Posts Tagged ‘Allen Frances’

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Therapists revolt against psychiatry’s bible

Wednesday, December 28th, 2011

Mental health professionals say new diagnoses will lead to overmedication

Salon Magazine, December 27, 2011

by Rob Waters

“epidemics of over-diagnosis in child psychiatry” have caused "huge numbers of children to be unnecessarily labeled with attention deficit disorder and bipolar disorder and treated with medications."

Anyone who’s ever tried to get reimbursed by a health insurance company after seeing a psychiatrist or psychotherapist, or taking a child or teenager to one, has no doubt noticed the incomprehensible numbers that appear on the clinician’s statement, perhaps preceding some slightly less imponderable phrase.

Maybe you are a 296.22 (major depressive disorder, single episode, mild) or a 300.00 (anxiety disorder NOS–not otherwise specified). Hopefully, you are not a 301.83 (borderline personality disorder). Your kid might be a 313.81 (oppositional defiant disorder) or, more likely, a 314.01 (attention deficit hyperactivity disorder, predominantly hyperactive-impulsive type).

Since 1952, a tome called the Diagnostic and Statistical Manual of Mental Disorders, better known as the DSM, has been reducing to a few digits the psychological malady said to afflict a patient. This bible of mental health treatment, published by the American Psychiatric Association (APA), provides a list and description of every mental health condition known to—or invented by—psychiatry, from histrionic personality disorder (301.50) to transvestic fetishism (302.3).

Over the decades, the manual, adapted from a guide for mental diseases developed by Army and Navy psychiatrists, has ballooned. The number of listed disorders tripled to nearly 300. A few have been discredited and dumped along the way. Most famous were battles over the inclusion of homosexuality. Successive iterations of the manual listed homosexuality as a “sociopathic personality disturbance,” then modified that to describe a more limited “sexual orientation disturbance” among people who were “in conflict with” their attraction to people of the same sex. That was later replaced by a disorder called “ego-dystonic homosexuality,” applied to those whose homosexual arousal was a source of distress. That item was dropped in the DSM-III-R, published in 1987.

The great book’s coming edition, the DSM-5, is slated for publication in May 2013. As the task force producing it has posted drafts on its website, an undercurrent of dissatisfaction has exploded into a full-scale revolt by members of U.S. and British psychological and counseling organizations. The chief complaint is that the newest version will lower the criteria needed to diagnose some conditions, creating “subthreshold” disorders, and generally making it easier for healthcare professionals to label a person with a psychiatric disorder and medicate him or her.

The latest rebellion against the DSM-5 began with a salvo from across the Atlantic. In June, a special committee of the British Psychological Society complained in a letter to the APA that “clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences.” The committee criticized the proposed creation of an “attenuated psychosis syndrome”—a sort of poor-man’s psychosis with less severe symptoms—“as an opportunity to stigmatize eccentric people.” They also objected to a proposed reduction in the number of symptoms needed to diagnose adolescents with attention deficit disorder (ADD) because it might increase diagnoses and the use of meds.

Then David Elkins, professor emeritus at Pepperdine University and president of the Society for Humanistic Psychology, a division of the American Psychological Association, formed a committee to discuss similar objections and draft a petition enumerating them. In October, he posted the petition online. “I figured we’d get a couple hundred signatures,’’ Elkins said.

The response stunned him and his colleagues. The petition attracted more than 6,000 signatures in three weeks; as of mid-December it had topped 9,300 signatories and garnered the endorsement of 35 organizations. On Nov. 8, American Counseling Association president Don Locke jumped in with a letter to the APA objecting to the “incomplete or insufficient empirical evidence” underlying the proposed revisions and expressing “uncertainty about the quality and credibility” of the DSM-5.

“This has become a grassroots movement among mental health professionals, who are saying we already have a national problem with overmedication of children and the elderly, and we don’t want to exacerbate that,” says Elkins.

For many critics, Exhibit A is childhood ADD. As the disorder describing fidgety, easily distracted kids morphed from “hyperkinetic reaction of childhood” to the current “attention deficit hyperactivity disorder,” the number of children given the diagnosis exploded, fueling, by one account, a 700 percent increase in the use of Ritalin and other stimulants in the 1990s. Diagnosis requires checking six of nine boxes from a list of symptoms that include “often does not seem to listen when spoken to directly” and “often fidgets with hands or feet or squirms in seat.” Sound familiar, parents?

