Australian of the Year Patrick McGorry’s call for early intervention to prevent Psychosis: A Stitch in Time or a Step too Far?

No sensible person would argue against Australian of the Year, psychiatrist Patrick McGorry’s call for early intervention to prevent psychosis; unless of course you know the detail of what Professor McGorry has advocated as early intervention. Put bluntly, Professor McGorry has advocated the use of antipsychotics, with a host of serious potential adverse side effects, on the hunch that adolescents may later become psychotic.

Specifically Professor McGorry is a leading international advocate for the inclusion of Psychosis Risk Syndrome, otherwise known as Attenuated Psychotic Symptoms Syndrome, in the next edition of the clinically dominant Statistical Manual of Mental Disorders (DSM-V) due for publication in 2013. He acknowledges that ‘the false positive rate may exceed 50-60%’ nonetheless has justified the use of pre-psychosis drugs by arguing ‘all those identified are by definition seeking help and need some form of care’.[1]

Criticism of his views on the use of pre-psychosis drugs have received limited publicity within Australia. However, in 2006 Time Magazine (Drugs before Diagnosis) stated ‘Calm and softly spoken, McGorry has a way of making the experimental use of antipsychotics seem like the only responsible course.’ Time outlined how Professor McGorry trialled the antipsychotic, Risperidone, on subjects without psychosis but that were suspected of being at risk of developing psychotic disorders such as schizophrenia.[2]

Risperidone (also known as Risperdal) is one of the more commonly used antipsychotics and has a range of serious potential side effects including metabolic syndrome, and sudden cardiovascular death.[3] [4] There have been more than 500 voluntary adverse event reports made to the TGA and these are just the tip of the iceberg as the vast majority of adverse events are never reported. [5] [6]

The results of Professor McGorry’s Risperidone trial were inconclusive; however Time describes McGorry’s determination to push on ‘full steam ahead – and damn the torpedoes.’[7] And Professor McGorry did push ahead, but now many of his international colleagues in the psychiatric profession are pushing back.

Dr Allen Frances the American Psychiatrist who led the 1994 revision of the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) is a fierce critic of Psychosis Risk Syndrome. With the benefit of hindsight he regrets aspects of the 1994 revision for having triggered ‘three false epidemics. One for autistic disorder… another for the childhood diagnosis of Bi-Polar disorder and the third for the wild over-diagnosis of Attention Deficit Disorder.’[8] Based on this experience Dr Frances warns of numerous problems with the drafting of the next edition DSM-V, recently writing that;

‘Among all the problematic suggestions for DSM-V, the proposal for a “Psychosis Risk Syndrome” stands out as the most ill-conceived and potentially harmful… The whole concept of early intervention rests on three fundamental [flawed] pillars… 1) it would misidentify many teenagers who are not really at risk for psychosis; 2) the treatment they would most often receive (atypical antipsychotic medication) has no proven efficacy; but, 3) it does have definite dangerous complications.”[9]

Dr Frances contends that up to 90% of those diagnosed with Psychosis Risk Syndrome would never go onto develop psychosis and concludes it is ‘the prescription for an iatrogenic [adverse effects resulting from treatment] public health disaster’.[10]

Critics closer to home include Adelaide University Associate Professor, and Head of the Department of Psychological Medicine at the Women’s and Children’s Hospital in Adelaide, Dr Jon Jureidini, who in the August 2010 said that Professor McGorry had falsely claimed that 750,000 young Australians were ‘locked out’ of care they ‘desperately’ needed. ‘He’s taken the biggest possible figure you can come up with for people who might have any level of distress or unhappiness, which of course needs to be taken seriously and responded to, but he’s assuming they all require … a mental health intervention…It’s the way politicians operate. You look at figures and put a spin on it that suits your point of view. I don’t think that has a place in scientific conversations about the need for health interventions.’[11]

Even one of Professor McGorry’s colleagues at the Orygen Youth Health Research Centre, Alison Yung, recently expressed strong opposition to the inclusion of Psychosis Risk Syndrome in DSM-IV stating;

‘I think the issue of antipsychotics is a crucial one. If someone meeting risk syndrome criteria also has depression and anxiety (the majority do), could they not be treated with psychological therapies such as cognitive behavioral therapy? So why the need for a specific risk syndrome diagnosis? Is the agenda really to use antipsychotics? …….I think there are concerns about validity, especially predictive validity, and this relates to potentially stigmatizing and unjustified treatment for some individuals as well as all the negative social effects of diagnosis. I think including the risk syndrome in the DSM-V is premature…….more people seek help, but the risk is that instead of getting maybe supportive therapy, they get antipsychotics and they will be diagnosed with the risk syndrome.’[12]

