Interview with Professor Patrick McGorry

Sky News Sunday Agenda program, 7th March 2010

Helen Dalley: Professor McGorry, thanks for joining us.

Prof. McGorry: Good morning Helen, thanks for having me on the program.

Helen Dalley: Now it was a big plan announced this week to change funding mainly for
public hospitals, but there wasn’t a lot in it about what will happen to mental health, was
there?

Prof. McGorry: We understand that there are going to be subsequent announcements,

but I think the main point is that Australia really does need a major shakeup, a major
reform of our health system, and to do it without mental health being front and centre
would be a serious problem. We really must see mental health, which is a mainstream
issue in Australia affecting seven million Australians, it must be very firmly at the centre
of this reform process.

Helen Dalley: So even if it is contained in the plan for primary healthcare and the
superclinics which are still to come, does it worry you from what you’re saying that
mental health might get left behind?

Prof. McGorry: I wouldn’t say worried. We’re expecting mental health to be very
strongly supported in the next series of announcements. And I think the community
deserves nothing less than that.

Helen Dalley: Well as much as reform of public hospital management is needed, how
vital is reform of mental healthcare delivery?

Prof. McGorry: Well mental health has really been stagnating for the last 10 or 15 years
around the country. And I think part of the reason for that is the structure of the health
system more generally. We were mainstreamed as a system out of the old 19th century
model of care probably about 10 or 15 years ago with reform plans in the 1990s under a
process called mainstreaming, where mental healthcare was integrated within acute and
general healthcare. Now this has not really been reviewed over this whole period, and
it’s really been struggling, partly because of a financial aspect. We haven’t invested in
growing the system proportionately to the need, so that only 35% of Australians who
have mental health problems or disorders get access to care. And this is comparing it
with 90% of people with physical health problems who get access, despite the waiting
list issue that always crops up in these debates.

Helen Dalley: So you’re saying it’s just totally lopsided?

Prof. McGorry: It’s totally lopsided and it really needs to be addressed. We need to
invest upstream as well as downstream.

Helen Dalley: What do you mean by that?

Prof. McGorry: Well we’re seeing the symptoms of this failure to invest on the
community side in emergency departments every day around the country. They’re really
clogged up with people presenting with quite serious and acute mental health problems.
Much of this could be diverted and prevented by much stronger investment earlier on

Sunday Agenda 7th March 2010 Prof McGorry

upstream in the community, and particularly focussing on teenagers and young adults.
The system currently is weakest where it needs to be strongest.

Helen Dalley: In your view then, is all the money invested in reducing hospital waiting
lists, is that just too lopsided?

Prof. McGorry: Well obviously there’s a great need across the whole health system, and
you know the waiting lists are a serious problem as well, and the prime minister and the
government are concentrating on that at the moment.

Helen Dalley: So it has to be equal?

Prof. McGorry: Yes, I think we’re looking for parity, we’re looking for equity in
healthcare, and people who are suffering mental health problems and even serious
illnesses don’t have equity at the moment. Since I’ve been in this role as Australian of
the Year, I’ve received countless emails, letters, describing the just incredible suffering
that’s going on around this country by people themselves and their families trying to deal
with this neglect of mental healthcare.

Helen Dalley: So do you think the federal government will step up and properly fund
mental health? Is there an understanding of that unmet need in the community?

Prof. McGorry: Yes, I think we’re starting to get there in terms of awareness. Beyond
Blue and whole range of initiatives have really mobilised community awareness of the
extent of the problem, and now it’s time for the governments around the country to catch
up with that and provide the appropriate level of 21st century care. I think we’re getting
there, and we certainly expect as a field the government to do something very significant
in the next few weeks on this front.

Helen Dalley: You mentioned before that a lot of people with mental health issues kind
of gum up the system. How do you mean? Do you mean people are turning up into
emergency departments when really that’s not where they should be cared for with
mental health issues?

Prof. McGorry: Well I think it’s appropriate for some people to be presenting there, but
the departments are being overwhelmed I think, and we’ve seen a reactive sort of
investment in mental health resources in EDs around the country. Whereas actually
what we also need is upstream investment on much strong community services, mobile,
accessible and I suppose integrated, as you were alluding to earlier, with primary care
structures.

