Sloppy. Not a skerrick of reasoned argument in the entire article.

The headline calls McGorry's proposal a "prescription for disaster" but nowhere do the authors tell us what kind of disaster they expect.

"[McGorry] calls the early symptoms [of psychosis] - including unusual beliefs, lack of initiative, and social withdrawal - the “prodromal” phase of these disorders."

So does one of his opponents in the debate over early intervention here: http://www.bmj.com/cgi/content/full/337/aug04_1/a710. The terms "prodrome" and "prodromal" are no more than standard medical jargon. The insinuation that McGorry is using an odd word - possibly of his own devising - to hide some nasty secret agenda is cheap and nasty.

I'm neutral on this issue and I remain so. Scare-mongering articles like this aren't going to convince me to join the debate over disease-mongering.

Perhaps Paul you need to have a basic understanding of the issue.

I found the article very interesting, although I was planning on only skimming it.

I was not aware of what was meant by the push for early intervention. I had assumed that it would have been an increase in more social/emotional coping strategy support - that is not medication based but learning better mental coping skills and safe behaviour, particularly for young people.

Suicide prevention and phychosocial wellbeing is not about medication alone, although I do believe some people find medication is very helpful.

Take the mining industry for example, there is a lot of unreported suicides or attempts (this may account for some workplace accidents) but the work and accomadation environment of mines do not have any mental health supports available. The standard is 'call lifeline'.

On mine sites there is a real macho grog culture, where workers are away from their family and supports for considerable times. Life and relationship problems are amplified by isolation, and preventative mental health is NOT to tell the person to 'harden the hell up'.

Thank you for bringing the issue of 'early intervention' being about drugging people 'just in case'. It raises more questions than answerers.

I began this paper in a rather antagonistic manner but was impressed by the argument. I must agree wholeheartedly with the comments by Aka in that I was not aware that a drug intervention was being proposed. I should have thought that identification of high risk individuals could be a good thing as long as they were being followed in some non–medical manner. Certainly the identification of "high risk" individuals must only be done with some form of intervention in mind, an intervention supported by evidence, but there is no need necessarily for this to involve medication. The risk of "medicalisation" is real, as is the risk of labelling people with perhaps self–fufilling prophecies.

"Perhaps Paul you need to have a basic understanding of the issue."

That remains a failure of the authors. In a general article for a general readership, anyone aiming to convince others to take one side or the other of a debate needs to tell readers what the debate is about and why it's important. Tedious as it might be, a clear, dispassionate and accurate exposition of the issues is needed.

This article raises some important issues. How easy would it be for misdiagnosis in a program that seeks early intervention when the symptoms are not definitive? There is still much confusion and criticism within the health fraternity over medicating ADD/ADHD students in a 'jumping the gun' approach.

The mental health sector certainly needs attention and soon.

Medication is not always the answer and as as society we should be looking at why there has been an increase in mental disorders and what factors contribute. Is there something wrong in the way we approach (or failure to approach) issues of human wellbeing.

Increase in drug abuse is one factor but not the only one.

Are issues like corporatisation of society, consumerism and lack of familial and social networks in any way contributing (particularly for depressive illness) and if so by how much?

The fact that McGorry receives funding from pharmaceuticals is not in itself a reason to dismiss his early intervention approach which is well intentioned. My GP has visits constantly from pharmaceutical reps but is able to make decisions based on his own research and past experience.

It would be better for funding to come from governments but mental health has been sadly neglected for some time and I suspect will continue to be unless it becomes a vote losing topic.

Paul Bamford's comment was what was sloppy here...

Paul said... "The headline calls McGorry's proposal a prescription for disaster but nowhere do the authors tell us what kind of disaster they expect."

Paul read the article! It's not just the authors who expect the disaster, it is Allen Frances, DSM-IV Chair who is explicitly quoted in the article warning of the "“prescription for an iatrogenic public health disaster”... the article goes on to state the toxic effects of the drugs being pushed by McGorry and his Big Pharma financiers. Can I hold your hand here on this one Paul? The expected iatrogenic health disaster is from the toxic effects of the drugs. It's obvious to every other reader what is meant by the headline... who is sloppy? You.

Nobody is suggesting McGorry invented the word prodromal. Nobody. This is not about the word, it is about the context in which it is used, to imbue what is at best nothing more than a psychiatric label, with a new 'phase'.

Paul you say "I'm neutral on this issue and I remain so. Scare-mongering articles like this aren't going to convince me to join the debate over disease-mongering."