Perhaps due to his Australian of the year status Professor McGorry is frequently quoted by the Australian media as an independent advocate for mental health reform. However he, and organisations he is influential in, have received support from the pharmaceutical industry.  Along with being treasurer and former president of the pharmaceutical industry funded International Early Psychosis Association,  McGorry is currently Director of Clinical Services at Orygen Youth Health Clinical Program and Executive Director of the Orygen Youth Health Research Centre. Orygen Youth Health Research Centre receives support from numerous pharmaceutical companies.[13] [14] Professor McGorry individually has received unrestricted grants from Janssen-Cilag, Eli Lilly, Bristol Myer Squibb, Astra-Zeneca, Pfizer, and Novartis and has acted as a paid consultant for most of these companies.[15]

Professor McGorry and his colleagues Professor John Mendoza and Professor Ian Hickie (who also recive support from the pharmaceutical industry) dominated the long overdue debate about mental health policy in the lead up to the August Federal election.[16] [17] Anyone who watched Insight on SBS (27 July 2010) would have noticed how deferential the presenter, politicians and participants were to Patrick McGorry, and to a lesser extent John Mendoza. Their blessing was desperately being sought by Peter Dutton and Mark Butler on behalf of the Coalition and Labor respectively.

Most enamoured of Professor McGorry’s approach was Dutton who stated “Well, we’re going to roll out a national scheme based on advice by people like John Mendoza, Pat McGorry, Ian Hickey, David Crosby and others….early intervention is proven without any doubt to work.”[18] Mendoza reciprocated Dutton’s admiration describing the Coalition’s approach as “streets ahead. It’s literally comparing an old clunker to a brand new motor vehicle.” Largely due to the advocacy of Professor McGorry and his allies Mental health was unquestionably a net positive for the Coalition in the election.

Professor McGorry is now pressuring the Gillard Government to match the Coalition’s 2010 election commitment of $440m to EPPIC (Early Psychosis Prevention and Intervention Centres)  like those run by Orygen Youth Health which is headed up by McGorry.[19] These centres aim “to facilitate early identification and treatment of psychosis” and “reduce delays in initial treatment”.[20] It is undeniable that early intervention in the form of identifying and addressing real problems must be supported. But the majority of Adolescents ‘seeking care’ and diagnosed with Psychosis risk Syndrome would not only suffer their original difficulties but posibly from the unnecessary administration of potentially harmful antipsychotics. Professor McGorry has justified this compromise of the Hippocratic obligation to ‘first do no harm’ by arguing the ‘real danger of lack of care overshadows the theoretical one of premature labelling and overtreatment.’[21]

Irrespective of these concerns there is no doubt Professor McGorry is a fantastic salesman. He combines excessive pessimism about the widespread prevalence of mental illness and unmet need, with optimistic promises of ‘21st Century’ solutions (which happen to have been developed by him and his allies) if only government will urgently fund these ‘proven approaches’.[22]

Mental Health does deserve the national spotlight and we can be grateful that Patrick McGorry’s appointment as Australian of the Year put it on the agenda. But the public are entitled to and informed debate about exactly what is being advocated.

Access to appropriate early intervention in mental health is long overdue, however prescribing antipsychotics to adolescents on the outside chance that they may develop later psychosis, is a bit like killing a fly with a shotgum.

[1]McGorry also stated “Early intervention covers both early detection and the phase specific treatment of theearlier stages of illness with psychosocial and drug interventions. It should be as central in psychiatry as it is in cancer, diabetes, and cardiovascular disease.” McGorry P.D. ‘Is early intervention in the major psychiatric disorders justified? Yes’, BMJ 2008;337:a695 3 August 2010)[2] Time Magazine also identified how McGorry ‘…wants to apply the principle of early diagnosis and treatment to “a range of mental health problems in young people: substance abuse, personality disorders, bipolar – the whole lot, really.’ Williams, D (18 June 2006) Drugs Before Diagnosis? Time Magazine,9171,1205408,00.html (accessed 18 November 2010) [3] Consumer Medicine Information: Risperidone (accessed 3 August 2010)

[4] Webb, D. & Raven M. ‘McGorry’s ‘early intervention’ in mental health: a prescription for disaster’ Online Opinion (6 April 2010) (accessed 18 November 2010)

[5] Adverse events information related to Risperidone obtained from the Therapeutic Goods Administration’s Public Case Detail reports

[6] As reporting is voluntary there is now way of knowing what proportion of actual adverse events gets reported. A 2008 study by Curtin University pharmacologist Con Berbatis indentified that only a tiny fraction (for general practitioners only 2 per cent) of adverse events are reported. (Con Berbatis, ‘Primary care and Pharmacy: 4. Large contributions to national adverse reaction reporting by pharmacists in Australia’, i2P E-Magazine, Issue 72, June 2008, p. 1)

[7] Williams, D (2006) Drugs Before Diagnosis? Time Magazine,9171,1205408,00.html

