The Royal Australian and New Zealand College of Psychiatrists (RANZCP) Inaugural Symposium on Youth Mental Health to be held in Melbourne on the 18th February 2012, covers the transition from youth into adulthood. It also initiates the new RANZCP Special Interest Group in Youth Mental Health for trainees and psychiatrists. It was established to promote training of a new workforce for early intervention in mental health. Sounds good, but is it?

Escalating Psychiatric Child Drugging in Australia

• Nearly 10,000 Australian children under 18 (almost 300 aged 6 and under) are being prescribed antipsychotics. To date there are 15 DEATHS linked to antipsychotics for children under 19. The Pharmaceutical Benefits Scheme pays out more than $3.4 million for antipsychotics prescribed to children.
• The numbers of children aged 2 to 6 on antidepressants increased from 877 in 2008/09 to 1,264 in 2009/10. This is despite the fact the Australian Government have not authorised the use of SSRIs (class of antidepressants) in any child under 18 for depression. There have been 5 deaths linked to antidepressants in the 10 to 19 age group.

“Early Intervention”: The Dangers

Chair of the Symposium and Chair of the new group, psychiatrist Prof. Patrick McGorry, is an advocate of “early intervention” treatment for mental disorders. He is the self-proclaimed “father” of “Psychosis Risk Syndrome” (PRS), which has drawn international criticism and is of grave concern. How dangerous is this? Essentially it is an arbitrary list of behavioural symptoms, which psychiatrists, claim can predict the onset of “psychosis.” Often predicted at age 12-14, psychiatrists can drug the adolescent with mind-altering antipsychotics (that can induce psychosis) to “prevent” the disorder.

Psychiatrist Professor Ian Hickie, a speaker at the conference and member of the new group, is currently conducting a clinical trial which involves giving antidepressants to the elderly who are “at risk” of depression, but are NOT actually depressed right now.

At the symposium Prof Hickie will cover new data from the youth mental health group headspace. He and Prof. McGorry and Hickie are Board Members of headspace. On the headspace website is a “Quick Reference Evidence Map” which recommends the antipsychotics risperidone, olanzapine and amisulpride as a drug intervention for those “at risk of psychosis.”¹ There have already been 109 deaths linked to these specific antipsychotics in Australia.

A leading mental health research group said the practice of drugging someone when they don’t have a disorder is akin to “performing mastectomies on women who are at risk of − but do not have − breast cancer.”

• Prof. McGorry has received unrestricted research grants from Janssen-Cilag, Eli Lilly, Bristol Myer Squibb, Astra–Zeneca, Pfizer and Novartis. He has acted as a paid consultant for, and has received speaker’s fees and travel reimbursement from all or most of these companies.²
• Prof. Hickie has received funding from Bristol-Myers Squibb, Pfizer’s funding of GPs training in Prof. Hickie’s depression screening method called SPHERE, helped make their antidepressant, Zoloft, a best-seller in Australia. He has served on the professional advisory boards convened by the drug industry in relation to specific antidepressants made by Bristol-Myers Squibb and Eli Lilly. He has led projects funded in, part, by Bristol-Myers Squibb, Pfizer, Eli Lilly, Wyeth and Servier. 3

Experts Express their Concerns Regarding Early Intervention

Professor Frances, the Chair of the current Diagnostic and Statistical Manual for Mental Disorders (DSM), used in Australia for insurance reimbursement, said of PRS: “Drug company marketing would influence parents and clinicians to be especially alert to any strangeness in teenagers.” False positives could be as high as 70-90 precent: that means 70-90 out of every 100 youths could be wrongly labelled with PRS.⁴

Head of Psychiatry at Melbourne’s St Vincent Hospital David Castle said Professor McGorry, who founded headspace and the Early Psychosis Prevention and Intervention Centres [EPPIC] and Professor Ian Hickie had overstated the evidence in their push for early intervention in young people at risk of psychosis.⁵

Dr. Jerald Block, psychiatrist writing in Bioethics Forum, reported that “preventive pharmacology” is “ethically questionable territory” because “you are potentially harming people.” The symptoms used to identify them as at risk of schizophrenia are “also remarkably common… adolescence is a period of life that is normally marked by tumultuous changes in personality.”⁶

Melissa Raven, psychiatric epidemiologist and policy analyst, adjunct lecturer in Public Health at Flinders University, South Australia, and David Webb, board member of the World Network of Users and Survivors of Psychiatry wrote: “McGorry’s campaign is part of a wider push to promote the medicalisation of mental health (for which psychosocial wellbeing is a better term).” “Further doubts must be raised about McGorry’s agenda when you see the substantial funding his organization (Orygen Youth Health) receives from the pharmaceutical industry…⁷

In 2011, a group of 13 international health experts lodged a complaint about Prof McGorry’s controversial trial of antipsychotic drugs on children who are “at risk of psychosis” saying it was unethical. This trial was to be funded by Astra Zeneca, the manufacturer of the antipsychotic to be used in the trial. Prof McGorry aborted the trial but has not ruled out further trials on patients.