Helen Dalley: In a nutshell, how should it be funded? Because you’ve been working
very much on preventative care, treatment out of hospitals in the community, is that area
needed in terms of an injection of funds more than perhaps acute beds in hospitals for
mental illness?

Prof. McGorry: I think it’s always unproductive to set one part of the system against the
other. We need investment across the board in mental health. We do need more acute
services as well. But the part that hasn’t been able to grow over the last 15 years or so
has been the community part, because the states have been left with the job. They
haven’t been able to finance it sufficiently, and they need help. Now the structure of that
help, how that’s to be arranged, is obviously a matter for the federal and state

Sunday Agenda 7th March 2010 Prof McGorry

governments to work out. But in the field and in the community what we’re looking for is
much greater expansion and investment on that side, as well as acute services.

Helen Dalley: Now you’ve worked on the Headspace treatment model, which is a kind of
one stop shop as we understand it. Briefly, why does this model work and can you
expand it and grow it?

Prof. McGorry: The figure for access that I mentioned earlier, 35% of Australians only
getting access to mental healthcare, drops sharply in young people to as low as 13% in
young men. So the current system is working very, very poorly for young men in
particular with mental health problems. Headspace and more specialised youth mental
health services such as Epic and Origin, these sorts of services which focus on
teenagers and young adults are solving this problem. They’ve shown and they’ve
produced evidence to show that young people will access these problems. They’ll
actually find them very low stigma, they’ll engage in them and they get access for the
very first time to evidence based care. So this is working. And the governments
deserve credit for supporting this innovative model which as you say is a one stop shop
bringing together primary care, specialist mental health, drug and alcohol and the like.
So this is the way forward. We have the solutions, we have the models in Australia,
what we need to do is roll them out around the country.

Helen Dalley: Can you roll out Headspace further? Have you got the funding for it, or is
this what you’d like to see in this new plan?

Prof. McGorry: I think the government’s considering some proposals from the field to
expand the Headspace model and also its backup system which is the early psychosis
model. This will not cost that much actually when you compare it with the figures that
have been bandied around about physical healthcare at the moment. For a relatively
small investment, 250,000 young Australians will gain access to effective mental
healthcare for the very first time. So I think it’s a very strong proposal and we’re
certainly hoping the government will look at it very favourably as well.

Helen Dalley: You mentioned programs for early intervention of psychosis, which was
one of the top recommendations in the National Health & Hospitals Reform Commission
report of last year. How are they progressing? Is that going to get backed? Is it going
to get money and to be rolled out nationally?

Prof. McGorry: Well I certainly expect it to be so because the early psychosis model
was pioneered in Australia, has been adopted in countless countries overseas. We’ve
seen hundreds of these services established in Canada, across Western Europe and
even in Asia. So Australia has really dragged the chain on this reform, and this is why
the Health & Hospitals Reform Commission gave it a very strong level of support in its
recommendations. The cost of not doing that is severe in human terms. It’s also going
to waste money if we don’t do it, because this is a very efficient and cost effective model
of care. It costs a third as much over time to treat patients in this type of care than in the
traditional late intervention system, so Australia really needs this.

Helen Dalley: How do you get in and kind of do early intervention? How do you detect
and prevent psychosis, particularly in young people?

Prof. McGorry: There are a number of elements involved, Helen. The first is obviously
awareness and helping the community, families, teachers and everyone in contact with

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young people to recognise the early signs of emerging psychosis and other mental
disorders, and then having a system that’s able to respond. So in mental health the
doors tend to slam shut in peoples’ faces, rather than open as they do in say areas like
cancer where there are warning signs of serious illness. So we have to make the
system responsive, which is things like Headspace and the early psychosis model, and
then we have to have evidence based care available around the country which brings in
issues of workforce, skills and so on. But the culture of care is vital. We have to have
youth friendly models of care that young people will actually feel comfortable in and will
engage in.

Helen Dalley: And presumably just briefly that affects homeless people too? They have
to feel comfortable and they greatly suffer mental disorders.

Prof. McGorry: Yes. In recent years the proportion of young people among the
homeless has increased greatly, and this is driven to a very large extent by untreated or
poorly treated mental illness. So it’s another indicator that our system is not really
working for young people.

Helen Dalley: Professor McGorry, we’re very pleased that you came on and spoke
about that this morning. Thanks very much for joining us.

Prof. McGorry: Thank you very much, Helen.

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