Two other newly proposed disorders singled out as problematic in the petition are “mild neurocognitive disorder” in the elderly and “disruptive mood dysregulation disorder” in children and adolescents. Both lack a solid basis in research and may fuel the use of powerful antipsychotic medications, which cause weight gain, diabetes and a host of other metabolic problems, the petition says.

“We are gravely concerned that if this is published as is in 2013, it will create false epidemics where hundreds of thousands of children and the elderly who really are normal will be diagnosed with a mental disorder and given powerful psychiatric medications that have dangerous side effects,” Elkins says. “That is not tolerable.”

David Kupfer, the University of Pittsburgh psychiatrist who chairs the task force overseeing the manual’s preparation, says he expects the final number of disorders included in the DSM-5 to be about the same as in the current book. He says he welcomes the criticism and that nothing is final. The task force has been testing proposed new diagnoses in 2,300 patients at seven adult treatment centers and four adolescent centers that are acting as field-test sites, he says.

“There’s a myth that all the decisions have been made, when in fact, all the decisions haven’t been made,” he says. “Just because [things have] been proposed doesn’t necessarily mean they’ll end up in the DSM-5. If they don’t achieve a level of reliability, clinician acceptability, and utility, it’s unlikely they’ll go forward.”

The most surprising critic of the DSM is a one-time pillar of the psychiatric establishment. Allen Frances, professor emeritus at Duke University, chaired the task force that created the DSM-4. Now he’s railing against both the process and proposed content of the new DSM in blogs on the website for Psychology Today that blast the new revision as “untested” and “unscientific.”

Psychiatric diagnoses are loose enough already, Frances  told me, and that laxity has led to “epidemics of over-diagnosis in child psychiatry” causing huge numbers of children to be unnecessarily labeled with attention deficit disorder and bipolar disorder and treated with medications.

“DSM has to be a safe, reliable and credible guide to current clinical practice,” he says. “It can’t be an untested program for future research.’’

The user revolt against the DSM-5 has emerged as a major challenge to the document, Frances says, and its future is looking unclear. He and Elkins are proposing that an independent committee of experts review the proposed draft and make recommendations.

The fight over the DSM-5 pits some of the greatest minds and biggest egos in the world of psychiatry, but it’s more than a battle among 301.81s (narcissistic personality disorder). For people seeking help for life’s problems who don’t want to be labeled mentally ill or have their treatment limited to medication, and for clinicians who want to help people without reducing them to a category, the stakes are high.

http://www.salon.com/2011/12/27/therapists_revolt_against_psychiatrys_bible/singleton/

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Psychiatry bible ‘turns sorrow into sickness’

Saturday, December 3rd, 2011

The Age
By Jill Stark
December 4, 2011

IT’S been branded a “dangerous public experiment” that could turn normal human experiences into an epidemic of mental illness with healthy people being drugged unnecessarily.

In radical changes to the way mental health conditions are diagnosed, what was once considered a child’s temper tantrum could be labelled ”disruptive mood dysregulation disorder”. If a widow grieves for more than a fortnight she might be diagnosed with ”major depressive disorder”.

If a mother in a custody battle tries to turn a child against the father, it might create ”parental alienation disorder”.

These are among new conditions proposed for the fifth edition of the psychiatrist’s bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), due to be finalised next year.

Some doctors in Australia are arguing the revised manual – used globally to diagnose mental disorders – is pathologising unhappiness.

The changes have also caused an international outcry, with the American Counselling Association, American Psychological Association, the British Psychological Society and others calling for the draft of the new edition to be independently reviewed.

They fear it is so inclusive, it risks labelling millions of healthy people as mentally ill.

”It’s such a narrow and limited view of human experience, to want to reduce every bit of suffering to medical diagnosis,” said Jon Jureidini, professor of psychiatry at the University of Adelaide. He said the changes would lead to increased prescribing.

The authors say ”misinformation” about the manual, produced by the American Psychiatric Association since 1952, is creating unnecessary fear and any inclusions will be based on robust scientific evidence. Psychiatrist Ian Hickie, director of Sydney University’s Brain and Mind Research Institute, rejects claims that the new manual would medicalise unhappiness. ”When people are in pain and suffering elsewhere we don’t say people are pathologising that. We say, let’s try and do the best we can to relieve that and get them back to function in the appropriate way,” Professor Hickie said.

