Patrick McGorry explained

Patrick McGorry
Birth Date:1952 9, df=yes
Birth Place:Dublin, Ireland
Nationality:Australian
Education:Bishop Gore School
Newcastle Boys' High School
Occupation:Psychiatrist
Organization:Orygen, The National Centre of Excellence in Youth Mental Health
Known For:Development of the early intervention services for youth psychosis
Australian of the Year
Term:2010
Predecessor:Mick Dodson
Successor:Simon McKeon
Children:Three

Patrick Dennistoun McGorry[1] (born 10 September 1952) is an Irish-born Australian psychiatrist known for his development of the early intervention services for emerging mental disorders in young people.

Position

McGorry is Professor of Youth Mental Health at the University of Melbourne.[2] He has written more than 640 peer-reviewed articles, published in journals including The Lancet, the British Journal of Psychiatry, the American Journal of Psychiatry and the Medical Journal of Australia.[3] He is executive director of Orygen, The National Centre of Excellence in Youth Mental Health[4] and founding editor of Early Intervention in Psychiatry published by the International Early Psychosis Association. McGorry also advocated strongly for the establishment of the Australian government funded National Youth Mental Health Foundation, which became headspace, and is a founding board member of that organisation.[5]

Early intervention in psychosis

McGorry and his colleagues developed an approach for young people who have symptoms of psychosis for the first time, based at the EPPIC clinic in Melbourne.[6] This EPPIC clinic has played a key part in an early psychosis treatment paradigm for psychiatry[7] [8] [9] and has led to significant reform of mental health services,[10] especially in the United Kingdom.[11] The EPPIC program's approach is best represented by the catch phrase "A stitch in time."[12] A linked development is the PACE clinic: a service for young people with sub-threshold symptoms who are at risk of developing psychosis.[13]

Initial evaluations of EPPIC showed that it was not only effective compared to the previous traditional model of care but that it was also cost effective.[14] [15] [16] [17] McGorry was awarded the Centenary Medal in 2003 in recognition of his work on the EPPIC program.[18]

McGorry has advocated to the Australian government to create a national network of early psychosis intervention centres, based on evidence that early treatment may improve long-term outcomes.[19]

Criticisms

McGorry has faced a number of criticisms of his work.

Early intervention for psychosis was initially met with resistance due to a claimed lack of evidence. In 2011, a systematic review concluded: "There is some support for specialised early intervention services, but further trials would be desirable, and there is a question of whether gains are maintained."[20] Some critics have argued that McGorry has exaggerated the evidence for early intervention and that long-term benefits and economic savings have not been established,[21] [22] [23] [24] [25] [26] [27] and one has gone as far as alleging that McGorry has "systematically misled" the Australian Government about the nature and implications of his evaluation study on EPPIC by misstating the description of the control group.[28]

In the past two decades evaluations in England and Denmark have shown that early intervention is effective over the first two years of care at least, but when patients return to traditional care some of the gains are lost.[29] [30]

McGorry's views on giving antipsychotic medication to at-risk young people have been criticised by a number of people, including Allen Frances the Chair of the DSM-IV Taskforce, on the basis that most at-risk young people will not become psychotic and pre-emptive treatment may be risky.[31] [32] [33]

A proposed trial of the antipsychotic medication quetiapine, led by McGorry, attracted criticism on ethical grounds.[34] [35]

He has been accused of having a conflict of interest in using his position on a government advisory committee to advocate for programs that he founded.[36] McGorry has denied that he has any conflict of interest and a spokesperson for the Australian government stated that McGorry was just one member of the Mental Health Expert Working Group, which was made up of experts from a range of health and non-health sectors, plus consumer and carer representatives and 'while these consultations helped to inform the development of the government’s record mental health package, decisions on the specific content...were solely a matter for the government'.[37] On 25 September 2012, Western Australian member of parliament Martin Whitely made a speech in parliament criticising the Australian Government for its support of McGorry's proposals. Whitely said that McGorry had made overblown claims for his programs and that they had been accepted without proper scrutiny.[38]

Headspace

See main article: headspace (organisation). Early intervention in psychosis has paved the way for a broader model of care ("headspace") that targets a range of youth mental disorders. Headspace was originally founded under the Howard government with its support continuing under the Gillard government. Its design and national rollout has gained bipartisan support. During the 2013 Australian Federal election, McGorry appeared in the media together with then Opposition Leader Tony Abbott at the launch of the Liberal-National Coalition's mental health policy. Abbott promised that, if elected, he would provide additional financial support for research and translation programs associated with Patrick McGorry.[39] After being elected to government, the Coalition announced in its first budget the allocation of $18M over 4 years to Orygen Youth Health Research Centre for establishment of a National Centre of Excellence in Youth Mental Health and $14.9M to headspace for the expansion of its youth mental health services.[40] In 2018 the Turnbull government committed to a three-year extension of funding ($13.5 million) to Orygen, The National Centre of Excellence in Youth Mental Health, and also committed an additional $30 million to headspace.[41]

