need a different range of beds in mental health, so we need much
more therapeutic environments than what we are currently left with with the acute mainstream acute
hospital beds.

They are far from therapeutic because of the pressures placed on staff and the system by this
lopsided model of care that we've developed.

TONY JONES: You've talked about havens instead of asylums.

PATRICK MCGORRY: I think we need smaller community-based environments which are therapeutic and we
need a range of bed types, which we haven't developed.

So I think, whether governments were trying to save money or not, we haven't developed the 21st
century system of care with a balanced system, upstream and downstream, to really provide the
appropriate level of resource.

TONY JONES: It could be very expensive. Is it clear what's necessary, in your view, in terms of new
funding, and in the views of others obviously in the mental health area?

PATRICK MCGORRY: Well, I think there's a very strong consensus in the field. It's often portrayed
as being divided but my experience in the last few months has been, there's a very unified view of
what is needed, and that's a combination of things.

It's upstream investment in a range of community based services, it may also involve strengthening
the acute system so it's not an either-or approach.

And there's a whole system of care that is missing, which obviously my work is really focussed on,
and that's an early-intervention model of care, which we have in cancer and heart disease. If
people have early warning signs of potentially serious illness, the doors just open up before them
and they are welcomed into the health system for appropriate care.

That doesn't happen in mental health and that burden of that falls squarely on young people
-children, adolescents, emerging adults - where 75 per cent of the emerging mental health problems
appear for the first time.

TONY JONES: I'm going to come to that in more details in a moment. Let's just take a step back for
one minute to the sort of funding that would be necessary just to do the things you are talking
about.

Are state governments capable of doing it or is this something the Federal Government will have to
provide new funding for?

PATRICK MCGORRY: Well, I think with the best will in the world, and I think in some states,
particularly Victoria, there has been a fairly committed effort to try to do this, but clearly the
state governments need help.

Some states more than others, but um, just as the Federal Government has recognised the states need
help with the system generally to cope with growth and meeting the needs, nowhere is that more
apparent than in the mental health system.

TONY JONES: So you're waiting for the Federal Government to show its hand because it's unclear as
yet. And there's a fear, obviously, that they could get bogged down in this huge debate over what
happens, just with hospitals.

PATRICK MCGORRY: Yeah, I think there's obviously at the moment a tremendous concentration on the
waiting list sort of issues, which always are the old chestnuts that come out at this time in terms
of health funding, but it's a much more serious situation on the mental health side.

So yes, I think the mental health field is very anxious to be part of the solution, and not be
locked out and excluded once again.

TONY JONES: Is it a public image thing, because, as you say, the mentally ill may have much worse
problems than arguably someone waiting for a hip replacement.

As terrible as that would be, being on a long waiting list, but the ones waiting for the hip
replacement, they're the ones that get the publicity, front page stories on tabloid newspapers and
so on.

PATRICK MCGORRY: As you say, I mean, we're not trying to compare levels of suffering here, but
there's no doubt that the people with mental illness and mental disorders are the most
disadvantaged in terms of access to care and also in terms of quality of care.

That's not to say that - there are many dedicated people working in the mental health system trying
to make it work under very adverse conditions but they are not receiving the right level of
support, and that's where the system needs to be scaled up more than anywhere else. It's not
expensive.

When we're spending nearly $100 billion on our health system these days, we're talking about an
investment of several hundred million, which is actually the cost of one major metropolitan
hospital. That's the sort of level which would make a very significance difference in the mental
health system.

TONY JONES: You've been making this argument to the Prime Minister, to the health Minister. Are
they listening?

PATRICK MCGORRY: Well, they are definitely listening and I certainly hope and expect...

TONY JONES: Are they receptive?

PATRICK MCGORRY: Well, I think what they're saying is, they will make an announcement on this in
the next few weeks. I'm hopeful and indeed I expect, on behalf of the Australian community and on
behalf of the mental health field, to see some genuine reform in the mental health field as we have
been promised in the general health system.

So we want to be part of this. Mental health must be part and centre of health reform in Australia.

TONY JONES: Your own specialist area, as I mentioned earlier and said we'd get on to talking about
it - we will now - is mental illness in young people. There's a hidden element to this and that is
the scale of it. Give us some idea.

PATRICK MCGORRY: Okay, well, 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.

If the access is 35 per cent in general, it drops to 25 per cent in young people and 13 per cent in
young men, so this is the least accessible part of the health system and that's because it's not
designed for them. The health system is designed for younger children and older adults with chronic
disease, basically.

And in the middle we've got healthy adults who, their main health problem is mental health and
substance abuse disorders. But the system is not strong in that area; it's weakest where it needs
to be strongest.

TONY JONES: There's something ironic here because it's more than a decade ago that I first met you
and you were working on quite ground-breaking research, modelling how you can help with early
intervention to stop psychosis in young people becoming chronic, becoming somehow built into their
system so it they - it becomes something they suffer for a lifetime.

