Citizens Committee on Human Rights

The Mental Health Watchdog

Australian National Office

1.25 Million 0-3 Year Olds to Be Screened for Mental Illness & at Risk of Being Drugged

The proposal to screen all 1.25 million children aged 0-3 years old is a result of Australia’s Productivity Commission’s Inquiry into Mental Health. The Productivity Commission is responsible for the accountability of government spending in all sectors. Specifically this inquiry was called to determine whether the current mental health programs are effective and if they deliver the best outcomes for children, families and the economy. They have released their Draft Report for feedback. Submissions and comments close on 23rd January 2020.

Prof. Harvey Whiteford is appointed an Associate Commissioner for this inquiry. He is the psychiatrist who designed and oversaw implementation of Australia’s National Mental Health Strategy (which commenced in 1992). Between 2008 and 2012 alone, his company, Harvey Whiteford Medical PTY LTD, received more than $1.1 million from the Department of Health for providing planning and services for national mental health reform, etc.1

The Draft Report fails to adequately investigate the real reasons behind the failure of Australia’s mental health system. Instead of addressing the complete lack of efficacy of psychiatric treatment and the clear evidence of the potential harm that psychiatric drugs can potentially cause, the inquiry seems to have been side-lined into proposition that the failure of current system is to do with lack of funding. Instead of tackling relevant issues such as complete lack of scientific testing behind psychiatric disorders, we are told only more funding and more subjective mental health screening will fix what is broken.

Click here to download a short summary

What is the Draft Report & Screening Based on?: The Draft Report and Australia’s failing National Mental Health Strategy is predominantly based on psychiatry’s main manual used in Australia to diagnose “mental disorders,” the Diagnostic and Statistical Manual of Mental Disorders (DSM). [PCDR, Vol 1, p.124, 147, 149, 150 & p. 1164, Vol 2, “APA 2013” reference.]

Psychiatrists themselves state there are no tests for psychiatric diagnosis (no x ray, scan, blood or urine test) to determine any infant, child or adult has any psychiatric diagnosis.2 Medicare currently uses DSM IV and the Pharmaceutical Benefits Scheme which funds psychiatric drugs is using DSM 5.3

PROPOSALS OF GRAVE CONCERN INCLUDE:

1.25 Million Zero to Three Year Old Children to be Screened for “Mental Illness”: The proposal is that these children will be screened for “mental illness” or “emerging mental illness.” The result of such a plan? The number of infants and toddlers already prescribed potentially dangerous mind altering drugs is set to greatly increase. Screening questions on checklists used to screen are so subjective that any child could be at risk of being labelled mentally ill and potentially recommended for a prescription of psychiatric drugs. (Productivity Commission Draft Report [PCDR] Overview, p. 11)

In 2007/08 Australia had Babies Under One Year Old on Psychiatric Drugs. At that time there were:

  • 201 children aged under 3 on antidepressants (48 aged under 1 year old)
  • 59 children aged under 3 on antipsychotics ( 5 aged under 1 year old) and
  • 46 children aged under 3 on ADHD drugs in 2007.4

Since that time the Department of Health no longer provides the numbers of children on psychiatric drugs by age, under 6.

We do know that the numbers of 2-6 year olds has skyrocketed and by 2015, there were a staggering:

  • 4,974 children aged 2-6 years on ADHD drugs,
  • 1,459 children aged 2-6 years on antidepressants
  • 1,384 aged 2-6 on antipsychotics (total of 7,817 children aged 2-6 years).5

Psychiatric Screening: Is the use of a highly subjective checklist usually based on the DSM in order to diagnose a child or adult with a “mental illness.” From these screenings and referrals, infants and children can be prescribed stimulants, antidepressants and antipsychotic drugs, placing them at risk of ill-health and potentially dangerous side effects─some even deadly.

Business man with check boxes.Early Intervention for “Emerging Mental Illness” Means: The infant or child doesn’t have it but they could get it in the future. How non-scientific is this? Essentially it is an arbitrary list of behavioural symptoms, which psychiatrists claim can predict the onset of “mental illness.” The psychiatrists can then treat the child to “prevent” the “disorder.” One example of this is “emerging psychosis.” Evidence shows, 82% to 90% will not go on to develop psychosis within a year of diagnosis. Despite this the premise is that they should be treated now. These screenings are a disaster for infants, toddlers, children and youth.6

The Australian Government has issued 67 psychiatric drug warnings to warn of the risk of agitation, aggression, increased blood pressure, hallucinations, life-threatening heart problems, suicidal behaviour and possible death.7 When New Zealand introduced 4 year old screening, within 4 years prescriptions of antidepressants to 0- 4 year olds increased by 140%.8 Every parent and adult deserves to know all the facts so they can give fully informed consent.