The rift reflects division within the mental health community over a global rise in the use of antidepressants, stimulants and antipsychotics, with many clinicians critical of drugs with potentially serious side effects being favoured over more costly talk-based therapies. Others argue that medication can be life-saving where other therapies have failed. The inclusion of conditions such as attention deficit hyperactivity disorder (ADHD) and autism in previous DSM editions is believed to have contributed to increased prescribing.

In the new edition, the diagnosis threshold for some existing disorders is also being lowered so that

over the death of a loved one can qualify as a major depressive illness.

The authors of DSM-5, however, argue that a bereaved person who is suffering from major depression is currently ineligible for that diagnosis, preventing them from getting help if they need it.

”A broad range of evidence … shows that there are little to no systematic differences between individuals who develop a major depression in response to bereavement and in response to other severe stressors – such as being … raped … or the loss of your treasured job,” Dr Kenneth Kendler, a member of the DSM-5 mood disorders group, said.

The changes also mean children only have to display six of 13 possible symptoms for a diagnosis of ADHD, compared with six of nine in the previous manual.

”Under the new criteria it’s almost harder not to get diagnosed with ADHD than it is to get diagnosed with it,” Martin Whitely, a West Australian Labor MP and anti-ADHD medication campaigner, said. ”There were about 60,000 Australian children on ADHD medications in 2010 – a lot of money has gone into marketing and selling the disease.”

One of the manual’s biggest critics is the man who developed the last edition, American psychiatrist Allen Frances. He told The Sunday Age the fact that the authors of the new edition have described it as a ”living document” makes it a ”dangerous public health experiment”.

”The DSM-5 is used in real life-and-death decisions – it shouldn’t be a set of hypotheses to be tested,” he said. ”The worst outcome of this would be all these suggestions get included and a lot of people get medicine they don’t need. But an almost equally bad outcome would be that psychiatry gets so tarred by this aberration that people who really need psychiatry and need the medicine stop taking it.”

http://www.theage.com.au/national/psychiatry-bible-turns-sorrow-into-sickness-20111203-1ocmm.html

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Those in favor of Psychiatry’s Billing Bible? The American Psychiatric Association. Against it? Just About Everyone else

Thursday, November 3rd, 2011

Click image to watch video (explaining in simple terms, what the “problem” with psychiatry is….)

Psychology Today – November 1, 2011

by Allen Frances, MD (Psychiatrist and former Chairman of the DSM task force)

So far, opposition to DSM 5 has been expressed by the following organizations: British Psychological Society; American Counseling Association; Society for Humanistic Psychology (APA Division 32); Society for Community Research and Action: Division of Community Psychology (APA Division 27); Society for Group Psychology & Psychotherapy (APA Division 49); Developmental Psychology (APA Division 7); UK Council for Psychotherapy; Association for Women in Psychology; Constructivist Psychology Network; Society for Descriptive Psychology; and the Society of Indian Psychologists.

An editorial by the Society Of Biological Psychiatrywondered whether DSM 5 was necessary at all. The community of personality disordersresearchers is virtually unanimous in its opposition to the DSM 5 personality disorders section. There has also been widespread opposition to the sections on somatic, autistic, gender, paraphilic, and psychotic disorders.

Last week, a petition was posted quietly be several divisions of the American Psychological Association. It demands reform of the DSM 5 process and the elimination of a number of its most risky and ill conceived proposals. The petition is gaining increasing support and has already been signed by almost 3000 people. It can be accessed at http://www.ipetitions.com/petition/dsm5/ )

Strikingly, there seems to be virtually no support for DSM 5 outside the very narrow circle of the several hundred experts who have created it and the leadership of the American Psychiatric Association (APA) which stands to reap large profits from its publication. There is no group and precious few individuals outside of APA who have anything good to say about DSM 5. And even within the DSM 5 work groups and the APA governance structures, there is widespread discontent with the process and considerable disagreement about the product.

http://www.psychologytoday.com/blog/dsm5-in-distress/201111/dsm-5-against-everyone-else

 

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DSM 5 in Distress—Seven Questions For Professor Patrick McGorry

Friday, August 19th, 2011

Psychology Today – August 18, 2011

by Allen Frances, M.D.

Psychiatry cannot promise more than it can deliver.

Whenever contradicted, Professor McGorry attacks the motives of the messenger rather than providing any reasoned rebuttal to the message.

