Prof Patrick McGorry: Fighting the Good Fight

By Dan Hutton on September 19, 2017 in

Professor Patrick McGorry is a luminary when it comes to youth mental health in Australia. He is the Executive Director of Orygen, Professor of Youth Mental Health at The University of Melbourne, and a Director of the Board at headspace. In May last year, headspace opened its doors at Bondi Junction, offering a prolific range of services, like access to GPs, a sexual health clinic, an oral health clinic, employment support, family therapy, psychologists and social workers. The Beast caught up with Prof McGorry to talk holistic approaches to youth mental health, why Australia’s asylum seeker policy is abominable, and how the power to change Australia’s mental health problems rests in our hands…

Where are you originally from?
Well, I was born in Dublin. My family’s Irish. We had a two-step immigration to Australia via South Wales. My childhood was in Swansea, and then to Newcastle, north of Sydney. Newcastle was such a great place. My dad was actually a chest physician who specialised in the diseases of coal miners. My mum was a nurse, but we had four kids in the family and she tended not to work after that.

You now specialize in the development of early intervention services for youth experiencing symptoms of psychosis, which is obviously not a rookie’s game. What planted the seed that made you want to pursue study in the area of mental health?
Well, I definitely wanted to do something to help people, but I thought medicine was a bit limiting. My dad, I guess, put on a bit more family pressure to do it, because there are a lot of doctors in my family going way back. My dad sort of said, “You’ve got to find something within medicine that’s going to suit you.” And he was right, really, because once I learned a bit more about psychiatry, I could see that that was the thing that needed to be done. It was such a neglected area and still is, really.

Any other area of medicine, there’s plenty of smart people who are doing a great job and making a difference, but I thought, “This is where I can do the most good.”

It’s the most fascinating thing, too, understanding how people think and how people will behave, and what could go wrong with that.

I can’t understand why it’s not more popular amongst doctors, actually.

Can you give us a brief run down of the path you trod between finishing high school and founding EPPIC, which is now ORYGEN’s early psychosis prevention and intervention centre?
I did medicine in Sydney, and then I went back and worked in Newcastle for a few years. Then I got an opportunity to come to Melbourne to do some research in schizophrenia, and that’s when I really started doing this early intervention with young people with mental illness. That began in the mid-80s.

Founding EPPIC was really the watershed, which got everything going, because we could see that these young people were coming into these old Dickensian mental hospitals, where I was working, and they were terrified and traumatised. The treatment was very custodial, and too much medication, and not enough humanity. We had to develop a new model.

We also wanted to help them earlier, because they were coming in after months or years of being seriously ill in life-threatening states, psychosis and psychotic states, usually something like a suicide attempt or some kind of crisis. It wasn’t because people had recognised they weren’t well. That usually meant the police were involved, which was completely ridiculous.

Here’s someone with a mental illness, and they’re being treated like a criminal.

So we had a lot of work to do, first of all, to try to make sure that the problem was picked up earlier, and also that the person was engaged in treatment in a much more engaging and non-traumatic way. And secondly, when they did get treatment, that they got a whole range of things, like psychological support, social support, vocational support, not just medication, because medication alone was really insufficient to help them recover.

So treatment has to be holistic if it’s going to work, basically?
Absolutely. And we developed that holistic model for a few years, which over the last 20 years, has really transformed care in many, many places around the world about early intervention for psychosis. That was kind of the first wave of reform that we kicked off.

On the back of that, when Orygen was set up in 2001, we decided to go for the full range of mental health problems in young people. Not just the more severe end, but everything. We also realised that if we were going to help young people, there were tens of thousands of them even in our own local area that needed help, not just a few hundred that we were treating. So we developed something called headspace, which became a national programme.

headspace was like the entrance hall and maybe the front room of our new youth mental health system for young people. You didn’t have to go through the third degree to get in, and get help, and that’s still the case.

What is it that makes headspace a trusted space for young people to go to? What’s going to make them feel comfortable?
Well, first of all, young people had a major role in designing the décor, and the style of practise. Youth participation was a big thing, and it is at Orygen as well. We wanted to make the services that young people had a stake in, so it would feel right for them.

The other thing is, being in primary care, any problem is okay to go in and talk about and get help with. You don’t have to have a really serious or definable problem. There’s no kind of screening-out of people. I think that blanket acceptance, coming in, is very important. And then word of mouth spreads the trust.

headspace has opened a branch at Bondi Junction. Are you familiar with the particular mental health needs of the youth community in the eastern suburbs of Sydney? Do they have particular needs?
I guess there are some differences in the needs of different communities around Australia. Like in Collingwood, in Melbourne, where we have a headspace, something like 48% of them are LGBTIQ. It just happens that that local community has got a lot of young people who are gender diverse.

