Professor Patrick McGorry
Professor Patrick McGorry is a psychiatrist and Professor of Youth Mental Health at the University of Melbourne, and is probably best known for his development of early intervention services for youth. He is a strong campaigner for youth mental health in Australia and is a director of Orygen, the National Centre of Excellence in Youth Mental Health, and a founder of Headspace, the youth mental health programme. His often controversial research work has focused on early intervention for young people deemed at risk of psychosis, including the possible use of antipsychotic medication. He was named the Australian of the Year in 2010 for his services to youth mental health and made an Officer of the Order of Australia that same year. In 2013, he was honoured with the National Alliance on Mental Health Scientific Research Award, the first time the award has been bestowed upon a researcher outside of the United States.
That ambivalence in the public has been driven by misuses of psychiatry in the past.
On earliest memories of science
I guess I was, in a way, more of a humanities person, but I did actually study science at school and ended up doing medicine. So medicine really is like a bit of a blend of humanities and science, and pyschiatry in particular allows you to be scientific and also, um, I suppose, look at the wider aspects of the human condition.
On moving into youth mental health
I decided to focus on youth mental health in particular because it was obvious when I started working in the youth mental health field that young people bore the main burden of the onset of mental disorders; it’s adolescents and young adults who disproportionally experience the first onset of major psychiatric disorders at a time in life when they are struggling to make the transition from childhood to adulthood. So it’s a very serious issue that was being totally neglected. The system focused on people with long-standing and chronic illnesses and it was terribly underfunded and neglected and so young people that could’ve been salvaged and aiming at recovery rather than just management of the illness were being totally neglected, so it was an obvious thing really.
On current work at Orygen
Well most of our work involves linking research, and clinical research in particular, with innovative models of care. We’re trying to tackle stigma, we’re trying to make services much more youth friendly with youth participation as well as professional expertise and we’re creating new cultures of care and new evidence bases to promote early intervention and recovery from potentially serious mental disorders.
The sort of research that’s really important here…ah, OK, so while many people are involved in laboratory type research, basic science, all that sort of thing, that’s all very familiar to the public, I guess, but what we do is much more applied. We’re trying to get some results within the next five or ten years. So that means testing novel therapies, whether they’re drug therapies or psychological and social therapies, in a clinical trial setting. And we’ve got access now to very large numbers of young people for the first time so we can actually explore the sort of treatments that are safe and effective. And that hasn’t been possible before. So clinical trials…I suppose trying to learn from the young people themselves, because we do have youth participation and influence from young people, and the sort of questions we want to ask as well.
I think there’s been huge investment in genetic research and in, I would say, rat and mice research which are fine in many other areas of medicine. There are challenges in finding animal models for mental disorders and so we’re much more focused actually on working with people and, ah, people are unique compared to all other species and they uniquely have mental disorders so it’s something we’ve really got to focus on more effectively. There are more challenges, it’s more difficult, much more difficult, to get funds because there’s a big bias towards basic research in medical research. But it’s very important if we’re going to see early results.
On drug therapies for mental health
There is a stigma in mental health, it’s not a fair or level playing field actually: in cancer research there’s great respect for companies and people that work with drug therapies, trying to develop better and novel therapies. In mental health there’s a lot of ambivalence from the public about that. Many people assume that the only human therapies that can be developed are psychological or social therapies. Now, that’s true, I mean they are very valuable, the psychological and social therapies - most of our work is in that space actually - but there’s been a terrible neglect and a sort of, what’s the word, a misplaced hostility towards drug therapies in mental health because some of these conditions are very serious. The drug therapies work extremely well in those serious forms of illness and we don’t have enough novelty or innovation in that space. Many of the companies have actually abandoned the field under this sort of public pressure, misplaced public pressure. So it’s a problem.
Now, that ambivalence in the public has been driven by misuses of psychiatry in the past, so there has been overuse of medication and a neglect of psychological and social therapies so you can understand, you know, how the debate has arisen in this way, but nevertheless we have to have balance here and safer and more effective drug therapies are a very important focus of future research.