Symptoms for So Called Psychiatric Disorders for 0 to 3 Year Olds Include: Irregular feeding patterns, difficulty sleeping, whining, crying, calling for absent parent, separation or stranger anxiety, temper tantrums, shyness, sleeping with the light on and hyperactivity.

All of the above could be normal child hood behaviour and if there really is a problem it will not be found and rectified with such screening. Instead the infant or child could receive a psychiatric diagnosis and potentially psychiatric drugs.9

Who Will do the Screening: It is proposed that maternal and child nurses in community health services will expand existing physical checks to include mental health screening. They will refer the identified child for “final diagnosis” which will again be based on a subjective checklist ─ no scientific tests.

The existing physical checks are recommended for the infant/child at: 1-4 weeks old, 6-8 weeks, 6 months, 12 months, 18 months, 2 years and 3 years old. So this subjective mental health screening would be done more than once.10

The Draft Report says there is no adequate data to assess whether the increased focus on infant emotional wellbeing in the past has had a substantial effect on young children and their families. Despite this complete lack of evidence, they are proposing to move full steam ahead with the screening proposals accompanied with more demands for money. [PCDR, Vol. 2, p.653, Vol 1, p. 11]

Screening of 3 Year Olds was Scrapped in 2015: Psychiatry has already attempted this in the past between 2012 and 2015, with the expansion of a physical check called the Healthy Kids Check to include screening for “mental illness” of 3 year olds. The expanded check was trialled at 8 Medicare Locals and scrapped in 2015 due to immense public criticism from the public and professionals.11 [PCDR Vol 2, p. 657 & 656]

Responses at the time from professionals to this 3 year old screening included:

  • Psychiatrist Allen Frances who was the DSM –IV Task Force Chair, said the screening of 3 year olds was “reckless” not evidence based and could lead to an explosion of false diagnoses that would see youngsters overmedicated and labelled with mental illness.12
  • The doctor’s magazine, the Medical Observer conducted a survey of GPs in 2012 and found that two thirds of GPs disagreed with the expanded Healthy Kids Check with a quarter believing it would lead to mis-diagnosis with more psychiatric drugs and a further 41% said the scheme was a waste of money.13
  • Child psychiatrist Dr Jon Jureidini, said he was “relieved,” that the proposal for the 3 year old check had disappeared.” 14

Yet, now psychiatrists want to use the same guidelines as those used in the dumped Healthy Kids Check to screen 0-3 year olds. [p. 658 of PCDR, Vol. 2]

Previous Spending Wasted on Early Intervention: The Draft Report clearly states that despite spending billions of dollars, countless hours of work by teachers, education professionals, doctors, nurses, specialists on early intervention and prevention measures ─ improvements in the mental health of children and young people have been limited. It further states, “there is very little information to allow us to determine whether investments in mental health and wellbeing are delivering improvements and what policy initiatives have been effective.” [ p. 650, 693 of PCDR, Vol 2]

Early Childhood Education Centres and Schools Being Turned into Mental Health Clinics: The Draft Report says early childhood education centres and schools act as the gateway for students and families to the mental health system. However, this usurps the role of schools: to be places of education, not clinics. Instead, already overworked teachers are being expected to be an adjunct to psychiatry, screening students for mental health problems and to refer them for a diagnosis. [p. 662, 659 of PCDR, Vol. 2]

At the staggering annual cost of up to $1.65 billion, a full time “Well-being” teacher is proposed for each public and private school who will be responsible for student’s mental health and organising referral lines to mental health services in the community. And it is proposed that teaching regulatory authorities mandate that teachers devote time each year on mental health education. If implemented, all of this will lead to more children on ADHD drugs, antidepressants and antipsychotics. [660, 661, 689, 675 of PCDR, Vol 2]

We already have a serious problem with Australian children being given antidepressants. There were 101,174 children under 17 on antidepressants in 2017/18, a 34 % increase in just 4 years, despite the fact they are not approved for children under the age of 18 for depression.15 A further 107,000 children were on ADHD drugs in 2017.16