The great news is that Professor McGorry has recently renounced the relevance of psychosis risk syndrome in the current practice of clinical psychiatry. He has done so in two separate and dramatic ways: 1) by withdrawing his support for the inclusion of psychosis risk in DSM 5; and 2) by promising not to include it as a target in Australia’s massive new experiment in early intervention. Psychosis risk syndrome is an extremely promising topic for ongoing research, but it is not nearly ready for current clinical application and if introduced prematurely could cause disastrous unintended consequences.

Professor McGorry’s sharp about face on both fronts could well be a wonderful double game changer. He is by far the most powerful psychiatrist in the world and an absolutely brilliant politician. Leveraging his unique stature as 2010 ‘Australian Of The Year,’ McGorry has succeeded in gaining the support of all the major Australian parties in the funding of a large and much needed investment in the country’s mental health. His new caution on psychosis risk will influence others to be less venturesome in prematurely promoting this potentially dangerous diagnostic proposal.

But a dark cloud surrounds the silver lining of having one psychiatrist in a position of almost unopposed influence. Professor McGorry has developed the messianic blind spot that is so common in visionary prophets. His zeal has made him an unreliable evaluator of scientific evidence, allowing him to defend absolutely indefensible positions with the convincing, but inaccurate, force of a true believer. A review of Professor McGorry’s public statements shows his willingness to ignore any evidence contrary to his belief, to change stated views back and forth when he regards this to be necessary or convenient, and to unfairly attack those who point out the fallacies and inconsistencies in his comments. His are the skills of a prophet and rainmaker, not those of a policy maker or a program developer or a sober reviewer of scientific evidence.

The most telling example of the McGorry blind spot was his ready dismissal of a recent Cochrane review that has discredited his extravagant claims for early intervention. This independent, systematic, comprehensive, and rigorous review of the scientific literature concluded there was insufficient scientific evidence to support McGorry’s grand assertions that early intervention programs promote enduring change and can reduce the lifelong burden and cost of illness. Early intervention does seem to be helpful temporarily while it is being provided, but does not seem to have any lasting impact on the course or cost of illness once it is stopped.

So, the Cochrane group lines up on one side and McGorry lines up on the other. Who to believe? The Cochrane group is widely credited for its impartiality and esteemed for its expertise in all aspects of scientific review. Its reports are considered a gold standard, exerting great influence on state of the art, evidence based medical practice throughout the world, particularly in Great Britain. One might expect that Cochrane’s stainless reputation would daunt a person even of Professor McGorry’s extraordinary power and blind conviction. But no. When the Cochrane report disappoints his expectations and fails to nourish his prejudices, McGorry feels no hesitation in attacking it, criticizing its methodology, and dismissing its discouraging conclusions. His rebuttal of the Cochrane group consists only of his personal endorsement of early intervention accompanied by the blithe (but empty) claim that it has strong supporting evidence. As far as McGorry is concerned, Cochrane be damned. Such idiosyncratic evaluation of scientific evidence cannot be trusted as a sensible foundation for mental health policy.

This is part of a pattern, not one isolated and exceptional instance of blind spot. Whenever contradicted, Professor McGorry attacks the motives of the messenger rather than providing any reasoned rebuttal to the message. His skill in the parry/thrust of the political sound bite is matched by an unwillingness to subject his views to anything resembling fact based discussion. When I expressed doubts about Dr McGorry’s excessive claims for his prevention model, he twisted my concerns to suggest that somehow I was defending the traditional US model of care against his innovative Australian model. This silly and totally incorrect attempt at diversion had not the slightest relevance to my two real motivations. Primary is the fear that by ambitiously overselling itself, psychiatry does a disservice to its patients and harm to its core mission and credibility. I believe strongly that scarce mental health resources must be judiciously spent to provide care for those who clearly need them- with continuity that starts with the first episode and lasts until they have either become well enough to do without or are dead. I therefore object to squandering vast resources upfront on those who may not need them using what are premature and still unproven methods. My secondary motivation (now somewhat assuaged by McGorry’s recanting, if he sticks to it) is the fear that the recognition of psychosis risk syndrome as an official diagnosis in DSM 5 and/or as a target in EPPIC programs will result in unnecessary stigma for the misidentified and dangerous off label overprescription of antipsychotic drugs.