McGorry terrifies a lot of people, not only here, but globally. This article isn't scaremongering, in fact, what is scary is how little critical thought has been applied to McGorry's dangerous positions, his millions of dollars worth of drug industry ties, along with the merit of his Australian of the Year award. You can remain neutral on drugging kids for life with toxic major tranquilizers just because they are socially withdrawn if you like, many others find themselves unable to remain neutral in the face of such a clear and present threat to public health as 'early intervention'.

Congratulations to Online Opinion for publishing a good, enlightening article on the threat posed by this garbage that is being pushed by the shrinks. I know I'll be keeping my children well away from these quacks.

Jane Mackintosh:

I have read the article. I stand by my initial criticisms. Moving on:

"McGorry terrifies a lot of people, not only here, but globally. This article isn't scaremongering, in fact, what is scary is how little critical thought has been applied to McGorry's dangerous positions, his millions of dollars worth of drug industry ties..."

In other words, you can't be a scare-monger if you're only joining in with a panic that has been started elsewhere.

You certainly haven't applied any critical thought to "McGorry's dangerous" position: like David Webb and Melissa Raven you have used McGorry's own public declarations of the sources of his research funding and some private consultancy work to insinuate that he is a hired shill of the pharmaceutical industry. You describe psychotropic drugs as "toxic chemicals" (as do the authors of the article) based, as far as I can see, on no other evidence than that of a self-help book written by a single author whose opinion may be influenced by a vested interest of her own: the desire to sell books and make money.

The really irritating thing about this article, and the responses I've received to my criticisms of it, is that I could be sympathetic to the position taken by David Webb & Melissa Raven. But their case is badly made. And it's not going to be made any better until some genuine critical *thinking* is applied to the question.

This, of course, is never going to happen in a public internet forum. If it did happen, it would be a first.

The first thing I thought about when I read this article was that maybe the writers were involved with some anti-psych group like Scientology.

Having listened to Doctor McGorry several times, the fact he was an Australian of the Year does not surprise me at all.
If he is looking at early intervention as a possible help to ward off the coming mental anguish in some people, then I say give it a try.

Having been involved in caring for many people with mental health problems over the years, I can tell you that it is definitely part of a Medical problem, not just psychological/mental/emotional problems.

If the psychiatric condition did not have many medical components we would not require Psychiatrists to have also been medical doctors as well. They are able to supply the scripts for antidepressant,
anti- anxiety and anti-psychotic medications for their patients.

As much as I have had many doubts myself about drug companies over the years, it is an unfortunate fact of life that we need their money to conduct research into providing cures, comfort, prevention and security in the form of new drugs.

The psychiatry world has come a long way since last century when most mentally ill people were simply locked away from sight in large institutions, left to live out their days in mental anguish.

Many people these days owe their lives (or at least their way of life) to these mental health medications.

Fix the illicit drug and alcohol problems in our current society, and we will go a long way to reducing the mental health problems.

Congratulations Melissa on bringing the truth about these issues out of the shadows.

Thank you for calling attention to the renegade and dangerous nature of McGorry's protocol. Thanks also for helping to highlight the naivete of our government, seemingly handing over unmetered credence to the likes of McGorry and Hickie (also former advisor to Beyond Blue) regarding mental health treatment and policy. Each of these men has too cosy a relationship with the pharmaceutical industry to be allowed the influence that they have.

How can we ever hope to obtain a true state of mental health for Australians so long as policy for it stays so heavily driven by such a sick and untrustworthy situation.

couldnt have said it better myself Jane!
well done.

Paul, open your eyes and your ears...
ignorence is not bliss, especially for our children.

The pharmaceutical companies also produce vaccines, antibiotics and chemotherapy medications.

Are we all going to stop taking these 'chemical cocktails' because the drug companies are making money out of them?

Are we understanding of why people need to take medications for physical illnesses but not for mental illnesses?

Why?

Here is an excellent article on this topic from Psychology Today, The former Chairman of the US Task force for the DSM citing the dangers of preventive psychiatry - what McGorry is asking Australians to implement:
"DSM5 'Psychosis Risk Syndrome'--Far Too Risky"

http://www.psychologytoday.com/blog/dsm5-in-distress/201003/dsm5-psychosis-risk-syndrome-far-too-risky

"Are we understanding of why people need to take medications for physical illnesses but not for mental illnesses?

Suzie, the topic is about use of antipsychotic medications as an <early intervention>. How early? Why Medications? What about Educational & Behavioural interventions. Our reliance on medications is like being lazy - changing our behaviour is too hard & takes too long, it's much easier & quicker to take a pill.

How is this going to interact with development? It much like the effect of genetically modified foods on our health.

Medications can become unaffordable, or inaccessible to some, who are then faced with having to deal with a condition that they have no real experience with when it comes to to handling the behavioural consequences that arise. It is food for thought that they side-stepped the term 'prevention'.