Existing Screening Checklists for Children Aged 4 and Above: Include such questions as has trouble sleeping, wants to be with you more than before, is afraid of new situations, fidgets and squirms, distracted, acts as if driven by a motor, does not listen to rules, avoids schoolwork and homework, and refuses to share.17

Increasing Number of Suicides: Since 2008/09 suicides in young people have increased by almost 40%, concurrent with the use of antidepressants increasing approximately 60% in young people.18 Australia’s drug regulatory agency has issued 67 psychiatric warnings with 7 of these to warn of the risk of suicidal behaviour with antidepressants19 and as previously mentioned they are not approved for use in children under 18 for depression.20

Australia’s Drug Regulatory Agency’s database in January 2019 revealed there have been 140 completed suicides, 326 suicide attempts and 606 reports of suicidal ideation linked to antidepressants.21 While not everyone who is on an antidepressant will commit or attempt suicide, clearly some do.

The Draft Report also advises that “There has been no significant and sustained reduction in the death rate from suicide over the past decade, despite ongoing efforts to make suicide prevention more effective.” [p. 14 of PCDR, Vol 1]

This link between psychiatric drugs and inducing suicide requires vital investigation.

Psychiatry’s Abusive Treatments were Not Investigated: There is no evidence in the Draft Report that the potential harm of psychiatric drugs was investigated. Restraint including chemical restraint (psychiatric drugs to subdue and control) which can both cause death were not covered in the Draft Report.

Dangerous side-effects meter.In 2017/18 there were 796 mechanical restraints incidents reported from states and territories in public sector acute facilities and physical restraint was used 16,917 times, a 16% increase in 3 years (14,533 in 2015/16 to 16,917 in 2017/18).22 Note: Queensland did not report the use of physical restraint except for 2017/18 and WA did not report mechanical restraint for any of these years.

Neither does the Draft Report indicate the use of electroshock was investigated as one of the “treatments” which can cause serious disability to children, pregnant women, the elderly and anyone who receives it. Electroshock is the application of hundreds of volts to the head to cause a seizure. It can cause brain damage, permanent memory loss, cardiovascular complications and even death. In 2018/19 Medicare funded 36,676 electroshocks.23 Electroshock must be banned.

Psychiatric “treatments” must be investigated as one of the reasons for the increased spending, yet consistently failing mental health system.

Drugs scattered over Australian notes.Conflicts of Interest: Conflicts of interest between psychiatrists, mental health support groups and pharmaceutical companies is an area which drives up the use of psychiatric drugs. Conflicts were not covered as a reason for the soaring costs with no results and increasing harm in the Draft Report.

No-one responsible for advising governments, involved in writing medical guidelines, conducting inquiries or doing anything that affects entire populations with potential conflicts of interest should take part in these advisory activities. Failure to declare conflicts of interest threatens public trust.

Wasted Tax Payers Money and No Real Help: For years experts have said there is inadequate or no accountability for huge amounts of money spent, which was the reason for this inquiry. Spending has increased 31.8% in the past six years ($6.9 billion in 2010/11 to $9.1 billion in 2016/17). The Draft Report says the real cost is estimated at $43 to $51 billion a year.24

Incredibly the Draft Report states, “Despite the rising expenditure on healthcare, there has been no clear indication that the mental health of the population has improved.” Yet as the solution, it is irrationally proposed that even more funding is the answer to further expand these failing ineffective programs. [p. 9 of PCDR, Vol 1]

The Productivity Commission’s Report on Government Services 2019, reveals that in
2016/17 results were appalling:

  • 62.8% of children aged 0-17 discharged from ongoing community care did not
    significantly improve.25
  • 40.9% of children aged 0-17 discharged from a psychiatric ward/facility did
    not significantly improve.
  • 44.6% of children aged 0-17 discharged from community care did not
    significantly improve.
  • 14.9% or 14,781 of those who were admitted to psychiatric acute inpatient
    services were re-admitted to acute wards again within 28 days.

The continual cry for more funding in the Draft Report and lack thereof is not the cause of the problem. Factually if psychiatry and its treatments were working there would be a reduction in children and adults requiring assistance. No other sector of society could expect to consistently produce such poor outcomes with tax-payer’s money and expect government handouts to keep increasing, so they can provide even more bad results.

