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11 Comments

  1. 1

    Daniel Reeders

    Great post, thanks Michelle.

    Reply
  2. 2

    ravenm

    Hi Sebastian. You have said that EPPIC is evidence-based and has been rigorously evaluated. What are you basing this on? Please could you cite specific references? Thanks. Melissa Raven

    Reply
  3. 3

    srosenberg

    Hi Melissa

    I understand you have already been furnished with considerable evidence directly from Prof McGorry and others. It seems you do not find this evidence convincing.

    EPPICs are not the only part of what will be required to reform mental health in this country. In addition to a range of new services and programs, I think there is also an urgent need for a review of governance arrangements to address the federal/state ambiguities which have contributed to neglect of mental health over decades.

    I note the comments you made on The Conversation some time ago, in which you stated your belief that the existing public mental health system is not “beyond redemption” and would be a better place to direct new invest than to EPPIC:

    http://theconversation.com/evaluating-evidence-for-early-psychosis-prevention-and-intervention-centres-eppic-3604#comment_11595

    I am not sure what evidence you are drawing on to assert this but it is an odd turn of phrase. It is to my mind of course not the system that needs redemption, but the consumers and carers now being let down daily by this ‘system’.

    Frankly I do not share your confidence that real reform of mental health can come from within the public mental health system, particularly if we are to push community-based care and early intervention. Over recent years, the public system has run these services down and new funding has been directed to old models of hospital-based care. In this context, services like EPPIC become very important.

    Reply
  4. 4

    ravenm

    Thanks Sebastian. I am happy to answer your question about the evidence basis for the comment I made a year and a half ago, and I will do so later today (I need to refresh myself on the context and issues and evidence). Meanwhile, please could you answer my questions about the basis of the comments you made yesterday about the evidence-base and rigorous evaluation of EPPIC? You are correct that I do not find the evidence convincing, so I am wondering what evidence you find convincing.

    Reply
  5. 5

    srosenberg

    Hi Melissa

    There is now a wealth of data in this area which has convinced me, both Australian and international, including that listed under the Publications area of the the EPPIC website. I also refer to feedback provided to me by service users and their families, and also from the NGOs with which EPPIC works.

    Hope this helps.

    Sebastian.

    Reply
  6. 6

    ravenm

    Hi Sebastian
    You said EPPIC was ‘rigorously evaluated’ and is ‘evidence-based’. Surely, as a Senior Lecturer and published academic author, you can cite a specific reference that actually supports each of those claims, rather than referring to non-specifically to ‘a wealth of data’?
    Thanks, Melissa

    Reply
  7. 7

    ravenm

    Hi Sebastian
    You asked what evidence I was drawing on in asserting my belief that the existing public mental health system is not “beyond redemption” and would be a better place to direct new invest than to EPPIC.
    I did not advocate funding the existing system without substantial change – there is a lot wrong with it (and with the broader health system). Redemption involves substantial change (and I find your suggestion that it is consumers and carers who need redemption odd, because redemption implies failings that need to be fixed).
    I said that there were multiple possible options apart from massively boosting EPPIC, including but not limited to increasing resources to existing child/adolescent and adult mental health services. I also mentioned boosting community services, which it seems we both advocate. I mentioned vocational support as one type of community service, and I think there is also a huge need for investment in housing/accommodation (in terms of both housing stock and support services).
    I also think that real reform of mental health cannot come from within the public mental health system – it needs much broader change than that, within the broader health system, the welfare system, education, employment, the legal/justice system, both for people with mental disorders and for the broader population (social determinants of mental health need to be addressed, not just social inclusion of people with problems).
    In terms of evidence that the existing public mental health system is not beyond redemption, the ‘People living with psychotic illness 2010’ survey http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-pubs-p-psych10 found relatively high levels of satisfaction and needs being met on multiple indicators (e.g. 62.2% of those with a case manager (69.2% of participants) reported being very satisfied with their case manager), as well as low levels on other indicators (particularly non-health-related outcomes)) – lots of improvement needed, but not grounds for writing the system off.
    NB: The people included in the survey are not representative of all people who develop psychosis, many of whom substantially recover:
    Mojtabai et al. 2003 Clinical Characteristics, 4-Year Course, and DSM-IV Classification of Patients With Nonaffective Acute Remitting Psychosis http://ajp.psychiatryonline.org/article.aspx?articleid=176532
    Zipursky et al. 2012 The Myth of Schizophrenia as a Progressive Brain Disease http://schizophreniabulletin.oxfordjournals.org/content/early/2012/12/04/schbul.sbs135.long
    Psychosis is not inexorably progressive/chronic (despite many such claims). Many potential EPPIC clients would have much better outcomes than the people in the survey, without specialist early intervention services.
    But long-term evidence for people with less chronic disorders is hard to find, because people whose problems resolve have much less contact with treatment services (fuelling the clinician’s illusion). And most Australian mental health service statistics are about provision of services, not outcomes.
    Still waiting for you to cite specific reference(s) to support your much stronger assertions about EPPIC being ‘rigorously evaluated’ and ‘evidence-based’.
    Melissa

