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CONCERNS AND ALTERNATIVES - FOLLOWING UP THE VIGIL

A GetUp vigil was held on Tuesday 10 August 2010 at the University of Melbourne.

The speakers included Dr David Webb and Piers Gooding.

Below is a compilation of concerns shared by the speakers and Vanaheim Group along with some suggested alternatives to Patrick McGorry's early intervention programs.

What are the concerns with McGorry's early intervention?

Controversial approach

McGorry is recognised not just here in Australia but internationally as a champion of "early intervention" in mental health. This sounds like something that nobody could possibly object to ... until you hear what this phrase means to people like McGorry.

He claims it is possible to identify people who are at risk of developing a psychotic disorder (e.g. schizophrenia) prior to them actually developing sufficient symptoms to warrant a diagnosis. He calls these early symptoms the "prodromal" phase of these disorders. The "early intervention" that he then calls for is medical intervention that would typically include treatment with neuroleptic medications (often referred to as antipsychotics).

This form of early intervention is quite controversial, even among some of his psychiatric colleagues. For instance, the following report in Time from 2006 (http://www.time.com/time/magazine/article/0,9171,1205408,00.html) says, amongst other things, "Calm and softly spoken, McGorry has a way of making the experimental use of antipsychotics seem like the only responsible course."

Hazardous pre-emptive medical intervention

There are many hazards with pre-emptive medical interventions, especially with such potent drugs as neuroleptics (which have been described as the second most toxic chemicals used in medicine after the drugs used in chemotherapy) including:

Imposing this level of toxicity on the number of young people McGorry calls for will lead to generational health problems.

For more background on this see the following recent article in Psychiatric Times by Allen Frances, professor emeritus of psychiatry at Duke University and chair of the DSM-IV Task Force who discusses this very topic in regard to the current revisions being proposed for DSM-V (the diagnostic bible of psychiatry): http://www.psychiatrictimes.com/display/article/10168/1541615?verify=0

A substantial body of scientific research is available here: http://www.psychrights.org (click on "Scientific Research by Topic")

Some good books on the subject include:

Bias from funding sources

Further doubts must be raised about Patrick McGorry's agenda when you see the substantial funding his organisation (Orygen Youth Health) receives from the pharmaceutical industry and also from the Stanley Foundation, which is notorious in the US for its particularly aggressive approach to the detention and involuntary treatment of people labelled with psychiatric disorders - see the Orygen website for details:

http://rc.oyh.org.au/ResearchCentreStructure/otherfunding
http://rc.oyh.org.au/ResearchCentreStructure/majorgrants

Forgetting human rights - involuntary treatment on the rise

Few people are aware of Australia's track record on human rights in mental health.

For instance, Victoria has over 5,000 people on Community Treatment Orders (CTOs or involuntary psychiatric treatment in your home), which is more than we have in our prisons and also, according to John Lesser, President of the Victorian Mental Health Review Board, more than any other (comparable) jurisdiction in the world.

Also in Victoria, every week over 100 involuntary patients are given ECT (electroconvulsive therapy or shock treatment) even though the World Health Organisation says that ECT without consent should be prohibited.

When he became Australian of the year, McGorry was widely quoted as describing refugee detention centres as "mental illness factories". The same can be said, though, about our mental health system but he chooses to remain silent about this, perhaps because he is a part of this system.

The McGorry campaign is part of a wider campaign to promote the medicalisation of mental health (though psychosocial wellbeing is a better term), which includes Jeff Kennett and beyondblue, Sane Australia, the Brain & Mind Research Institute led by former beyondblue CEO Ian Hickie, and many others.

This excessive medicalisation of what it is to be human, which extends beyond mental health, is being called "disease mongering" and is a major social issue being debated elsewhere in the world. But not yet in Australia where the medical profession dominates the public debate on these issues.

Looking at similar early intervention programs from around the world, early intervention programs lead to increased involuntary treatment of children.

The best examples are TeenScreen and the Texas Medication Algorithm Project (TMAP), which have well documented cases of involuntary treatment, one example: http://motherjones.com/politics/2005/05/medicating-aliah.

Orygen's own materials canvas involuntary treatment: www.orygen.org.au/docs/CLINICAL/SupportingaYPwithMI.pdf, http://www.eppic.org.au/acute-care-1

Links to Australian articles about Patrick McGorry's style of early intervention

Misleading claims in the mental health reform debate:
http://www.onlineopinion.com.au/view.asp?article=10793

McGorry's 'early intervention' in mental health: a prescription for disaster:
http://www.onlineopinion.com.au/view.asp?article=10267

Mental health claims overblown:
http://www.smh.com.au/opinion/politics/mental-health-claims-overblown-20100811-11zoj.html

What are the alternatives?

Over the past few decades, there have been a number of well-documented but little known alternatives that have almost invariably initially thrived then perished for lack of funding and publicity.