Money given for other areas of medicine show noticeable progress such as improving survival rates for cardiovascular disease over the past 20 years.26

The Draft Report supports the system of activity based funding for hospital and community based care as a method of funding (hours of care provided, numbers treated 27). This does not ensure accountability in the mental health system or real help that returns children and adults to happy and productive lives. When the very science behind something is wrong and the psychiatric system itself is abusive, no amount of money thrown at it will improve the system. [p. 47 of PCDR, Vol1]

Mum and girls throw leaves up in the air playing with kids in autumn park happy and smiling.

The Real Cost and the Solution: The real cost is not money but destroyed lives, no real help and deaths. Australia’s drug regulatory agency reports as of January 2019, there were 1,707 deaths linked to antidepressants and antipsychotics.28

There is no doubt whatsoever that children and adults get depressed, sad, troubled, anxious or nervous or even act psychotic. The question then is simple ─ is this due to some “mental disease” that can be verified as one would verify cancer or a real medical condition? The answer is no.

Children and adults should be given holistic, humane care that improves their condition. Medical studies have proven that this should include medical tests to determine if the problem is caused by an undiagnosed medical condition.

If a child is exhibiting unwanted behaviour in school, they may be behind and need tutoring or educational basics. The use of phonics and a small dictionary can also assist learning. Some children are very intelligent and gifted and become bored, start to fidget and become a problem as they need a more challenging curriculum. There may also be a lack of interest, the real test is how much attention can a child give to what they like doing?

Medical doctors recommend a good diet, sufficient sleep and exercise.

Institutions should be safe havens where adults and children voluntarily seek help without fear of indefinite incarceration and harmful or terrifying treatment. They need a quiet and safe environment where they can get workable and accountable help for their problems. The existing money spent needs to be re-directed into proven workable solutions.

TAKE ACTION

Lodge a Submission by 23rd January 2020

Lodge a Submission or Comment: Submissions can be made on this link, 500 word comments can also be made at any time on the same link: pc.gov.au/inquiries/current/mental-health/make-submission#lodge

Submissions can also be mailed, but must have a submission cover sheet which is obtained on this link: pc.gov.au/inquiries/current/mental-health/make-submission/mental-health-submission-coversheet.pdf

The Productivity Commission’s Draft Report can be accessed on this link: https://www.pc.gov.au/inquiries/current/mental-health/draft

Contact CCHR for free bulk copies of a 2 page Fact Sheet which can be viewed here.


