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.