[8] Frances, A in Whitely, M (2010) Speed Up and Sit Still: The Controversies of ADHD Diagnosis and Treatment p.18 UWA Publishing, Crawley, Western Australia

[9] Frances, A (2010) DSM5 ‘Psychosis Risk Syndrome’—Far Too Risky Psychology Today

[10] Frances, A (2010) DSM5 ‘Psychosis Risk Syndrome’—Far Too Risky Psychology Today

[11] The Age Julia Medew August 9, 2010 McGorry Misleading the parliament

[12] Schizophrenia Research Forum, Live Discussion: Is the Risk Syndrome for Psychosis risky Business Posted 4 October 2009

[13] McGorry was the former President and is the current Treasurer ( of the “International Early Psychosis Association” which is funded by antipsychotic manufacturers Astra Zeneca, Lilly and Janssen-Cilag (

[14] McGorry is currently Director of Clinical Services at Orygen Youth Health Clinical Program and Executive Director of the Orygen Youth Health Research Centre. Orygen Youth Health receives support from AstraZeneca, Bristol Myer Squibb, Eli Lilly, and Janssen-Cilag. Orygen Youth Health, Research Centre – Other Funding (accessed 3 August 2010)

[15] McGorry individually has received unrestricted grants from Janssen-Cilag, Eli Lilly, Bristol Myer Squibb, Astra-Zeneca, Pfizer, and Novartis and has acted as a paid consultant or speaker for most of these companies McGorry P.D. ‘Is early intervention in the major psychiatric disorders justified? Yes’, BMJ 2008;337:a695 (accessed 3 August 2010)

[16] Professor Mendoza was co-author of the “Not for Service” report which was issued in 2005.  Apart from the Commonwealth Govt, the report was funded by unrestricted grants from AstraZeneca, Bristol-Myers Squibb, Eli Lilly Australia, GlaxoSmithKline, Medicines Australia, Pfizer Australia and Wyeth. (Not For Service: Experiences of Injustice and Despair in Mental Health Care in Australia, Mental Health Council of Australia, Canberra, 2005 (3 August 2010)). He is also a principle of ConNetica Consulting Pty Ltd, whilst they have very broad purposes such as providing a review, survey and planning service to government and not for profit organizations, including those involved in mental health. It currently lists Eli Lilly as one of its private sector clients (ConNetica Consulting, About Us (accessed 3 August 2010))

[17] Professor Hickie and colleagues created the ‘SPHERE: A National Depression Project’ ( As was reported in The Australian Pfizer work in conjunction with SPHERE through a company called Lifeblood who are paid to review SPHERE. Through the use of SPHERE Pfizer have restored Zoloft to the number one antidepressant in Australia. ( Professor Hickey received the following grants totalling $411,00 from pharmaceutical companies: $10,000 from Roche Pharmaceuticals (1992); $30,000 from Bristol-Myers Squibb (1997); $40,000 from Bristol-Myers Squibb (1998-1999); $250,000 from Pfizer Australia (2009); $81,000 from Pfizer Australia (n.d.) Cited in Ian Hickie, Curriculum Vitae, last updated 23 August 2009 (3 August 2010) Some of these research funds were for a trial for a new antipsychotic medication.

[18] Insight SBS television 27 July 2010 transcript available at

[19] $440 million of this has been allocated to Early Psychosis Prevention and Intervention Centres and an additional $255 million to “Headspace”, where McGorry and Hickie are directors.

[20] Orygen Youth Health, EPPIC: About Us (3 August 2010)

[21] McGorry P.D. ‘Is early intervention in the major psychiatric disorders justified? Yes’, BMJ 2008;337:a695 (3 August 2010)

[22] Address to the National Press Club Canberra by Prof. Patrick McGorry July 7, 2010

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  1. Paddy’s avatar

    I’d be interested to know what the process is for getting disorders/syndromes incorporated into each edition of the DSM. Seems like it depends somewhat on the popularity of a disorder’s proponents!


  2. martin’s avatar

    The short answer is that sub-committees of the American Psychiatric Association consider new disorders and modifications to existing disorders for inclusion in the DSM. Votes are rarely taken it is usually by concensus and historically most members of the sub-committees have ties to the pharmaceutical industry.


  3. Duncan’s avatar

    Mcgorry is a dangerous fraud who has a completely wrongheaded approach to mental illness. The evidence of the harm that neuroleptics do to adults is mounting and giving them to children is unconscionable. Their effect in the long term is to turn transient disorders into chronic ones. I am still withdrawing from mirtazapine and seroquel and it has been horrendous: insomnia, nausea, dizziness, frequent convulsive spasms, mood swings and more. I would go back to how I was before in a second compared to how I am now. These medications are worse than heroin, meth, cocaine or any of the other serotonin boosters. They are poison and Mcgorry must be stopped in his quest to get every vulnerable person addicted to them for life.



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