References

  1. Contract Notice ID numbers: CN99216, CN824891, CN415063, CN348304, CN205813, CN445908, CN41201, Aus Tender, Australian Government. https://www.tenders.gov.au/Search/KeywordSearch?keyword=Harvey+Whiteford
  2. Examples of no tests include: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, DSM-IV- TR, American Psychiatric Association, pages 88 , 89, 305; Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, DSM-5, American Psychiatric Association, pages.61, 101.
  3. Examples of DSM usage: Pharmaceutical Benefits Scheme, atomoxetine entry (Strattera), click on “Authority Required (Streamlined),” http://www.pbs.gov.au/medicine/item/9094P ; Australian Government, Department of Health, 16 Nov.2019. Medicare Benefits Schedule entry for psychiatric attendance (item 319), AN.0.31, MBS Online, Australian Government, Department of Health, 16 Nov.2019. http://www9.health.gov.au/mbs/fullDisplay.cfm?type=note&q=AN.0.31&qt=noteID&criteria=DSM%20IV
  4. “Table 1. Number of patients who had at least one prescription filled for PBS/RPBS listed antidepressant drug in 2007/08 year by age and State/Territory. Department of Health and Ageing, 2008, https://cchr.org.au/wp-content/uploads/2016/08/Antidepressants-2007-2008.pdf ; “Table 1. Number of patients who had at least one prescription filled for PBS/RPBS listed antipsychotic drug in 2007/08 year by age and State/Territory. Department of Health and Ageing, 2008, https://cchr.org.au/wp-content/uploads/2016/08/Antipsychotics-2007-2008.pdf ; “Number of Patients on Attention Deficit Hyperactivity Disorder (ADHD) Drugs,” Freedom of Information Request No: 112/0708, Department of Health and Ageing, 2008 https://cchr.org.au/wp-content/uploads/2017/02/Part-1-of-numbers-on-ADHD-drugs-2007.pdf
  5. “Report 3A, Number of Unique Patients by Patient Age Group and Patient State for Requested ADHD Items Supplied from 1 January 2015 to 31 December 2015,” Request Number- MI5329, Department of Human Services, Strategic Information Division, Information Services Branch, 27 May 2016. https://cchr.org.au/wp-content/uploads/2016/08/Numbers-on-ADHD-Drugs-30-May-2016.pdf ; “Report 1A, Number of Unique Patients by PaCent Age Group and Patient State for Requested Antidepressant Items Supplied from 1 January 2015 to 31 December 2015,” Request Number-MI5329, Department of Human Services, Strategic Information Division, Information Services Branch, 27 May 2016. https://cchr.org.au/wp-content/uploads/2016/08/Numbers-on-Antidepressants-30-May-2016.pdf ; Report 2A, Number of Unique Patients by Patient Age Group and Patient State for Requested Antipsychotics Items Supplied from 1 January 2015 to 31 December 2015,” Request Number- MI5329, Department of Human Services, Strategic Information Division, Information Services Branch, 27 May 2016. https://cchr.org.au/wp-content/uploads/2016/08/Numbers-on-Antipsychotics-30-May-2016.pdf
  6. “Evidence Summary: Identification of young people at risk of developing psychosis,” headspace National Youth Mental Health Foundation, 2015. https://headspace.org.au/assets/Uploads/Evidence-Summary-Identification-of-Young-People-at-Risk-Developing-Psychosis.pdf
  7. Fully referenced layman’s summary of all psychiatric drug warnings issued by Therapeutic Goods Administration, https://cchr.org.au/wp-content/uploads/2018/10/Australian-government-warnings-on-psychotropic-drugs-180801.pdf
  8. Imogen Neale, “Ministry hides test’s real purpose,” Stuff, 25 June 2012. http://www.stuff.co.nz/dominion-post/news/politics/7160837/Ministry-hides-tests-real-purpose
  9. The DC:0-3 Casebook, Zero to Three, National Center for Infants Toddlers and Families, 1997, p.21, 22.; C.H. Zeanah, A.S. Carter, J. Cohen, M.M. Gleason, M. Keren, A. Lieberman, K.M.C Oser,  “Introducing a New Classification of Early Childhood Disorders: DC:0-5,” ZERO TO THREE, January 2017.
  10. “My personal health record,” NSW Ministry of Health, 2019, p.3. https://www.health.nsw.gov.au/kidsfamilies/MCFhealth/Publications/blue-book.pdf
  11. Karyn E Alexander and Danielle Mazza, “Scrapping the Healthy Kids Check: a lot opportunity, MJA, Volume 203, Issue 8, 19 Oct. 2015. https://www.mja.com.au/journal/2015/203/8/scrapping-healthy-kids-check-lost-opportunity
  12. Sue Dunlevy, “Child health check ‘is reckless,’” The Australian, 12 June 2012, p.2.
  13. Neil Bramwell, “Two-thirds of GP’s disagree with well-being check,” Medical Observer, 18 Sept. 2012.
  14. Sarah Colyer, “Axing kids check retrograde,” MJA Insight, 19 October 2015.
  15. “Table 1- Number of PaCents supplied PBS/RPBS prescriptions for antidepressant medicines by age group, 2002-03 to 2017-18,” Department of Health, January 2019. https://cchr.org.au/wp-content/uploads/2019/10/2002-2017-18-Numbers-on-antidepressants.pdf ; https://cchr.org.au/wp-content/uploads/2019/10/2002-2017-18-Percentage-prescribed-antidepressants.pdf
