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Professor McGorry defends early intervention -

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Professor Patrick McGorry argues the early intervention model he promotes has been proven to reduce
mental illness symptoms and reduce costs to the health system.


TONY JONES, PRESENTER: Mental health expert and former Australian of the year Professor Patrick
McGorry joins us now from our Parliament House studio.

Pat McGorry, thanks for being there.


TONY JONES: Now you've talked about the federal pledge of $1.5 billion of new funding. What will
you be asking from the state premiers tomorrow?

PATRICK MCGORRY: Well, all Australians know that the mental health system is broken and we need
transformational change, and despite the Federal Government having put a significant amount of
money - obviously as John Mendoza just said, a lot more is required - but it is a significant
investment and it is across the board. It's across all of life's stages.

Only 25 per cent of the investment is actually focused on young people, so I think some of the
comments you just heard earlier are quite misleading.

But it is across the board, and as David Crosby said, we've had this famine mentality in the field
with people fighting over these scraps. We've got to invest across the board, but we've got to
invest also where the major gaps are and where the most change can actually make a difference.

And that's why, as John Mendoza just said, investing in young people where the peak surge of
incidence of new cases actually occurs through adolescence and in early adulthood, and we also know
the facts are - these are facts, not really to be debated, because they're National Mental Health
Survey facts.

The weakest access across the whole life span is in the age group who have the most need, so this
is why governments have actually gone down this track.

But they also recognise - and the biggest single investment in the Government's package is $500
million for people with severe and enduring mental illness, so still the biggest investment is in
this group. What we'd be looking for from the premiers is co-investment in these critical programs
that will transform things, particularly ...

TONY JONES: Can I just interrupt you there? When you say co-investment, do you mean matching
funding? Are you basically asking the premiers as a group and those from the Territory, the leaders
from the Territory to put up $1.5 billion to match the $1.5 billion of the Federal Government?

PATRICK MCGORRY: Well that would be nice, but I think the ask is more modest than that. It's to
match investment in the programs where the Commonwealth has said it will pay for 50 per cent of the

For example the EPPIC program that was mentioned by several of the speakers earlier; that requires
state governments, if they want to have those services developed in their jurisdictions, to
co-invest with the Commonwealth to create that new transformational change.

And the other areas under the national partnerships agreement to try to tackle issues for people
with severe and enduring mental illness, notably housing issues and programs that might take the
pressure off the very beleaguered acute health system, the emergency departments.

So those are the areas of co-investment.

And the problem is that the state governments, over the last decade or so, almost to a man, or to a
state, have allowed their community mental health services to deteriorate quite seriously, and
that's really a legacy of mainstreaming of mental health services within acute hospitals where the
community mental health budget's just sitting there like a big cash cow which can be drawn upon to
prop up other services within the acute hospital, with the result that the community mental health
services buckle, they don't work very well then and more and more people end up in emergency

Everyone knows this. The most important immediate thing the premiers can do tomorrow is to
ring-fence or quarantine the mental health budgets within those acute hospitals, and that's not
just about young people, it's about all stages of life.

TONY JONES: Well I know you've said the issues with young people comprise only 25 per cent of the

In recent months though a number of critics, some quite harshly, have questioned your key focus on
early psychosis intervention. You've just heard a little bit of that. What is going on here? Is it,
as Mr Crosby suggested, that there's an envy in certain parts of the psychiatric community or is
there a genuine fear that you're actually getting this wrong?

PATRICK MCGORRY: Well, look, let's take the early psychosis reform for a start. This was something
that was pioneered in Australia in the early '90s. We had a national early psychosis project in the
late '90s which started to build that infrastructure in this country. It was allowed to just ebb
away and nothing happened in this country for 10 years.

Let's be clear: what happens when - to young people and their families when we don't have these
programs is long delays in getting access to care, even for severe psychotic illnesses, and when
they do get access, it's very cursory and there is no psycho-social wrap-around or recovery program
for these patients to make a proper recovery and reintegrate back into society.