Examples of alternatives around the world that currently exist include the Sequoia Psychotherapy Center in California, The Freedom Center in Massachusetts, Runaway House in Germany, Soteria Alaska in Anchorage and Soteria Bern in Switzerland. These alternatives can be narrowed into three categories:

Drug-free professional services model

The drug-free professional services model is generally for-profit, non-coercive psychotherapy. For example, the Sequoia Psychotherapy Center (SPC), based in Fresno, California, is a community based treatment facility. Services include a comprehensive day treatment program that provides an alternative to hospitalisation. Traditional outpatient services are also available.

SPC does not rely on psychiatry's principles. It is one of a handful of facilities that specialises in medication-free treatment. On a practical level, this model is the most likely to succeed because its forprofit structure allows some independence from the government, although in practice there are financial problems stemming from poor marketing strategies - generally SPC relies on word-of-mouth "advertising", and certainly does not have the budget or the marketing capabilities of the allies of psychiatry.

Non-professional services model

In contrast, the non-professional services model generally fails when government funding is pulled. For example, Soteria House. This house was set up as an experiment funded by the National Institute of Mental Health in the US.

The Soteria Project was a study of people newly diagnosed as having schizophrenia and deemed in need of hospitalisation. Soteria House used interpersonal phenomenological interventions by a non-professional staff, usually without antipsychotic drugs, in the context of a small, homelike, quiet, supportive, protective, and tolerant social environment. This environment was compared with usual general hospital and psychiatric ward interventions.

The results of the study, confirmed in replicated studies and critical evaluations, confirmed that around 85-90% of acute and long term patients deemed in need of acute hospitalisation can be returned to the community without conventional hospital treatment and without antipsychotic drug treatment.

In fact the study found that the Soteria drug-free environment was as successful as drug treatment in reducing psychotic symptoms in 6 weeks. In the long term, many more people recovered completely compared with those reliant upon the standard treatment principles.

Further, the clients were treated at a considerably lower cost. Unfortunately, Soteria House and its later cousin Emanon ran out of funding. There is currently Soteria Bern in Switzerland, and another one in Alaska. It is important to note that Soteria House should not be confused with existing programs such as ORYGEN Youth Health. Such programs are run by professional mental health workers, rather than the students and other nonprofessional staff who formed such an integral part of the recovery process at Soteria. Similarly, such programs do not have a psychiatric drug-free philosophy.

Ex-patient separatist model

Both the professional and non-professional alternatives, however, do not necessarily offer what many ex-patients call for: a safe place to go and just hang out with people who are not going to see them as a problem to be solved and who are not going to try to change them or the way they live.

Often the people who need the support of other ex-patients have been scarred—both spiritually and physically—by involuntary psychiatric practices. Thus, Judi Chamberlin in On Our Own advocates such organisations being completely separate from the mental health professions, including any form of hierarchy.

The Freedom Center in Northampton, Massachusetts is one example of such an organisation, as their web page attests—

If you are labelled with ‘mental illness,’ are a psychiatric abuse survivor, or go
through extreme mental and emotional states, we invite you to join us. Allies and
supporters willing to share their personal experiences are also welcome (mental
health staff allies are welcome but should contact us first). We alert people to the
serious dangers of psychiatric drugs so that they can make truly informed
decisions, and we oppose how the system pushes drugs on people, but we
support everyone’s choice in their own recovery as they define it for themselves.
We don’t judge people. Whether you take psychiatric drugs or you don’t take
psychiatric drugs, you are welcome at the Freedom Center. We respect self-
determination and choice, and approach all drug use and lifestyle choices from a
harm reduction philosophy. (emphasis in original)

The Center provides free acupuncture two days a week, free yoga classes once per week, has weekly meetings chaired by whoever wants to chair them, provides lectures on legal rights, and is compiling first person oral histories for those whose stories would otherwise be side-lined. Similar organisations seem to be appearing around the US.

The largest problem for most of these alternatives is the lack of funding. Generally, in Australia, those who would benefit from such alternatives are not wealthy—subsisting on Centrelink payments—and closely monitored by a team of mental health workers, making the logistics of organising such a group difficult.

Australian Alternatives

In Australia, any alternatives are few and far between—and are not found on government-sponsored web sites. In fact the only alternatives located by Vanaheim Group to date are Eagle’s Wings and Teen Challenge—both Christian rehabilitation programs aimed primarily at young people experiencing problems with living, in particular over-use of drugs—and the Schizophrenia Drug-free Crisis Centre & Helpline in Adelaide. Individual psychotherapists and psychiatrists who disagree with the current mainstay are difficult to locate and generally ostracised by their peers.

Should the government fund true alternatives such as Soteria House and the Freedom Center there would be no need for the current involuntary treatment provisions, electroshock and psychosurgery would be redundant, and early intervention would not include McGorry's controversial and problematic program.