Accusations of conflict of interest by Professors Patrick McGorry and Ian Hickie remain. Yet despite calls from their critics, the two Professors keep up their supply of ad hominem responses. Here’s some responses to today’s piece and some background to the current conflict.

 

Updated 9:25PM AEST Sunday 25th September:

Faulty link to Lifeblood archived webpage removed, page embedded in story. Minor editing.

Updated 3:02PM AEST Saturday 24th September:

Left Flank blog post “The McGorry-Hickie reform controversy: Why has mental health become so political?” & 1 additional piece added.

Updated 10:28AM AEST Saturday 24th September:

Saturday letters to editor have been added.

Updated 1:32AM AEST Saturday 24th September:

Earlier formatting gremlins have been sorted and additional material added.

The Opinion:
Ignore the critics, public need to back fresh start in mental healthcare | smh.com.au

Ignore the critics, public need to back fresh start in mental healthcare In 2004 I traversed the country with colleagues documenting the failings of our mental health systems. Our report Not for Service: Experiences of Injustice and Despair stirred John Howard and Morris Iemma to initiate the investment of $5 billion between 2006 and 2011 in reform measures – including Medicare support for psychological services.

Professor Hickie: “…an odd mix of armchair critics, conspiracy theorists and a former chairman of the American Diagnostic and Statistical Manual taskforce, Dr Allen Frances, oppose the expansion of early intervention programs for teenagers and young adults. Conversely, child advocates have attacked the proposed reforms for putting too little emphasis on the expansion of specialised child services.

In parallel, the Scientologists have repeatedly used freedom of information legislation to mount an ”investigation” into the work of McGorry, our colleagues and myself. Various members of these groups have made highly personal ”conflict of interest” allegations in an attempt to distract attention from the evidence that favours these new approaches.”

“…the critics have taken their querulous views straight to the popular press.
If you ever want to see the way that legitimate psychiatric research is devalued see the campaign being conducted against pat McGorry
ian_hickie
August 20, 2011
McGorry accused of conflict of interest

Patrick McGorry Photo: Pat Scala PSYCHIATRISTS, psychologists and patients’ groups say there is a growing backlash against the federal government’s mental health reforms and have accused its expert adviser, former Australian of the Year Patrick McGorry, of a conflict of interest.

The Response:

Critics of early intervention are scientologists or conspiracy theorists who don’t care about children says Ian Hickie http://t.co/JhCOgMft
jillastark
September 22, 2011
Personal attacks & refusal to engage in open scrutiny continue in Hickie op-ed piece http://t.co/OCuRQLKA #mentalhealth #ruralmh
JumanjiT
September 22, 2011
FAIL: Ian Hickie lists psychiatric opponents of Early Intervention model alongside Scientology. Weak argument. http://t.co/EaMaHDbi #auspol
Dr_Tad
September 22, 2011
Take Note McGorry & Hickie: I am a #mentalhealth consumer! I will not be told to sit down & shut-up. I have a voice & I will use it!
AlisonFairleigh
September 22, 2011
Ian Hickie apparently astonished that there is objection to mental health $ being put into unproven treatments at expense of ones that do.
jillhill99
September 22, 2011
Ian Hickie @NationalTimesAU op-ed piece forgets GetUP silence since federal budget http://t.co/sHw8p4n1 #mentalhealth #ruralmh #auspol
johnalchin
September 22, 2011
GetUp have been silent on mental health since the budget, and have tried not to get drawn into the controversy surrounding Better Access funding cuts.
‘Better Access’ to Psychologists

Last week the health budget was released, which came just after a recent review of the Better Access initiative. Psychologists had been waiting with keen anticipation to see how the government might improve mental health policy, informed by this recent study.
One of Ian Hickie’s “armchair critics” hits back. Appears not all #mentalhealth consumers are behind him as he implies http://tiny.cc/52wbp
jillastark
September 23, 2011

An open letter to Ian Hickie from mental health consumer @LindaMadHatter:

Originally posted here:
Now also posted at ABC The Drum :
Dear Mr Hickie

I am what you might have thought of when you referred to “armchair critics” in your opinion piece in Fairfax Media on September 23. I am a mother of two, and a mental health consumer. I am also a “critic” of the new mental health reforms. First of all, you speak of “$2.2 billion to new programs”.
Good response to the Headspace/Better Access controversy by a patient, @LindaMadHatter, at @abcthedrum yesterday: http://bit.ly/njQyjI
Dr_Tad
September 23, 2011
For the record those accusing Hickie, McGorry of conflict of interest weren’t scientologists.They were eminent psychiatrists. #mentalhealth
jillastark
September 22, 2011
A recent article in Psychiatry Update:
Disagreement over cuts to Better Access has gained intensity with a senate inquiry hearing contradictory claims from leading psychiatrists. In minutes released from the Senate”s ongoing inquiry into mental health services, Professor Maria Tomasic, president of 
RANZCP, said any cut to Better Access was “regrettable,” calling instead for “finetuning”.
Four letters to the Editor have been published in response to Professor Hickie’s op-ed:
In his Letter to the Editor, Dr. Tad Tietze writes:

I’m a public hospital psychiatrist who greatly admires Ian Hickie for his tireless efforts in mental health research and advocacy. However, I thought his intemperate spray at opponents of his preferred set of policy and treatment prescriptions – in particular the controversial early intervention model he and Pat McGorry have championed – demeaned his position and the serious debates in question (”Ignore the critics, public need to back fresh start in mental healthcare”, September 23).