So it's all very well for people to say that there's a risk of over-medication. Actually these
programs provide the opposite; they provide less reliance on medication and much more emphasis on
psycho-social care. So, again, ...

TONY JONES: OK. Let me go to this question of evidence. Is there statistical evidence over this
period that your programs have been running to show that there've been significant percentages of
young people who do not experience worse psychosis because of the early intervention?

PATRICK MCGORRY: Absolutely. This is - of all the things in the Government's package in May, this
is the most evidence-based reform. It's been going for 20 years, countries all round the world have
contributed to the evidence base.

Because we dropped the ball in the '90s, it's been on the backburner in Australia, so other
countries have gone ahead, implemented these reforms across the board in many, many Western
countries and much of the evidence has come from overseas. So, Australians have been missing out
because of these misinformed critics who are actually giving the wrong impression about this
reform. There is very good evidence.

TONY JONES: One of the harshest of those critics is an American psychiatrist, Professor Alan
Frances. He calls Australia's early intervention programs the "... largest and most reckless public
health experiment ever attempted." I mean, it's a pretty extravagant criticism. How do you respond
to that?

PATRICK MCGORRY: Well, it's quite bizarre. Dr Frances has obviously no knowledge of the Australian
health care system nor of the processes that these reform proposals have had to go through to get
to this stage.

I mean, it's been - we've debated these issues in the journals, in the health reform commissions,
we've even debated them on the beaches, I would say. I mean, it's been a massive effort to actually
get it through all these lenses.

So I think what we're seeing now is some disaffected critics who, as David Crosby said, are not
happy with the result. They've had their chance to put the case; the case hasn't got up from their
point of view.

I've been a researcher in this area for 20 years, I'm a scientist; this is not advocacy, this is
not faith, this is absolutely hard evidence. These programs improve outcomes and they reduce costs.

So an early psychosis program will end up costing per patient per annum about a third of what the
standard adult mental health care costs. So actually these reforms release money for other areas of
psychiatry, so it's very self-defeating for people to criticise their implementation.

TONY JONES: I was trying to figure out why an American would be amongst your strongest critics, and
it seems that Professor Frances and others are quite worried that what you're doing here in
Australia will entrench a newly-described state of mental illness known as "psychosis risk

Is what you're doing here really that revolutionary that it could affect the way psychiatry is
practiced all around the world?

PATRICK MCGORRY: Well, my colleague Alison Yung and I in the early days of our early psychosis work
in the '90s, patients were presenting to the first episode psychosis programs with lot of distress,
a lot of functional impairment, but with warning signs of psychosis.

So, these patients were in need of some kind of assistance. So what we set about doing was first of
all following up these patients in a supportive way and we learned that they had a very high risk
of transitional to psychosis, something like 30 to 40 per cent within 12 months, which is very,
very high, about 400 times higher than the general population.

And so obviously there was a need to try to reduce that risk, so a number of research studies,
which I think Jon Jureidini referred to, were conducted both here and overseas. There are about six
randomised control trials, if he wants to talk evidence, showing that a range of treatments will
reduce that risk to about 10 per cent.

Now, the sort of things that work in reducing risk are cognitive behaviour therapy, a psychological
treatment, omega three fatty acids, a fish oil, both of which studies we have done, and low-dose
anti-psychotic medication. Now that's the controversial bit.

But what the studies actually show is there is no need to use anti-psychotic medications as first
line in these patients. So the fears that Dr Francis is fanning in this country are actually the
converse of what the reality actually shows from the research.

So, I think we're on very firm ground knowing how to help these young people and they certainly
need help. And they shouldn't be turned away, as Dr Jureidini implied. They should be helped and
they can be helped within this new blend of Headspace and EPPIC models which will be rolled out
hopefully to most of Australia over the next few years.

TONY JONES: Pat McGorry, very interesting to hear you spell that out. We have to leave you there
for now. We'll come back no doubt to talk about this again in the future. We thank you very much
for joining us once again on Lateline.

PATRICK MCGORRY: Thanks a lot, Tony.