So there are some variations, but you know what’s very interesting is, even though everyone thinks their community’s different, the needs are pretty common across most communities for young people. They just want to have a good social life, have good vocational opportunities, jobs and training, and education. They want somewhere that’s safe to live.

By and large, young people are just young people.

We try to help young people in this transition from childhood to adulthood, because it’s challenging for anyone, even if they’re the most resilient person in the world. If they develop mental health problems during that period, it really makes it very difficult for them. If you’re going to have mental health problems, they will have mostly appeared in 75% of cases by the age of 25. I’d say especially in that 18 to 24 period, when young people are kind of a bit more adrift from their family of origin, and their peer group’s a bit fragile, maybe. That’s when they’re really at risk.

Is financial situation a barrier to accessing help at headspace?
No. Services at a headspace centre are either free or have a low cost, and you can ask if there is a cost when you make your appointment.

Although, we are having trouble with that, because the grant that the government gives has not increased for six or seven years, so the headspace centres are struggling financially, now, for the first time.

You’ve said mental health is like the “poor relative” in terms of budget policy…
Financially, it’s just a disgrace. I’ve used the word “apartheid”. 5% of the health budget is spent on mental health. Somewhere between 13% and 20% of the burden of disease, is caused by mental illness, and we get a lousy 5% of the health budget.

It’s simply the result of discrimination. You’ve got a serious health problem, which kills people, which disables people at a level that’s greater than cancer and heart disease, actually, and has much greater economic impacts because of the time in the life cycle, but governments do not fund it.

If you had unlimited funds, how would a coherent national mental health strategy look to you?
Okay, well, I think first of all, we’ve got to have a really strong, easy-to-access front end which is like headspace in our world. Then you’ve got to back it up with really specialised expertise, which you do get if you have, say, chest pain and you go to the GP. You can access a team of cardiovascular experts, who will make sure that you get world-class care, no matter where you live. But in mental health, even if you get in the front door through headspace, the specialist expertise is very sparse.

About a third of the young people in headspace centres cannot get the next level of care that they need. It’s like a war zone. If you go to an emergency department on any night of the week, you’ll see all these young people in absolutely desperate situations, who can’t get into anything better than the basic level. When you look at something like eating disorders, or like complex mood disorders, there are hardly any specialised units in Australia for that.

You’ve said in the past that a firm environment can be particularly conducive to fostering ill mental health. I don’t know if you’re aware, but the proportion of lawyers living in the eastern suburbs is off the chain. Could you give some advice to people working in such firm environments about how to sustain positive mental health?
I think the legal profession is beginning to realise that its culture is pretty toxic and unsupportive of young people with mental health problems, and that there has been tremendous pressure to not actually disclose and seek help. There’s something about the culture of these big firms, and the professions. It’s very short-sighted, because you’re wasting these incredibly powerful resources, and talented people.

In terms of how individuals can help themselves, aside from systemic change… physical exercise is very important. When I was at Uni in Sydney, I lived at Maroubra and I used to surf at Maroubra and at Bronte all the time, which was very calming. Don’t self-medicate with alcohol and drugs. What else can we say? The work-life balance is interesting. If you really love your work, and you’re not burning out from overwork, then I think it’s not a problem. But if you’re really not getting fulfilment from your work, that’s something to think about.

If you want to change cultures, like workplace cultures, it’s not just a matter of convincing the bosses and letting them take it from there. Organising grassroots initiatives in a firm culture is another way to do it, bottom-up as well as top down.

You have called detention centres “factories for producing mental illness.” Can you speak to this?
Well, this has been a massive failure on the part of both sides of politics. I mean, they’ve both really sunk to the bottom, the lowest common denominator, on this issue. They’ve pretended it’s about saving lives at sea, and obviously that was a priority. But the boat turn-back seemed to have done that, so I just ask the question:

Why do we feel the need to continually persecute genuine refugees who have been heavily traumatised, just simply because their timing was wrong at the point that they tried to get to Australia?

I think this is something that probably the majority of Australians now feel very uncomfortable about. I’ve seen hundreds of asylum seekers as patients over the years, and I think if any Australian really sat down and put themselves in their shoes, they would behave in exactly the same way to try to come here. If that’s the case, then why are we treating asylum seekers this way?

