Misleading claims in the mental health reform debate

So most of the 750,000 are not locked out of treatment, and most do not desperately need it. Most choose not to access treatment, and often that choice is appropriate, because the disorders are mild and transient. 750,000 is a gross over-estimate of treatment need, particularly need for specialist services like headspace and EPPIC.

Conclusion

These are only two of a number of inaccurate claims made by McGorry and Mendoza that inflate the scale of problems in the mental health system and exaggerate the benefits of their brand of solution - central to which is massively increased funding for headspace and EPPIC - which they imply is the only alternative to the status quo.

But does it really matter if some of the claims made by high-profile mental health advocates are inaccurate? The system is in crisis, and radical change is needed. McGorry's plan, resoundingly seconded by Mendoza and many mental health community groups, has the support of the public and politicians, so shouldn't we capitalise on the momentum?

That is how many people will respond to our critical analysis of these claims. It is essentially how GetUp has responded.

However, we believe it does matter that people have been misled to believe that more than a third of people who kill themselves have been inappropriately discharged from hospital, because this implies that massive resources should be directed towards psychiatric inpatients, who constitute only a small proportion of people at risk of suicide, and it deflects attention from other at-risk groups such as unemployed and elderly men. Such resourcing would have inevitable opportunity costs in terms of funding of other services.

We believe it does matter that people have been misled to believe there is a huge hidden waiting-list of young Australians desperately in need of mental health treatment, because this implies that even more resources should be directed towards a relatively narrow age-band. It matters even more that it is claimed that the treatment required is headspace/EPPIC treatment, and the claim is used to justify demands for greatly increased funding for those services, which would increase the opportunity costs.

We also believe it matters that the important role of GPs in mental health treatment is being ignored and implicitly denigrated. This is likely to lead to further deskilling and under-resourcing of GPs, reducing their capacity to intervene effectively with young people, many of whom have mild and relatively short-term mental health problems.

We are not entirely alone in criticising McGorry's campaign for mental health reform centred on specialist early intervention in youth mental health. The Royal Australian and New Zealand College of Psychiatrists' submission (PDF 157KB) to the National Health and Hospitals Reform Commission expressed concern about “investment in age specific community based services that have neither identified transition points nor evidence to support that age specific services provide better outcomes” and cautioned that “there are no simple solutions to reforming the mental health sector”. However, this seems to have been ignored by the NHHRC: its report (which will profoundly influence Australian health policy for decades) endorsed McGorry's demand for a national rollout of EPPIC and favourably mentioned headspace.

On a different level, we also believe it matters that high-profile mental health advocates are able to mislead by proclaiming authoritative-sounding statistics that almost no one bothers to check, and that misleading claims are incorporated into health policy. This uncritical acceptance is an impediment to evidence-based policy. Worse, when the inaccuracies of claims are pointed out, there is often reluctance to acknowledge the misinformation and attempt to rectify it, as is the case with GetUp.

McGorry and Mendoza's mental health reform campaign, which has become a popular bandwagon, exemplifies flawed problem-solving in which participants move too readily to the solution stage without adequate investigation of the problem and without objective analysis of a range of possible solutions. The histories of medicine and health policy are littered with popular but ill-informed bandwagons (PDF 100KB) like this.

We agree that the mental health system needs reform. However, we believe that there is far too much at stake to take the risk of fast-tracking a solution supported by inaccurate claims and populist sentiment. Furthermore, we argue that inaccurate claims are actually part of the problem, because they obscure the real issues, potentially bias resource allocation, with inevitable opportunity costs, and impede the formulation of effective strategies to improve the wellbeing of Australians.