Yes people who are dysfunctioning due to a mental health disorder nede to take medication, but antipsychotic medication as early intervention? Sounds like an asylum in a pill. They cannot lock them away anymore, but suppress the symptoms with drugs. This is an over-generalised opinion, but that's the beauty of a forum.

I do acknowledge there are some disorders that are not preventable because of faulty body chemistry, or brain development, and an earlier form of drug-based interventions can have long term benefits on a psychosocial level. It's just not a blanket solution for all mental issues.

To condition people to rely on medication as the answer to their mental problems earlier, is not teaching them how to manage themselves. It's creating a whole new issue for the future. Much like the adage, 'give a [person] a fish, and you feed [them] for a day, but teach a [person] how to fish, and you feed [them] for a lifetime.' I say, Teach people how to manage the behaviours and promote community support, don't just prescribe a quick fix that has the transitory effect at the time, and leave the mess for future generations to pick up.

I'm neither for or against McGorry, I just don't agree with the concept.

Ms_Mistri,< "...an earlier form of drug-based interventions can have long term benefits on a psychosocial level. It's just not a blanket solution for all mental issues."
Was McGorry suggesting we use early drug intervention for all mental issues? I didn't see that suggestion.

I would suggest that McGorry knows more about psychiatric disorders than most people. Do you not think behaviour modification has been done to death already for many years?

It certainly helps some people, but usually in conjunction with drug therapy if it is a serious disorder.

If he can help people avoid the extreme onset of some psychiatric disorders, then more power to him.

I think I'm going to be unpopular here and say that I agree, mostly, with Dr. McGorry's stance. If you've ever seen someone with schizophrenia, you'll know that no amount of 'talk therapy' is going to help stop their delusions. It only really helps with coming to terms with their illness and the implications of it.

Schizophrenia is not the only mental illness. There is bipolar. Depression. Anxiety. Eating disorders. Personality disorders.

While I believe that medication should not be prescibed by anyone but a psychiatrist, and only after thorough assessment, I think that medication for early intervention is fine. In fact, I think it's better than allowing people to reach a point of desperation where suicide becomes an option. Besides that, doesn't early intervention mean that people are more likely to be able to manage their condition better, sooner?

This is a step in the right direction. For years we've had mental illnes pushed aside as general health's uninteresting little sister. Now it's finally getting some help and funding. We need to make the most of it.

I'd like to also ask the authors, what are your mental health qualifications? And what makes you so informed as to make decisions in regards to what psychiatrists are prescribing?

Know the stress involved from several known and diagnosed, along with others we believe yet still to be officially diagnosed, as suffering mental health problems.

Our main tasks are:

(a) identification of those at risk of suffering mental health problems;

(b) educating those at risk to their probable illness, with symptoms, risks, and ability to deal with likely "episodes" with minimal damage to their lives ;

(c) educating general community about common illness "episodes" with symptoms, risks, and how can react towards those with likely "episodes" so as to minimize damage to lives and relationships for those suffering an "episode" and those around them ;

(d) obtaining compliance with treatment plans of those suffering "episodes" ;

Do not support widespread commencement of "preventative medication" until do know more from studies concerning effectiveness of proposed treatment with clearly minimal contra issues.

Yet agree, mostly, with Dr. McGorry's stance.

Contact with persons experiencing "episodes" of schizophrenia or other mental illnesses, you soon realize 'talk therapy' rarely persuades sufferers to act in manner to help stop their delusions, reduce or prevent further "episodes", and to improve their health.

Their long term treatment requires them coming to terms with their illness and the implications of it.

Our national crisis response approach to mental health prolongs period of denial, delays effective treatment.

Even crisis response approach would be more effective it we more effective follow up treatment plans, with preventative action, with those treated in crisis clinics.

Soon enough non-compliant patients are re-admitted under the mental health act, then discharged, then re-admitted...

Centrelink has ability to apply pressure, to place people on reduced requirements, so rewards their "sickness", without requiring tests of compliance with court approved treatment plans to prevent re-occurrence !

The privacy act cited as preventing action.

David and Melissa's Article is important so as to get us thinking about Dr McGorry's position on a pre-emptive strike on the causes of mental problems.
It sounds good in theory but the extended use of any, let alone mind transforming medications, may well in some individuals, cause prolonged ,dangerous and debilitating insecurity.
Is "Labelling" say, 10% of people a perceived but not proven risk to themselves, or society, and supplying them with prevention drugs really a good idea ?
Will compulsory DNA testing be part of the idea ?
What happens to the individuals considered a risk ,if the drug supply for some reason is unavailable or it's cost becomes prohibitive?
Let him spell out how it would work in All stratas of Australian Society in all situation.