Patrick McGorry: “The majority of young people don’t get any help at all.”
See below for Patrick McGorry interviews on access to mental health care and transition to adulthood and effective mental health care
Professor Patrick McGorry (Melbourne, Australia), keynote speaker at the ESCAP 2017 congress, is a renowned researcher on early intervention for psychosis and in other aspects of youth mental health. Now he seems to be an activist, against the worldwide discrimination of mental illnesses, and on the barricades to allow 12 to 25 year olds easy access to mental health care.
McGorry: “Yes I have become an activist. I have been around for a long time now, trying to be a good clinician and trying to conduct research. If I take a look now at all the evidence that is on the table now, it is high time we do something with it and bring it to the real world.”
“Imagine if people with cancer or heart disease were told: ‘It’s not serious enough, come back later when it is worse’. We are talking about a massive double standard here between mental illness and somatic illness.”
Neglect of treatment
“There are so many young people out there, who do not get help. The neglect of treatment for these young people does have real consequences. Critics tend to talk about over-diagnosis, but – while some young people do receive a wrong diagnosis and treatment – in fact we are very far away from overtreatment. The contrary is true: we are facing an enormous problem of undertreatment or none at all.”
“What we have to set up is a stage-based system of care, that allows people to get simple care first – just education and support, psychological help or social interventions. If these are insufficient you might consider more complex treatment such as more intensive psychotherapy and, at some point, medication. In a step-wise way with increasing intensity and specificity as required. So you are responding proportionally, and actively guarding against overtreatment. The worldwide risk at the moment is undertreatment. The majority of young people don’t get any help at all. No one is fighting alongside them or working with them, with the common exception of their worried parents.”
Competition for funding
By the end of the last century, Patrick McGorry’s views on early diagnoses were controversial and heavily criticized – they were supposed to have been “misleading” and his research outcomes were dismissed as “exaggeration”. McGorry: “Early intervention in psychosis has been resisted by a vocal minority of academic psychiatrists in some English-speaking countries, because they had a misplaced fear that somehow the chronic patients with long-term disability are going to miss out if we start focusing on early diagnosis. You never would hear that in cancer, you never would hear the public care specialists say: ‘I am sorry but you can’t get any money for early detection of breast cancer, because we find that the late phase of it must be treated better first...’ But that is what some of our colleagues were essentially saying, and I can even understand it at one level for there is nowhere near enough money in mental health care and there is competition for different areas of funding. So when people see new money being invested in one area, they think: ‘Why can’t we have that money?’ That is naturally how they think. The people though, who never criticized early intervention were the families, the public and the politicians. They could see the logic and the economics of it. And the parallels with physical illness.”
“Of course we cannot always cure people, but we can surely change the course of an illness if it is treated early and consistently well. By starting to do it, we actually began to produce the large international body of evidence that it did help. The thing that really nailed it now is the RAISE study in the US, which has replicated what was done in Europe and Australia in the nineties. With a very good methodology, the RAISE outcomes show that you can transform the early course of illnesses if you treat them properly very early especially if treatment delay is kept to a minimum. And it is worthwhile: if you offer early treatment, the person’s life can be preserved, their trajectory, their social world and their prospects can be safeguarded. If you wait for five or ten years, people are in their late twenties and thirties and a critical period of life has passed them by.”
“The need for care of some sort precedes diagnostic clarity in terms of our traditional DSM or ICD systems. So they need some kind of help, and there are large numbers of these young people. We have to provide that care. Crucial to solving the problem of young people with mental health problems not entering the services, is developing a strong primary care system that suits young people. This has been done in Australia, Canada, and Denmark with Headspace, in Ireland with Jigsaw and Headstrong.”
The focus of standard psychiatric care should move from chronic care only, to including this kind of specialized early intervention services, McGorry believes. The Australian Headspace concept offers very accessible, local facilities – ‘soft-entry’ or ‘low-threshold’ as some Europeans say, almost like youth cafés” – where young people can talk to someone about any problem they have, “or only to drink a cup of coffee” – however with real multidisciplinary expertise also available on site. Various health and social care disciplines are represented in these centres that collaborate with schools, labour market agencies, social work and youth work organizations. The Headspace concept aims at eliminating the mismatch between the need for mental health and the lack of entry to it. “We are developing this entry point that avoids that horrible word ‘triage’, which always makes me think of a war time military system: who is worth saving and who is not... That is not something you want to be doing in medicine and health care; you want to respond to people’s genuine needs... So in stead we are offering a place where any young person and their family can come in and at least get some assessment and support. Stigma-free and effective.”
Headspace initiatives in Europe
Headspace initiatives in Europe: Headstrong (Ireland), Youthspace (UK), Milestones (EU). Initiatives in Denmark and the Netherlands are on their way. Read the British Journal of Psychiatry special issue on Youth mental health: appropriate service response to emerging evidence.
Professor Patrick Dennistoun McGorry (Dublin, 1952) is the executive director of Orygen, professor of Youth Mental Health at The University of Melbourne, and a director of the Australian Board of the National Youth Mental Health Foundation (Headspace). He is a world-leading researcher in the area of early psychosis and youth mental health, and has a strong interest in promoting the mental health of the homeless, refugees and asylum seekers.
His work has played a critical role in the development of safe, effective treatments and innovative research into the needs of young people with emerging mental disorders, notably psychotic and severe mood disorders. He has also played a major part in the transformational reform of mental health services to better serve the needs of vulnerable young people.
Selection of publications by Patrick McGorry:
Convergence Science Arrives: How Does It Relate to Psychiatry?
Eyre HA, Lavretsky H, Forbes M, Raji C, Small G, McGorry P, Baune BT, Reynolds C 3rd.
Altering the course of schizophrenia: progress and perspectives.
Millan MJ, Andrieux A, Bartzokis G, Cadenhead K, Dazzan P, Fusar-Poli P, Gallinat J, Giedd J, Grayson DR, Heinrichs M, Kahn R, Krebs MO, Leboyer M, Lewis D, Marin O, Marin P, Meyer-Lindenberg A, McGorry P, McGuire P, Owen MJ, Patterson P, Sawa A, Spedding M, Uhlhaas P, Vaccarino F, Wahlestedt C, Weinberger D.
The effectiveness of simple psychological and physical activity interventions for high prevalence mental health problems in young people: A factorial randomised controlled trial.
Parker AG, Hetrick SE, Jorm AF, Mackinnon AJ, McGorry PD, Yung AR, Scanlan F, Stephens J, Baird S, Moller B, Purcell R.
Niacin Skin Sensitivity Is Increased in Adolescents at Ultra-High Risk for Psychosis.
Berger GE, Smesny S, Schäfer MR, Milleit B, Langbein K, Hipler UC, Milleit C, Klier CM, Schlögelhofer M, Holub M, Holzer I, Berk M, McGorry PD, Sauer H, Amminger GP.
Heterogeneity of Psychosis Risk Within Individuals at Clinical High Risk: A Meta-analytical Stratification.
Fusar-Poli P, Cappucciati M, Borgwardt S, Woods SW, Addington J, Nelson B, Nieman DH, Stahl DR, Rutigliano G, Riecher-Rössler A, Simon AE, Mizuno M, Lee TY, Kwon JS, Lam MM, Perez J, Keri S, Amminger P, Metzler S, Kawohl W, Rössler W, Lee J, Labad J, Ziermans T, An SK, Liu CC, Woodberry KA, Braham A, Corcoran C, McGorry P, Yung AR, McGuire PK.