There are many people with serious mental illnesses for which psycho-social treatments will provide some respite and some help, but the existing drug therapies and biological treatments have been ineffective. In other words, they’re what’s called ‘treatment resistant’, the person has a treatment resistant illness. And that’s a significant minority of people, but especially with illnesses like schizophrenia, certainly with Alzheimer's disease, you know, 100% of patients are treatment resistant in the biological sense there, so we desperately need new discoveries and cures, and unfortunately the pharmaceutical industry has been beaten out of the field by public antipathy and the lack of any commercial benefit that they can extract from it.
On early intervention
Well, we need to learn the lessons from other areas of medicine, particularly cancer and heart disease, where it’s recognised that, ah, there’s not much point in looking after the late, chronic stages of illness if you haven’t got in early enough to actually prevent a lot of these preventable, you know, deaths and disabilities. So we’re trying to learn those lessons. Early diagnosis, safe and stigma free care and aiming at cure, or certainly limiting the impact of these potentially serious illnesses.
If you’re a young person, that is a teenager or a young adult, luckily in Australia we have now built the beginnings of a primary care system for young people called headspace. So this is like a blend of a youth café and a clinical service, in the community in a primary care setting with a whole range of disciplines working to help young people first of all get a listening ear and an expert assessment, and then more specialised care if they need that. So Australia’s really the only country in the world that’s invested heavily in this. We’re a building a new system of youth mental health care and that’s the first port of call.
Also there’s eheadspace which is another way in, another portal. And what we haven’t built yet is the specialist backup system for that entry point, that’s the next step.
For other stages of life our mental health system needs further investment and reform as well.
On youth mental health issues
Well, young people have not read the psychiatric text books so they present with a whole range of problems. Mixtures of relationship problems, anxiety, depression, drug and alcohol use, personality difficulties and in some cases the more serious forms of mental illness: schizophrenia, bipolar and anorexia for example, borderline_personality, um, so we have to have quite a broad range of expertise and we need to have some more specialisation around the more serious types of problems, so it’s a very heterogeneous group actually.
So we always aim to treat young people as an individual, everyone’s a unique person, and there’s a very nice ad that I’ve seen where they show a picture of a fingerprint and, um, it’s a bit like that, everyone’s different, but there are some common features across these different kinds of problems which allow us to kind of use evidence and research expertise and knowledge from research to actually treat people in a much more effective way as well.
Young people are coming forward in ever greater numbers. They had the worst access to mental health care across the entire life span, even though they had the greatest need, till about five or six year ago, but now they’re coming forward because there’s somewhere to go and they’ve got much better knowledge about the sorts of problems that they might seek help for and there is somewhere to go now, at last. Somewhere that they actually feel comfortable and they’re respected and, um, it’s a youth friendly sort of environment they can come into now so we’ve got to first base, I’d call it a base camp, but we haven’t climbed the rest of the mountain yet.
I think a problem is the lack of visibility of the problem. Like, you can’t walk into a hospital ward like you can with physical illnesses and sit down on the bed and see the person’s really sick and you can see the physical evidence for that, but nevertheless, I think that most people these days know what we mean we when we’re talking about mental illness and mental ill health because 50% of us will experience it at some point in our lives.
On moving from youth mental health care to adult mental health care
Yeah, that’s a problem because the adult mental health services are very chronically focused and hospital based. The community mental health reforms of the past are, I suppose, struggling in this country and probably in many other countries too. So there is a problem. We get young people off on the right foot and many of them recover, probably most as a result of that, but there is a subgroup who do need longer term care and unfortunately they still have a lot of trouble getting that in a positive way.
Well, I think there are areas of mental health, across the life span, that all need support, from children right through to the elderly, but we know that the most cost-effective investment is going to be in this transition from childhood to adulthood. That’s when many of the major disorders that can become chronic present for the first time. It’s a very challenging period of life and we know that if we intervene effectively during that period we can enable people to have more fulfilling lives, to reach their potential, to avoid premature death, because obviously suicide is a big threat for young people, or death from other medical causes as well. And so it’s definitely the most cost-effective area so it should be top of the list for new investments.