Now, this early intervention model seems to have worked well in Victoria, and it's been
transported, as I said at the beginning, to many parts of the world, but not nationally in
Australia. What happened?

PATRICK MCGORRY: Well, yeah, in the late '90s there was a lot of support for that in Australia. It
sort of died off. Other countries have run with it, as you say. There are hundreds of centres
delivering early intervention for psychosis around the world.

This reform is recommendation number two on the health and hospitals reform commission list of
mental health recommendations. It's well overdue.

The evidence is very, very strong now that, not only does it improve outcomes, as you say - the
early detection and comprehensive care in the first few years after diagnosis - but also it saves
money.

We published a paper last year showing that the cost of care over the next eight years after
diagnosis dropped to one third for those patients who have received early intervention compared to
those who've received generic late intervention in the standard system. So actually, it's very
economically irresponsible not to role this out in Australia.

TONY JONES: Let's talk about how it would roll out if it were to be done.

I mean, the first stage in the process, in a way, is a system called the Head Space program, which
I guess is where young people are picked up in the early stages, and then if they show signs of
serious disorders, they can be transferred to the- to where you deal with the serious disorders
with the early intervention.

No, tell us how many of these Head Space centres there could be or should be and how much that
would cost.

PATRICK MCGORRY: Just to give the Government a pat on the back, here, they have actually set up 30
of these one-stop shops around Australia.

Every state and territory has this resource developing. It's really a toe in the water.

It's treated 20,000 young people in a one-stop shop, youth-friendly environment - very low stigma.

Young people are voting with their feet: 93 per cent of them are engaged in the centres, and
benefit from them, so it's been evaluated. And the Government, I think, is seriously considering
expanding this.

TONY JONES: You want them to build 60 new centres similar to this so it can reach regional
Australia and other parts of the country. How much would that cost?

PATRICK MCGORRY: Head Space is recommending and requesting a level of support from the Federal
Government, yes. It's 60 centres.

We want the existing ones strengthened as well so they can really hit their straps and treat more
young people.

Um, 90 centres would actually, over time, provide services to 250,000 young people per year, which
would make a very big dent in that level of unmet need that I referred to earlier.

But they do need to be backed up, as you said, by specialist youth mental health centres.

TONY JONES: Well, that's the second part, isn't it? The specialist centres, the ones that take the
people- the young people who look like they may have psychosis, who can be dealt with early. You
want 20 more of those built.

PATRICK MCGORRY: Yeah. I think we need about 20 of those nationally over time. I think it would be
feasible to establish 10 in the first stage, and that would cost another $100 million recurrent.

So the two programs, expanding Head Space and backing it up with an effective youth friendly system
of care for the more serious disorders - not just psychosis but borderline personality, serious
mood disorders and so on.

That would be an effective system, so for a cost in the first stage of $200 million recurrent -
which, as I say, is a fraction of the cost of a major metropolitan teaching hospital - Australia's
front line services for young people would be transformed.

Now, that's not the only thing we need to do, but it is the area that I've particularly focussed on
in my work.

TONY JONES: And the cost benefit of doing it?

PATRICK MCGORRY: The cost benefit would be very substantial. We commissioned Access Economics to do
a much broader spectrum report on youth mental health care and this is a $10 to 30 billion industry
depending on whether you cost indirect as well as direct costs.

The cost effectiveness goes up the more you scale-up the system. They show that you can increase
the cost effectiveness by a factor of 10 by scaling it up in this sort of way.

There are all sorts of benefits, not just in human capital but in terms of savings, in terms of
welfare benefits, in terms of more tax returns. I mean, we're making a key section of the
population much more productive, and more sort of mainstream members of society through these sorts
of interventions.

TONY JONES: Well, potentially saving their lives, in fact.

PATRICK MCGORRY: Well, absolutely. Suicide- We haven't even got on to the suicide issue, but youth
suicide, youth homelessness - these are collateral damage from poorly treated or untreated mental
health problems.

TONY JONES: We've run out of time but I've got to ask you this question I raised at the beginning.
Do you actually have a champion inside Cabinet to help you push this through because you'll need
one?

PATRICK MCGORRY: We definitely need champions inside Federal Cabinet and we need champions in the
Opposition as well. It's a bipartisan issue that we are looking for support for, and mental health
has never really had that kind of support in the past.

We've had, I'd say, desultory support at different times, but we need solid support and we need it
from the Australian community too.

All the people that have been writing to me, contacting me, we need them to actually indicate much
more strongly on the back of the awareness that's improved in Australia in recent years that new
services are required.

TONY JONES: Patrick McGorry, we'll have to leave you there. We- I guess a lot of people now
understand why you are Australian of the Year, but we thank you very much for joining us tonight.

PATRICK MCGORRY: Thank you, Tony.