McGorry's 'early intervention' in mental health: a prescription for disaster

Since his appointment as Australian of the Year, Professor Patrick McGorry has established a prominent profile in the media, calling for major mental health reform. It is clear that many people, including the Federal Government, are listening to him.

Most recently, the independent grass-roots community advocacy organisation GetUp has launched a campaign promoting McGorry's call. While it may seem an obviously worthwhile campaign - and indeed we agree that radical reform is required in the mental health sector - GetUp and others who support McGorry's call do not appear to have looked closely at what he is actually calling for.

McGorry is recognised not just here in Australia but internationally as a champion of “early intervention” in mental health. This sounds like something that nobody could possibly object to - and McGorry cleverly uses metaphors such as “a stitch in time” - until you consider what early intervention actually means.

McGorry claims that it is possible to identify people who are at risk of developing a psychotic disorder (e.g. schizophrenia) before they actually develop sufficient symptoms to warrant a diagnosis. He calls the early symptoms - including unusual beliefs, lack of initiative, and social withdrawal - the “prodromal” phase of these disorders. The early intervention that he then calls for is medical intervention that typically includes antipsychotic medications.

This form of early intervention is quite controversial, even among some of his psychiatric colleagues. For instance, in a 2006 report in Time Magazine, Professor Thomas McGlashan, a leading US early intervention researcher, cautioned that there was insufficient evidence to justify pre-emptive drug treatment. McGorry himself admitted that it is impossible to predict with certainty which young people will become psychotic. However, as journalist Daniel Williams observed, “Calm and softly spoken, McGorry has a way of making the experimental use of antipsychotics seem like the only responsible course”.

There are many hazards with pre-emptive medical interventions, especially with such potent drugs as antipsychotics (which have been described as possibly the second most toxic chemicals used in medicine after the drugs used in chemotherapy), which have serious side-effects including diabetes, metabolic syndrome, and sudden cardiovascular death. McGorry, however, dismisses such risks as “theoretical”. Furthermore, there is little scientific evidence of the effectiveness of these drugs for prevention.

Under McGorry's proposed reform, large numbers of “false positives” - young Australians - would be caught by the wide early intervention net and exposed to serious risks from drugs that have not been proven to be effective.
A recent article in Psychiatric Times discusses early intervention in regard to the current revisions being proposed for DSM-V (the next edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, the diagnostic “bible” of psychiatry). The article, which describes pre-emptive treatment as a “prescription for an iatrogenic public health disaster” is by Allen Frances, Professor Emeritus of Psychiatry at Duke University, who chaired the DSM-IV Task Force that oversaw the development of the current edition. Frances emphasises the high rate of false positives, the lack of evidence of efficacy of antipsychotics, and the dangerous side-effects.

Further doubts must be raised about McGorry's agenda when you see the substantial funding his organisation (Orygen Youth Health) receives from the pharmaceutical industry and also from the US Stanley Foundation, which is notorious for its particularly aggressive approach to the detention and mandatory treatment of people labelled with psychiatric disorders. Some details of this funding are available on the Orygen website (under Major Grants and Other Funding). However, McGorry, who has personally received funding from many manufacturers of antipsychotics, frequently reports no conflicts of interest, particularly in his many recent Medical Journal of Australia articles, including a supplement on early intervention that repeatedly advocates the use of antipsychotics. In the US, several of these antipsychotic manufacturers have been charged with illegal promotion practices (PDF 48KB).

McGorry's campaign is part of a wider push to promote the medicalisation of mental health (for which psychosocial wellbeing is a better term). Prominent among the advocates are Jeff Kennett and beyondblue, the Brain & Mind Research Institute (BMRI), which is led by former beyondblue CEO Ian Hickie, SANE Australia, and the Mental Health Council of Australia (MHCA).

BMRI, SANE, and MHCA all receive substantial pharmaceutical industry funding. This excessive medicalisation of what it is to be human, which extends far beyond mental health, is called “disease mongering” and it is enthusiastically promoted by the pharmaceutical industry. Disease mongering is a major social issue being debated elsewhere in the world, but unfortunately there is currently little debate here in Australia, where the medical profession dominates the public debate on these issues.

If people and organisations wish to support radical reform of our mental health system, they should be promoting this debate - not the public relations spin of McGorry and his allies.