Australia's reckless experiment in early intervention

Patrick McGorry is a charismatic psychiatrist who has recently gained heroic status.

First he was chosen to be Australia's Man Of The Year. Now, he has convinced the Australian government to spend more than $400 million over 5 years to fund his plan for a nationwide system of Early Psychosis Prevention and Intervention Centres.

McGorry is the visionary prophet and pied piper of preventive psychiatry. His goal is to diagnose mental disorders early and treat them expectantly - before they can do their worst damage.

McGorry's goal is certainly great. But its current achievement is simply impossible and Australia's plans are patently premature.

Early intervention to prevent psychosis requires first that there be an accurate tool to identify who will later become psychotic and who will not. Unfortunately, no such accurate tool exists.

The false positive rate in selecting prepsychosis is at least about 60% to 70% in the very best of hands and may be as high as 90% in general practice.

That's right, folks, 9 misidentified non-patients for 1 accurately identified truly prepsychotic patient. Those are totally unacceptable odds.

What are the costs?

McGorry does not recommend antipsychotic medications as a routine part of his prevention regimen. But experience teaches us that they will be overused despite having no proven efficacy and posing the risk of massive weight gain (and its consequent array of serious complications).

The false positives will also suffer unnecessary stigma and worry and will undergo unnecessary and misdirected treatment. And surely there are many more productive ways to spend $400 million doing a better job of managing the mental health needs of those who have real and treatable psychiatric disorders.

Unfortunately, McGorry is a false prophet whose visions are offered at least a few decades before their time.

Australia, led astray by his impractical hopes, is about to embark on a vast and untried public health experiment that will almost surely cause more harm to its children than it prevents.