Conferences such as this can potentially increase the risk of not just youths, but also toddlers and children being prescribed dangerous psychotropic drugs.

Conflict of Interest

The symposium fails to publicly disclose any conflict of interest between psychiatrists speaking and the pharmaceutical industry—an industry that often benefits from promotion of their drug product during such meetings.

Consider the other conflicts of interest independently found on this RANZCP symposium:

• RANZCP: received at least $757,000 between 2006 and 2010 for sponsorship and exhibitor fees for their conferences from pharmaceutical companies.
• Prof. Chris Pantelos: Professor of neuropsychiatry at University of Melbourne, “has been on advisory boards for Bristol-Myers Squibb, Faulding, Sanofi and Novartis; has received funding for unrestricted research from Eli Lilly, Novartis, Janssen-Cilag, Bristol-Myers Squibb and AstraZeneca; and has received travel assistance to attend meetings from Eli Lilly, Novartis, Janssen-Cilag, AstraZeneca, Pfizer and Bristol-Myers Squibb.”⁸
• Dr Simon Davidson: child, adolescent and family psychiatrist from Canada produced a brochure with another for the Canadian Psychiatric Association which was funded by a health educational grant from Eli Lilly, Pfizer and SmithKline Beecham.⁹
• Prof. Nick Allen: clinical psychologist, from Orygen (Prof. McGorry’s Youth Health Research Centre who are supported by AstraZeneca, Bristol Myers Squibb, Eli Lilly, and Janssen-Cilag) was the Chief Investigator of a depression study funded by Pfizer.¹⁰
• Dr Cathy Mihalopulos: from Deakin University who is qualified in economics and psychology¹¹ was funded with another person by Janssen-Cilag to develop unit costs of the Prof. McGorry’s EPPIC program for their use in the economic evaluation of the antipsychotic risperidone.¹²
• Dr James Scott: child and adolescent psychiatrist from University of Queensland, has received grants to attend educational functions by Eli Lilly and Janssen-Cilag.¹³

Parents Have the Right to Know

While children and youth can suffer from emotional trauma, parents are not told that unlike for medical conditions, there are no blood or urine test, brain scan (MRI, PET scan) or any physical or genetic test to scientifically/medically confirm the existence of the mental disorders children are labelled with. Mental problems, while very real, are not physical diseases. The cause of the problem needs to be found for each child and adult. There are many safe and scientifically based alternatives to psychotropic drugs.

1. See under Clinical Guidelines for Psychosis on this link: http://www.headspace.org.au/what-works/resources/-evidence-summaries
2. http://www.bmj.com/cgi/content/full/337/aug04_1/a695
3. Prof. Gordon Parker and Ian Hickie ,”Is Depression Over Diagnosed? Yes,”BMJ, 18 Nov. 2007.
4. Gary Greenberg, “Inside the Battle to Define Mental Illness,” Wired Magazine, 27 Dec. 2011.
5. http://www.smh.com.au/nsw/doctors-in-different-headspace-on-suicide-20110806-1igk0.html
6. http://www.ahrp.org/cms/index2.php?option=com_content&do_pdf=1&id=386; http://ww.bioethicsforum.org/ethics-of-preventive-psychopharmacologic-treatments.asp.
7. David Webb, Melissa Raven, “McGorry’s ‘early intervention’ in mental health: a prescription for disaster,” Online Opinion, http://www.onlineopinion.com.au/view.asp?article=10267.
8. eMJA_ Managing patients with treatment-resistant schizophrenia: http://www.mja.com.au/public/issues/178_09_050503/pan10585_fm.html
9. http://publications.cpa-apc.org/browse/documents/20
10. http://www.findanexpert.unimelb.edu.au/researcher/person13078.html and http://rc.oyh.org.au/ResearchLeaders/nicholasallen
11. http://www.deakin.edu.au/hmnbs/hsd/staff/index.php?username=cathymi
12. http://www.healthprograms.unimelb.edu.au/__data/assets/pdf_file/0020/31790/biennial_report_1998_1999.pdf page 32
13. http://www.itsmyhealth.com.au/healthy-living/parenting-and-babies/adhd-label-extended-to-4-year-olds