I recently attended an international conference where McGorry and other advocates of early intervention spoke, and what came through was how little evidence there was for the headspace model that our government has adopted so enthusiastically. There is also very little evidence for the use of medications in patients thought to be at risk of psychosis.

Professor Hickie uses an old debating trick, rolling a disparate group of critics into one list without seriously addressing any of their concerns. By mentioning Scientologists alongside professional detractors, in one of his four main points, he seems to want to deflect public attention from debates within psychiatry rather than illuminating them.

Professor Hickie is dead right that psychiatrists should devote their time to debating public policy and arguing for social change. But that also means engaging in explanation rather than bombast when criticised. The public (and his colleagues) will thank him for the former and not the latter.

Read more: http://www.smh.com.au/national/letters/feted-hero-was-seriously-flawed-in-others-eyes-20110923-1kpha.html#ixzz1YpCzlBKb

The Background:
BLOG POST: Me trying to put the Headspace controversy in a wider context, at Left Flank. http://bit.ly/roJbls #mentalhealth #auspol
Dr_Tad
September 23, 2011
left flank: The McGorry-Hickie reform controversy: Why has mental health become so political?

Yesterday one of Australia’s most prominent psychiatrists, Professor Ian Hickie, wrote an op-ed piece in the SMH titled, “Ignore the critics, public need to back fresh start in mental healthcare”.

Flinders University psychiatric epidemiologist and policy analyst, Melissa Raven has written (and co-written with Jon Jureidini) a number of articles and papers that accuse Professors McGorry, Hickie & Mendoza of making misleading claims to support their policy reforms.

She also alleges that Professor McGorry has misrepresented the EPPIC research and that these misrepresentations have remained unchallenged and have been assumed to be correct by the federal government:

The research basis for EPPIC

The EPPIC study: methodology, results, and misrepresentation The EPPIC study was a small, methodologically weak study that compared initial EPPIC treatment with initial treatment in an earlier specialised inpatient early psychosis intervention program in Melbourne, commencing in 1989.

and Western Australian Labor MP Martin Whitely has been raising concerns about EPPIC for some time now:

Speed Up & Sit Still

Prescription drug abuse – A large and growing problem with a very simple solution Methadone is meant to save lives by preventing drug abuse. Other prescription drugs are supposed to improve physical and mental health.

Retired psychiatrist & pseudonymous blogger  “Mickey” has been providing North American readers with his own commentary on the EPPIC debate in Australia. This is his latest post:

1 Boring Old Man » how best to help…

The Early Psychosis Prevention and Intervention Centre [EPPIC] is an integrated and comprehensive psychiatric service aimed at addressing the needs of people aged 15-24 with emerging psychotic disorders in the western and north-western regions of Melbourne. EPPIC is a specialist clinical program of Orygen Youth Health [OYH] which is itself a component service of NorthWestern Mental Health and Melbourne Health.

Many recognise & respect the fact that Professors McGorry and Hickie and many of their colleagues ‘wear many hats’.

 

Some critics may suggest a conspiracy in the close connections between these key advisers to government, the EPPIC/Headspace teams, and the redistribution of federal mental health funding to these & similar organisations. Such claims should not nullify the concerns of fellow psychiatrists, mental health workers, consumers and carers that have repeatedly surfaced surrounding allegations of conflicts of interest, failures to disclose an interest, etc.

 

It is time for Professors Hickie & McGorry to publicly answer their critics given the level of concern that has arisen in the mental health sector and amongst consumers & carers.

Lifeblood – Our Philosophy – Results – Case Study 1

One of our major on-going programs at Lifeblood is the SPHERE project. “SPHERE: a national mental health project’ aims to assist GPs, Mental Health professionals and the Community in dealing with the identification, treatment and management of mental health disorders, including depression, anxiety and physical pain.

Text taken from the archived version of the Lifeblood website above:

In 2001 Pfizer Australia joined SPHERE as an implementation partner. This partnership saw the SPHERE project offered to all Australian GPs. Through the implementation of the SPHERE training modules, the Pfizer sales team gained regular, unprecedented access to these key GPs, who had significant interest in mental health. This activity assisted in restoring the market share and growth of the Pfizer antidepressant Zoloft®, restoring it to the Number One product in this market.

GP jaunts ‘boosted’ drug sales

THE organisers of a course for doctors have boasted how their sessions helped make anti-depressant Zoloft the market-leading brand. In a remarkably candid claim about the links between medical education and the commercial interests of drug companies, a website for Lifeblood, a private company, says a national training program offered to all GPs delivered a significant boost in sales to the pharmaceutical giant Pfizer Australia.

