Since Professor Patrick McGorry was appointed 2010 Australian of the Year, mental health has had a remarkably prominent public profile.
GetUp has played a major role, with a campaign promoting McGorry's call for radical reform, particularly in relation to youth mental health, arguing that early intervention should be the norm. Many Australians have enthusiastically responded, donating money, signing a petition, and sending faxes to politicians.
A further impetus came when Adjunct Professor John Mendoza dramatically resigned as Chair of the National Advisory Council on Mental Health (or, as he terms it, “head advisor to the Rudd Government on mental health”) and joined the GetUp campaign. Mendoza endorses many of McGorry's demands, including a national rollout of headspace youth mental health centres and the Early Psychosis Prevention and Intervention Centre (EPPIC).
McGorry and Mendoza are adept at capturing media attention, using emotive statistics and feel-good messages as powerful soundbites. However, few people seem to have critically examined their claims, which have been widely accepted at face value.
We have examined several claims, and found them seriously problematic. Not only is there a high degree of spin in the rhetoric but also there is misrepresentation of evidence.
Two claims are analysed here. In each case the evidence cited to justify the claim, although relevant, does not support it, and other evidence challenges the validity of the claim.
Claim: One third of Australian suicide cases had been discharged inappropriately
According to Mendoza, more than a third of Australians who kill themselves had been discharged too early or without care from hospitals. This claim has been publicised by GetUp on its website and in emails from Mendoza about his resignation distributed to GetUp members.
Mendoza has confirmed to one of us (JJ) that the basis is the 2007 New South Wales Tracking Tragedy report. The introduction of that report does refer to “a third of suicides”:
Other systematic reviews of suicide and previous work of this Committee suggest that around a third of suicides may realistically have been preventible [sic] with more optimal care.
However, the report does not support Mendoza's claim, because it focuses specifically on 113 cases of suicide by people receiving treatment for depression in community mental health settings, not on suicides in the general population. It is tragic that approximately 38 suicides might have been prevented, but this number is hundreds less than one-third of the 1,776 suicides in the NSW population in that period (2003-2005 inclusive). Furthermore, only 14 (12 per cent) of the 113 people had been discharged (figure 1, p34), appropriately or otherwise.
An earlier Tracking Tragedy report revealed there were about 20 suicides annually in NSW within 28 days of discharge. It concluded that “Suicide death on discharge from hospital is a rare event”.
In the period covered in that report (1999-2003), there were approximately 750 suicides annually in NSW. The 20-odd people discharged within 28 days prior to suicide annually constituted only 2.7 per cent of them. Even if all those discharges were inappropriate, Mendoza's claim would be wrong by a factor of more than ten. However, the report concluded that only “Between one-quarter and one-third of suicide deaths following discharge from hospital could reasonably be prevented”. Taking the higher of those estimates gives approximately 7 out of 750 (less than 1 per cent), making Mendoza's claim more than 30-fold wrong.
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About the Authors
Melissa Raven is a psychiatric epidemiologist and policy analyst, an adjunct lecturer in Public Health at Flinders University, and a member of Healthy Skepticism.
Jon Jureidini is head of the Department of Psychological Medicine, Women's and Children's Hospital, Adelaide where he works in Consultation-Liaison psychiatry. He has academic status as Senior Research Fellow, Department of Philosophy, Flinders University and as Associate Professor in the Disciplines of Psychiatry and Paediatrics, University of Adelaide. He is spokesman for Healthy Skepticism Inc, an organisation devoted to countering misleading drug promotion. He is also a member of the Women's and Children's Hospital Patient Care Ethics Committee, and a chair of the board of Siblings Australia, an organisation which advocates for the needs of individuals with ill and disabled siblings. Publications in the last two years have addressed prescribing for children, immigration detention, suicide, and child abuse.