  16. Dr Bernie Towler Commonwealth’s Principal Medical Adviser, testimony to United Nations Committee on the Rights of the Child, 12.30 minutes on UN video of testimony, 10 Sept. 2019. http://webtv.un.org/search/consideration-of-australia-contd-2403rd-meeCng-82nd-session-commiXee-on-the-rights-of-the-child/6084998390001/?term=&lan=english&page=8
  17. “Paediatric Symptom Checklist,” Beyond Blue, on their website page titled, “Child Mental Health Checklist,” for kids aged 4 to 16, https://healthyfamilies.beyondblue.org.au/age-6-12/mental-health-conditions-in-children/child-mental-health-checklist ; “Connors 3rd EdiCon-Connors 3-Teacher Assessment Report,” C Keith Connors, using DSM 5, 2014, p. 5. https://paa.com.au/wp-content/uploads/2019/03/Conners-3-Teacher-Assessment-Report.pdf
  18. Sue Dunlevy, “Happy drugs in link with Suicide,” Courier Mail, 2 June 2019, p. 5; Dr MarCn Whitely, Dr Melissa Raven, “More young Australians suicide/self-harm and use antidepressants while experts dismiss FDA warning,” PsychWatch Australia, 1 June 2019, https://www.psychwatchaustralia.com/post/more-young-australians-suicide-self-harm-and-use-antidepressants-while-experts-dismiss-fda-warning
  19. Department of Health and Ageing Therapeutic Goods Administration, Medicines Safety Update, “Medicines associated with a risk of neuropsychiatric adverse events,” Volume 9, Number 2, June 2018; Department of Health and Ageing Therapeutic Goods Administration, Medicines Safety Update, “Antidepressants – Communicating risks and benefits to patients,” Volume 7, Number 5, October-December 2016; Department of Health and Ageing Therapeutic Goods Administration, Medicines Safety Update, “Atomoxetine and suicidality in children and adolescents,” Volume 4, Number 5, October 2013; “Australian ADHD drug warnings are already in place: TGA,” AAP Newswire 22 February, 2007; “Suicidality with SSRIs: adults and children,” The Australian Therapeutic Goods Administration, Adverse Drug Reactions Bulletin, Vol. 24, No. 4, August 2005; “Use of SSRI antidepressants in children and adolescents” The Australian Therapeutic Goods Administration, Adverse Drug Reactions Bulletin, Vol. 23, No. 6, August 2004; “Warnings for high dose tricyclics antidepressants,” The Australian Therapeutic Goods Administration, Adverse Drug Reactions Bulletin, Vol. 23, No. 5, October 2004.
  20. Suicidality with SSRIs: adults and children,” The Australian Therapeutic Goods Administration, Adverse Drug Reactions Bulletin, Vol. 24, No. 4, August 2005.
  21. Therapeutic Goods Administration Database of Adverse Event NotificaCons-Medicines, List of reports generated for each antidepressant, as of 03/01/2019 and added manually. https://www.tga.gov.au/database-adverse-event-notifications-daen
  22. “Table RP.5:Restraint rate, public acute sector acute health hospital services, states and territories, 2015-16 to 2018-18, Mental Health Services Restrictive Practices, Australian Institute of Health and Welfare. Note: Queensland did not report the use of physical restraint except for 2017/18 and WA did not report mechanical restraint for any of these years. Download Excel spreadsheet on this link, see under blue bar graph on webpage to download, https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia/report-contents/restrictive-practices/restraint
  23. Statistics generated on Medicare Australia website using MBS item codes: 14224 for electroconvulsive therapy. https://www.medicareaustralia.gov.au/statistics/mbs_item.shtml
  24. Table EXP.34: Expenditure ($ million) on mental health services, by source of funding, 1992-933 to 2016-17, Mental Health Services in Australia, Australian Government, Australian Institute of Health and Welfare. (Current Prices ) https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia/report-contents/expenditure-on-mental-health-related-services ; Productivity Commission Draft Report, Overview & Recommendations, Australian Government Productivity Commission, October 2019, p.2.
  25. Mental Health Management, Table 13A.34, Table 13A.62, Part E, Chapter 13, Mental Health Management, Report on Government Services 2019, Australian Government, Productivity Commission, 30 Jan 2019. https://www.pc.gov.au/research/ongoing/report-on-government-services/2019/health/mental-health-management
  26. Cardiovascular disease: most deaths and highest costs, but situation improving, Australian Institute of Health and Welfare, https://www.aihw.gov.au/news-media/media-releases/2011/2011-mar/cardiovascular-disease-most-deaths-and-highest-co
  27. https://www.ihpa.gov.au/what-we-do/activity-based-funding
  28. Therapeutic Goods Administration Database of Adverse Event Notifications-Medicines, List of reports generated for each antidepressant, as of 03/01/2019 and added manually. https://www.tga.gov.au/database-adverse-event-notifications-daen ; Therapeutic Goods Administration Database of Adverse Event Notifications-Medicines, List of reports generated for each antipsychotic, as of 03/01/2019 and added manually. https://www.tga.gov.au/database-adverse-event-notifications-daen