Professor Patrick McGorry has written the article below in response to a recent Croakey post by Melissa Raven, a psychiatric epidemiologist and policy analyst, an Adjunct Lecturer in the Department of Public Health at Flinders University, and a member of Healthy Skepticism.

Patrick McGorry writes:

Melissa Raven accepts that official data does indeed show that approximately 750,000 young Australians with mental disorders do not access mental health care, yet continues to falsely characterise my consistent concern that this cohort should receive access to mental health care as misleading the public.

It appears that Raven bases this false claim on her view that only the 170,000 young Australians in this group with severe disorders merit access to mental health care (alarmingly only half of this group do so).

This line of reasoning is not only an example of bad faith on Raven’s behalf (I have never argued that 1 million young Australians have serious mental illness) but also reprises a discredited argument that young people should wait until their mental ill-health becomes serious before accessing care.

This late intervention philosophy is associated with risk, preventable damage and stigma and for this reason access to appropriate, staged mental health care for young Australians with mild, moderate and serious mental ill-health is overwhelmingly supported by political parties and the health and social sectors (most recently expressed in a letter co-signed by 65 organisations).

To argue that young Australians with mild to moderate mental ill-health do not need access to mental health care applies a standard to mental health that would not be acceptable in physical health.

Imagine restricting access to health services to only Australians with severe physical ill-health and locking out all those with milder conditions with the admonition that they should just regard their distress as part of the human condition and suck it up!    

headspace was created as a stigma free model specifically for the group of young Australians with mild to moderate mental ill-health that Raven appears to be suggesting should not have full access to this kind of mental health care. headspace provides information, skilled assessment and linkage to a range of health and social services appropriate to a young person’s need.

As with mild physical ill-health, skilled assessment of mild mental ill-health is most likely to result in a plan that combines changes in routine, diet, exercise and alcohol consumption with some moral support.

Low risk and non-stigmatising care that doesn’t label yet creates the pathway for more specialised interventions if the initial wave of advice and support doesn’t solve the problem.  It would be mischievous to misrepresent this type of 21st Century mental health care as predominantly or exclusively about medication and psychotherapy.  This is nothing more than a straw man that Raven is seeking to set up in order to tear it down.

As with physical health, responses to mental ill-health should always be tailored to need in a stepwise manner to balance risks and benefits.  For this reason, brief interventions provided by health professionals form one part of the headspace model and referral to specialist youth mental health services is confined to headspace clients with the most complex and severe needs.

It is difficult to see what exactly Melissa Raven’s objections are to all young Australians one day having the option of getting information, assessment, support and referral when experiencing mental ill-health. It might be helpful for her to explain this.

Dr Raven and Dr Jureidini also question the link between poor responses to mental ill-health and suicide. Although 90% of people who complete suicide have a diagnosable mental disorder, only a quarter previously accessed mental health care. Accessing care is proven to reduce suicide risk and the period immediately after discharge is one of significant elevated risk for suicide.

In the context of these facts the achievable possibilities for preventing suicide should be clear. Yet, once again Raven is at odds with what commonsense and the facts clearly demand.

It is also perplexing as to why Melissa Raven should characterise the early intervention paradigm represented by linked headspace and EPPIC centres as a “prescription for disaster” and to respond to corrections of her inaccurate claims as “silencing dissent”.

She has been repeatedly provided with the facts on headspace and early intervention but they are inconvenient to her purpose and hence ignored.

Young Australians – and Australians of other ages – deserve a health system that cares for mind and body equally effectively. That means applying the same standards of access to care for mental health as to physical health. Those who believe otherwise should be upfront about this perspective.

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