Well if you go off something like the taped conversation between Turnbull and Trump about the refugee exchange policy, it seems to be a case of dehumanisation being politically expedient.
Yes, I found that very hard. I know Malcolm Turnbull personally, and I know Bill Shorten personally. I get on very well with them, I think they’re very humane people. But it just shows the power of this issue to lock people into things that probably both of them realise are not the right thing. But somehow, we’ve got to break out of this straitjacket of terrible policy.

That leads us to another big issue that politicians seem to be straitjacketed into, which is the marriage equality debate – something that affects the mental health of LGBTQI Australians, certainly.
Yeah, I mean, it’s bizarre, because both leaders are 100% behind it, and yet internal dynamics with minorities within the government, seem to be dictating what’s happening, and it’s clearly harmful.

We have a lot of LGBTQI patients who are affected by this [postal survey]. I mean, it sounds subtle, but what people are saying to them is that whether they have equal rights is debatable, and there’s a debate about whether their sexuality is acceptable or not.

No one else is able to debate those sorts of issues about heterosexual people, you know?

I have a son who was part of the campaign in Ireland for the marriage equality referendum there, which was necessary in Ireland. It’s not necessary here. He’s very clear about how damaging it was, for LGBTQI people in Ireland, because of the kind of intolerant attitudes that were given platforms publicly over a period of weeks.

Popular culture has long embraced stereotypes of the “psycho” and the “crazy chick” for narrative and shock value. Why does this need to stop?
Well why is it not okay anymore to use racist or sexist terms like it was 20 or 30 years ago, but it’s still okay for anyone, including politicians or media, to use words like psycho or nut job or crazy or whatever. You hear leading politicians using those terms, especially nut job, when they’re describing behaviour they don’t agree with, or they think is irrational. That’s very hurtful to people with mental illness, and to the people that look after them, and the people who live with them. That hasn’t been challenged very much, has it?

And are pop culture attempts at “nuanced” representations of mental illness, like Netflix’s 13 Reasons Why, a detriment or a benefit to global dialogue about, and progress in, mental health?
Yeah, well, I mean I think I’ve got mixed feelings about 13 Reasons Why, because I think it’s really important that suicide is front and centre in public discussion. It was covered up like domestic violence for years. It was covered up with the support of the mental health professions, because of their fear of contagion and copycat, which is an issue, but they didn’t think about the much greater damage of not talking about it at all, and how many deaths that’s actually caused because of the fact that people don’t feel it’s okay to talk about it. Also, the public have not realised it is such a huge issue. It’s twice as big as the road toll.

So I think we should have an account.

I think we should actually report individual suicide cases, in the same way that we report road deaths.

We can manage the contagion risk in other ways, like by not glamorising it, not sensationalising it, not making it look attractive as an option, which has been some of the criticism of TV programmes like 13 Reasons Why. But I don’t really think it glamorised it, actually. I watched it, and I don’t think it was realistic, but I also don’t think it was a problem to show the actual act. A number of other mental health professionals got very upset about them actually showing it. I mean, everyone knows if you cut your wrists you might die. I don’t see publicising suicide as so much of an issue, unless it’s a celebrity.

If you yourself are fighting this uphill battle all the time, obviously you need to rely on other people. So who are the people in your life that you get strength from, to keep doing what you do?
Well, my colleagues. We have a whole range of people who are absolutely committed and determined, especially at Orygen. I’ve got friends like Ian Hickie, who works in Sydney. He’s another fearless campaigner for mental health reform and investment. There’s quite a lot of people.

But the one thing I’d say about that is, we need a grassroots movement if we’re going to change this issue. We need to have hundreds of thousands of Australians mobilised to demand the same sort of rights that people with cancer and heart disease get in terms of healthcare. Even sympathetic politicians – and I think the Prime Minister in your electorate there is sympathetic, he does care about suicide and he’s actually tried to do something to prevent suicides at the Gap – won’t do anything unless they see that it’s high up in the public’s agenda. So we’ve set up an organisation called Australians For Mental Health, which is going to be a grassroots campaign/organization/social movement. That’s going to be getting stronger over the next few months, and readers should get involved in that.

What do you see as the future for headspace, and for yourself?
Well, every community in Australia should have a headspace, or access to one, and every headspace should be backed up with expert care, so it’s not just sitting out there like a shag on a rock, doing the basic stuff without real solid support from multi-disciplinary teams of experts. I just want to remain involved, and playing a part.

Keep fighting the fight, basically?
Yeah. But I want to win it.