Recognition and other activities

In January 2010 McGorry was named Australian of the Year for his services to youth mental health.[42] [43] [44] In June 2010 he was appointed an Officer of the Order of Australia.[45]

In 2013 McGorry was honoured with the National Alliance on Mental Illness Scientific Research Award, the first time the award has been bestowed upon a researcher outside of the United States.[46]

In 2015, McGorry was awarded the Lieber Prize for Outstanding Achievement in Schizophrenia Research, given by the Brain & Behavior Research Foundation.[47]

In 2018 he was awarded the Lifetime Achievement Award by the Schizophrenia International Research Society.[48] He was the first psychiatrist elected as a Fellow of the Australian Academy of Science.[49]

McGorry served as President of the Society for Mental Health Research (Australia) (2013-2017), Schizophrenia International Research Society (2016-2018), and International Early Psychosis Association (1997-2006). he was president of the International Association for Youth Mental Health. He was a member of the Million Minds Mission for mental health launched by the Australian Government in 2018.[50]

On 10 October 2023, McGorry initiated and was one of 25 Australians of the Year who signed an open letter supporting the Yes vote in the Indigenous Voice referendum. He said he was driven to do so out of fear for the damage to mental health that Indigenous Australians would suffer if the Voice is rejected.[51] [52]

Notes and References

  1. Web site: University Secretar's Department Lists of Members – Professors Emeritus The University of Melbourne. www.unimelb.edu.au. 29 January 2010.
  2. Web site: Patrick McGorry (Australia). International Early Psychosis Association. 25 January 2010. dead. https://web.archive.org/web/20110706125056/http://www.iepa.org.au/%28S%28jrpzht45b25m1ejgcohjqd45%29%29/ContentPage.aspx?pageID=40&AspxAutoDetectCookieSupport=1. 6 July 2011. dmy-all.
  3. Web site: Patrick McGorry . Google Scholar . 17 July 2018.
  4. https://orygen.org.au/People/Patrick-McGorry Orygen, The National Centre of Excellence in Youth Mental Health
  5. Web site: headspace. headspace Board. 10 January 2014. dead. https://web.archive.org/web/20140110093741/http://www.headspace.org.au/about-headspace/who-we-are/board. 10 January 2014. dmy-all.
  6. 10.1093/schbul/22.2.305 . McGorry PD . Edwards J . Mihalopoulos C . Harrigan SM . Jackson HJ . 1996 . EPPIC: an evolving system of early detection and optimal management . . 22 . 2 . 305–326 . 8782288 . free .
  7. Edwards, J. & McGorry, P.D. (2002) (eds). Implementing Early Intervention in Psychosis. A guide to establishing early psychosis services. London. Martin Dunitz.
  8. McGorry PD, Killackey EJ . Early intervention in psychosis: a new evidence based paradigm . Epidemiol Psychiatr Sci . 11 . 4 . 237–47 . 2002 . 12585014 . 10.1017/s1121189x00005807. 11005414 .
  9. McGorry PD, Killackey E, Yung A . Early intervention in psychosis: concepts, evidence and future directions . World Psychiatry . 7 . 3 . 148–56 . October 2008 . 18836582 . 2559918 . 10.1002/j.2051-5545.2008.tb00182.x.
  10. Killackey E, Yung AR, McGorry PD . Early psychosis: where we've been, where we still have to go . Epidemiol Psychiatr Sci . 16 . 2 . 102–8 . 2007 . 17619539 . 10.1017/S1121189X0000470X. free .
  11. Joseph R, Birchwood M . The national policy reforms for mental health services and the story of early intervention services in the United Kingdom . J Psychiatry Neurosci . 30 . 5 . 362–5 . September 2005 . 16151542 . 1197282 . 27 January 2010 . https://web.archive.org/web/20151117102841/https://www.cma.ca/multimedia/staticContent/HTML/N0/l2/jpn/vol-30/issue-5/pdf/pg362.pdf . 17 November 2015 . dead .
  12. 10.1007/s004060050014. "A stitch in time"… the scope for preventive strategies in early psychosis. 1998. McGorry . P. D.. European Archives of Psychiatry and Clinical Neuroscience. 248. 22–31. 9561350. 1 . 7621618.