    Reply
  8. 8

    srosenberg

    Hi Melissa

    Thanks for this and your reply. The best reference which pulls together the evidence I refer to is the report prepared by Orygen for the now defunct National Advisory Council on Mental Health. You can find the report here:

    http://www.health.gov.au/internet/main/publishing.nsf/Content/C1A49DEC3BC514E5CA25792B00781998/$File/earlypsy.pdf

    Hope this is helpful.

    Seb.

    Reply
  9. 9

    ravenm

    Thanks Sebastian
    So no primary references? Just an Orygen report that misrepresents pre-EPPIC as ‘standard care’ (pp. 22, 29, 30) – and misleadingly implies that a sample of 32 patients is a ‘large sample’ of 723 patients (p. 16)?Melissa

    Reply
  10. 10

    johnny

    the reality– psychosis and all mental health/psychiatric diagnosis are misery claims by people with misery in their eyes, drugging people sick with poison, nothing more nothing less,that’s right insanity in the mix,and that’s without a doubt,and if i am wrong let them who say otherwise,allow those their poisoning to put it to a test, they wont will they, that’s a fact also,I’ve never seen anyone being poisoned not to get sicker and sicker as time goes by,more in despair,sadder and sadder, I’ve never seen any get better, that’s a fact also,the fact is everyone can have a severe mental health problem that can be seen as any one of the 300 odd sick tags available in the psychiatric bible,how dare anyone call anyone sick till the end of time, and then poison them with insanity until the end of time,when these people just want to be free of that insanity being forced into them, play with the clever words as much as you want, but you will never take that out of the mind or the heart of the oppressed,or their family’s heart and mind,who have to watch as these tyrants poison and destroy the life the trust and the hope out of their loved one. And to anyone who challenges that with blah blah blah,i just hope someone does it to you, and then when you come into a blog page to tell your truth, your pain, your reality , someone scoffs at you, and tells you your wrong, and then injects you with some more poison so you can get better, because that,s how these tyrants are responding to the cries of the people they oppress and poison, our children, our brothers and sisters, our mothers and fathers,us. And that’s a FACT. Your sick, take this, be sick,get sick, act sick , stay sick, there is no recovery, there is only management by, us, the people poisoning you with sick, in words and poison, incarceration and when all that fails as you reach tolerance to all the different poisons and combinations of poisons,we are going to electrocute you silent, and so broken down you will never challenge us again.

    Reply
  11. 11

    ihaywood

    I never quite worked out what the EPPIC “secret sauce” really is: from the outside they seemed to offer the same CATT team/case-management/inpatient ward model as the other State area services.
    Despite 6 years of psychiatry training in Victoria, much of it in the West, I’m forced to guess how our flagship evidence-based service actually works. Yes, I could have taken better notes in the I think 2 lectures we got from Orygen consultants, my point is for all their clinical successes they have failed woefully to engage with psychiatrist training.
    After 20 years they should have a significant cadre of consultants all over the place who have worked there and know what they do, instead from a training point of view it’s like Willy Wonka’s chocolate factory (“no-one goes in and no-one comes out…”)
    In fairness it’s not all their fault: it’s not like McGorry could have just put an ad for psychiatry registrars in the Age classifieds: training is tightly regulated by the psychiatry college, but over the years EPPIC could have done a lot more to integrate with existing adolescent psychiatry training and make training positions available.

    Reply

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