Says The Australian: The Lifeblood claim was made on behalf of SPHERE, a mental health program undertaken by 12,000 GPs since 1998. Pfizer has been a commercial partner of the program since 2001. The Brain and Mind Research Institute headed by Ian Hickie helped establish SPHERE and has an ongoing commercial relationship with the program.

In a National Times piece published 10 days ago, Sydney Morning Herald columnist and psychiatry registrar Dr. Tanveer Ahmed provided this critique of Professors Ian Hickie & Patrick McGorry:

“It was launched by Professor Ian Hickie, who has been rightly recognised for giving mental health a greater profile, but who has also played politics to do so.


Hickie has done more than any other clinician to promote tick-a-box diagnosis, particularly among general practitioners, who now regularly prescribe antidepressants through questionnaires alone. With former Australian of the Year Professor Patrick McGorry, Hickie has made overblown claims about the prevalence of mental health.


It is disingenuous to suggest, as McGorry has done, that there is no conflict of interest because their organisations are non-profit. Their bodies shared in $2.2 billion of funding in the federal budget. Their exorbitant claims – such as one in four people will suffer mental illness – are indicative of a blurring of the lines between illness and normal, human responses to adversity.”

TwitLonger — When you talk too much for Twitter

My response to Pat McGorry’s criticisms of our story on his aborted drug trial: At no point did we say the trial was aborted as a result of the ethics complaint. We gave Professor McGorry adequate space to explain that the decision was made before the complaint was lodged.

“This is part of a pattern, not one isolated and exceptional instance of blind spot. Whenever contradicted, Professor McGorry attacks the motives of the messenger rather than providing any reasoned rebuttal to the message.” – Allen Frances, M.D.  (emphasis added)

@jillastark I notice Professor Helen Christensen defending McGorry neglected to note membership on OYH research board http://bit.ly/rcc6iI
JumanjiT
August 28, 2011

Some commentary on the recent controversy re: Orygen/McGorry patent applications:

boringoldman: analysis issues/confusion Orygen’s fish-oil (omega 3 fatty acids) treatment patent: http://1boringoldman.com/index.php/2011/09/20/corrigendum-ii/ http://1boringoldman.com/index.php/2011/09/19/corrigendum-i/
psychepi
September 21, 2011
In this article by Professor Alison Yung, there’s some interesting banter in the comments section between Melissa Raven and Dr. Sherilyn Goldstone re: her employment with Orygen Youth Health & co-author with Yung & McGorry over professional disclosure and comments made in a private capacity:
Early intervention for psychosis: not just popping pills

A controversy is brewing on the website Psychology Today and subsequently in The Australian newspaper. At the heart of the issue is US psychiatrist Dr Allen Frances’ comments on the Australian Federal Government’s planned mental health reforms in early psychosis.

A new media release in Australian Doctor claims Better Access evaluation was flawed. Again they provide critics academic tenure yet omit Orygen connections. This feels familiar. Registration required sadly.

and of course there’s that question of “who is Kate?” That story coming soon.

The former chair of the DSM-IV Task Force, Dr. Allen Frances has seven questions for Professor Patrick McGorry that largely remain unanswered:

Seven Questions For Professor Patrick McGorry | Psychology Today

The great news is that Professor McGorry has recently renounced the relevance of psychosis risk syndrome in the current practice of clinical psychiatry. He has done so in two separate and dramatic ways: 1) by withdrawing his support for the inclusion of psychosis risk in DSM 5; and 2) by promising not to include it as a target in Australia’s massive new experiment in early intervention.
Maybe Australians should be asking more questions too?

The Senate Committee:

Parliament of Australia: Senate: Committees: Community Affairs Committee: Commonwealth Funding and Administration of Mental Health Services

Committee SecretarySenate Standing Committees on Community AffairsPO Box 6100Parliament HouseCanberra ACT 2600Australia

Links to the 550 submissions listed (more still to be processed and made available), additional information, correspondence, etc:

Parliament of Australia: Senate: Committees: Community Affairs Committee: Commonwealth Funding and Administration of Mental Health Services: Submissions Received

NOTICE: There are delays in the processing of submissions and other evidence. Please do not call to inquire about the status of individual submissions. All submissions will be processed as soon as possible. The committee advises that, contrary to some submissions, it has made NO recommendation regarding the two-tiered rebates system.

Links to the public hearing transcripts. They make very interesting reading.:

Parliament of Australia: Senate: Committees: Community Affairs: Commonwealth Funding and Administration of Mental Health: Public hearings and transcripts

Committee Secretary Senate Community Affairs References Committee PO Box 6100 Parliament House Canberra ACT 2600 Australia Website feedback: web.senate@aph.gov.au Last reviewed 12 September 2011 by the Senate Web Administrator © Commonwealth of AustraliaParliament of Australia Web Site Privacy Statement Images courtesy of AUSPIC

Monday: The weight of evidence for the Better Access program and why it should remain.