  13. Yung AR, McGorry PD, McFarlane CA, Jackson HJ, Patton GC, Rakkar A . Monitoring and care of young people at incipient risk of psychosis . Schizophr Bull . 22 . 2 . 283–303 . 1996 . 8782287 . 10.1093/schbul/22.2.283. free .
  14. McGorry PD, Edwards J, Mihalopoulos C, Harrigan SM, Jackson HJ . EPPIC: an evolving system of early detection and optimal management. Schizophrenia Bulletin. 1996. 22. 2. 305–26. 8782288. 10.1093/schbul/22.2.305. free.
  15. Mihalopoulos C, McGorry PD, Carter RC . Is phase-specific, community-oriented treatment of early psychosis an economically viable method of improving outcome?. Acta Psychiatrica Scandinavica. 1999. 100. 1. 47–55. 10442439. 10.1111/j.1600-0447.1999.tb10913.x. 24815565. free.
  16. Mihalopoulos C, Harris M, Henry L, Harrigan S, McGorry P . Is early intervention in psychosis cost-effective over the long term?. Schizophrenia Bulletin. May 2011. 35. 5. 909–18. 19509308. 10.1093/schbul/sbp054. 2728818.
  17. McCrone P, Craig TK, Power P, Garety PA . Cost-effectiveness of an early intervention service for people with psychosis. The British Journal of Psychiatry. 2010. 196. 5. 377–82. 10.1192/bjp.bp.109.065896. 20435964. free.
  18. Web site: Professor Patrick D. McGorry (AO, MD, PhD, FRCP, FRANZCP). Our Research: Research Leaders. Orygen Youth Health. 30 November 2013. dead. https://web.archive.org/web/20131203014439/http://oyh.org.au/our-research/research-leaders/professor-patrick-d-mcgorry-ao-md-phd-frcp-franzcp. 3 December 2013. dmy-all.
  19. Vincent, M. (2011). Budget provides mental health relief. AM, 11 May 2011. http://www.abc.net.au/am/content/2011/s3213405.htm
  20. Marshall . M . Rathbone . J . 2011 . Early intervention for psychosis . Cochrane Database of Systematic Reviews . 6 . 6. CD004718 . 10.1002/14651858.CD004718.pub3 . 21678345 . 4163966.
  21. Creagh, S. (2011). Review finds limited evidence for early psychosis intervention centres. The Conversation,, 30 June 2011. http://theconversation.edu.au/review-finds-limited-evidence-for-early-intervention-in-psychosis-2091
  22. Bosanac . P. . Patton . G.C. . Castle . D.J. . 2010 . Early intervention in psychotic disorders: faith before facts? . Psychological Medicine . 40 . 3. 353–358 . 10.1017/s0033291709990341. 20120515 . free . 11343/32983 . free .
  23. Amos . A . 2012 . Assessing the cost of early intervention in psychosis: a systematic review . Australian & New Zealand Journal of Psychiatry . 46 . 8. 719–734 . 10.1177/0004867412450470. 22696550 . 27598337 .
  24. Amos . A . 2013 . An axeman in the cherry orchard: Early intervention rhetoric distorts public policy . Australian & New Zealand Journal of Psychiatry . 47 . 4. 317–320 . 10.1177/0004867412471438. 23568159 . 8198295 .
  25. Orygen Youth Health Research Centre (2011) Early Psychosis Feasibility Study. Canberra: National Advisory Council on Mental Health
  26. Raven, M. (2011). Evaluating evidence for Early Psychosis Prevention and Intervention Centres (EPPIC). The Conversation 2 November 2011. http://www.theconversation.edu.au/evaluating-evidence-for-early-psychosis-prevention-and-intervention-centres-eppic-3604
  27. Amos . A . Aug 2012 . Assessing the cost of early intervention in psychosis: a systematic review . Aust N Z J Psychiatry . 46 . 8. 719–34 . 10.1177/0004867412450470. 22696550 . 27598337 .
  28. Raven . M . 2013 . EPPIC mirage: cost-effectiveness of early psychosis intervention . Aust N Z J Psychiatry . 47 . 7. 599–601 . 10.1177/0004867413484598. 23814149 . 28833438 .
  29. Craig TK, Garety P, Power P, Rahaman N, Colbert S, Fornells-Ambrojo M, Dunn, G. The Lambeth Early Onset (LEO) Team: randomised controlled trial of the effectiveness of specialised care for early psychosis. British Medical Journal. 2004. 329. 1067. 15485934. 10.1136/bmj.38246.594873.7c. 526115. 7474.
  30. Petersen L, Jeppesen P, Thorup A, Abel MB, Ohlenschlaeger J, Christensen, TO, Krarup, G, Jorgensen P, Nordentoft, M. A randomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness. British Medical Journal. 2005. 331. 602. 16141449. 10.1136/bmj.38565.415000.E01. 1215551. 7517.
  31. Frances . A . 2010 . Psychosis risk syndrome—far too risky? . Australian and New Zealand Journal of Psychiatry . 45 . 10. 803–804 . 10.3109/00048674.2011.614217. 21910651 . free .
  32. Dunlevy, S. (2011). US expert slams McGorry's psychosis model. The Australian, 14 June 2011. http://www.theaustralian.com.au/national-affairs/us-expert-slams-patrick-mcgorrys-psychosis-model/story-fn59niix-1226074544901
  33. Jorm . AF . Sep 2012 . Ethics of giving antipsychotic medication to at-risk young people . Aust N Z J Psychiatry . 46 . 9. 908–9 . 10.1177/0004867412455233. 22802552 . 206398433 .
  34. Stark, J. (2011). Drug trial scrapped amid outcry. The Age, 21 August 2011. http://www.theage.com.au/national/drug-trial-scrapped-amid-outcry-20110820-1j3vy.html.
  35. Raven . M. . Stuart . G.W. . Jureidini . J. . 2012 . 'Prodromal' diagnosis of psychosis: ethical problems in research and clinical practice . Australian and New Zealand Journal of Psychiatry . 46 . 1. 64–65 . 10.1177/0004867411428917. 22247095 . 206397893 .
  36. Stark, J. (2011). McGorry accused of conflict of interest. Sydney Morning Herald 7 August 2011. http://www.smh.com.au/national/mcgorry-accused-of-conflict-of-interest-20110806-1igxd.html
  37. Thompson, J. McGorry’s mental health minefield. Medical Observer, 6 October 2011. http://www.medicalobserver.com.au/news/mcgorrys-mental-health-minefield?print=friendly
  38. Dunlevy, S. (2012). Doubts cast on youth mental health program. Herald Sun 7 October 2012. http://www.heraldsun.com.au/news/national/doubts-cast-on-youth-mental-health-program/story-fndo48ca-1226489760605
  39. News: Mental health is largely missing from the election campaign . 12 August 2018 . The Conversation . 2 September 2013.
  40. Web site: Expense Measures (Health) . Australian Government budget 2014-15 . Australian Government . 12 August 2018 . https://web.archive.org/web/20181111200225/https://www.budget.gov.au/2014-15/content/bp2/html/bp2_expense-14.htm . 11 November 2018 . dead .
  41. Web site: $110 million additional investment in child and youth mental health . The Hon Greg Hunt MP Minister for Health . Australian Government Department of Health . 12 August 2018.
  42. News: Mental health expert is Australian of the Year. ABC. 25 January 2009.
  43. Web site: Australian of the Year 2010. australianoftheyear.org.au. 25 January 2010. dead. https://web.archive.org/web/20100128040936/http://www.australianoftheyear.org.au/recipients/?m=patrick-mcgorry-2010. 28 January 2010. dmy-all.
  44. Book: Lewis, Wendy . Australians of the Year . Pier 9 Press . 2010 . 978-1-74196-809-5 . Wendy Lewis .
  45. https://honours.pmc.gov.au/honours/awards/1142609 It's an Honour: Officer of the Order of Australia
  46. Web site: NAMI. 2013 Research Award. http://webarchive.loc.gov/all/20131003023507/http://www.nami.org/template.cfm?section=2013_research_award. dead. 3 October 2013. 9 January 2014.
  47. Web site: Meet the 2015 Outstanding Achievement Prize Winners. Brain & Behavior Research Foundation. 29 August 2016. https://web.archive.org/web/20160911070048/https://bbrfoundation.org/meet-the-2015-foundation-outstanding-achievement-prizewinners. 11 September 2016. dead.
  48. Web site: Awards and Grants . Schizophrenia International Research Society . 12 August 2018.
  49. Web site: Professor Patrick McGorry . Australian Academy of Science . 12 August 2018.
  50. News: Setting up a research fund for mental health: Greg Hunt . 12 August 2018 . Australian Broadcasting Corporation . 6 March 2018.
  51. Web site: Butler . Josh . Australian of the Year winners sign open letter saying no vote in voice referendum would be a 'shameful dead end' . . 11 October 2023 . 11 October 2023.
  52. Web site: Winter . Velvet . Voice referendum live updates: Australians of the Year Yes vote letter in full . . 10 October 2023 . 11 October 2023.

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