McGorry has also tried to stifle his Australian critics- consistently evading their well reasoned and empirically supported arguments with the false innuendo that their motivation is simply to protect turf. His distraction technique employs catchy phrases (“Merchants of doubt do no favours for people with mental illnesses”) and dismissive insults (critics are a ‘cadre’). This so called ‘cadre’ of ‘merchants of doubt’ happen to be highly respected colleagues who are doing precisely what needs to be done- challenging McGorry in an open discussion of his excessive claims and of his idiosyncratic take on the literature. They are trying to protect Australia from blindly making a risky public health bet promoted by a stubborn ‘true believer’ who refuses to engage in meaningful dialog and cannot be unconvinced even by clearest evidence contradicting his personal belief system. It is crucial that scientists and policy makers always be honest and skeptical ‘merchants of doubt’ -not joiners in a parade of the credulous marching blindly off a cliff. McGorry needs to meet opposition with facts and rational debate, not innuendo and insult.

This brings me to my immediate purpose here. Let’s all get off the personal and focus instead on the issues. Below are seven questions that beg for Dr McGorry’s immediate public response. No evasion or questioning of my motivation is called for- just straight answers to simple questions. It will be useful for Professor McGorry to respond for the record now, before Australia’s makes final the terms of its much needed and awaited investment in mental health.

Question 1) Please spell out on what scientific basis you have dismissed the findings of the Cochrane report and indicate why Australia should base policy decisions on your personal interpretation of these data rather than on Cochrane’s more objective and systematic approach?

Question 2) What will be your role in establishing the goals and in directing the implementation of Australia’s early intervention programs and what protections are in place to ensure that opposing voices and interpretations get a fair hearing? Who else will be involved in the governance of these programs and how will they be selected?’

Question 3) Can you now state with certainty that the newly
funded early psychosis intervention programs will be restricted exclusively to those who are already diagnosed with definite psychosis and will definitely not include individuals deemed to be only at some increased risk for future psychosis?

Question 4) Do you now agree that it is inappropriate to prescribe antipsychotic medication for psychosis risk except under the close supervision of an approved research protocol?

Question 5) What protections will be in place to avoid the premature and incorrect differential diagnosis of psychosis? The distinction between prepsychotic and psychotic is much clearer on paper than in practice and psychotic symptoms in teenagers are often transient, caused by substance abuse or mood disorder. Will strict diagnostic requirements, careful differential diagnosis, and quality control guard against incorrect, premature, and stigmatizing diagnoses and also against unnecessary and potentially harmful treatments?

Question 6) Why not roll out the EPPIC programs in gradual steps? This would ensure that the model translates well from the research environment to day to day practice and would provide an opportunity to demonstrate its efficacy and cost effectiveness before disproportionate investments are made in it.

Question 7) How do you justify the funding shortfalls for other necessary continuity of care programs that will likely be caused by the front ending of expenditures for EPPIC (especially given lack of convincing evidence that EPPIC confers enduring benefits or any reduction in future need for, or cost of, services)? Is it worth staking such a large proportion of the mental health budget on such an uncertain roll of the dice?

His track record makes clear that Professor McGorry can not be relied upon as a neutral reviewer of scientific evidence or a neutral advisor on the question of which mental health investments will bring to Australians the highest and safest returns. His countrymen should be very grateful to Professor McGorry for having obtained desperately needed funding for mental health, but should also be cautious in following his lead in determining how to best to allocate it. The mental health situation in Australia is without historic precedent. Never before has the future direction of an entire country’s mental health program depended almost solely on the unopposed opinions and actions of one charismatic psychiatrist and his band of loyal followers. His inordinate power places a huge responsibility on Professor McGorry to exercise responsible and responsive leadership. Direct answers to the questions raised above are needed to ensure that public policy will follow the scientific evidence and not be unduly influenced by the blinkered zeal of one man, however well meaning and highly respected he may be.

http://www.psychologytoday.com/blog/dsm5-in-distress/201108/seven-questions-professor-patrick-mcgorry

 

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Scandalous Off Label Use Of Antipsychotics: Another Warning For DSM-5

Monday, August 8th, 2011

Psychiatric Times

By Allen Frances, MD | August 5, 2011

I never would have entered the DSM-5 controversy were it not for two of its proposals that risk furthering the already frightening overuse of antipsychotic medication, particularly in children and teenagers. DSM-5 plans to introduce two new and untested diagnoses that would offer natural targets for poor drug prescribing–psychosis risk syndrome (AKA attenuated psychotic symptoms) and temper dysregulation (AKA disruptive mood dysregulation). There is no evidence whatever that antipsychotics would confer any benefit on the kids so labeled (and too often mislabeled), but great reason to worry that this would not stop their being used needlessly and recklessly.

The DSM-5 supporters of these two proposals believe my concern is ill founded, or at least excessive. They argue that they would not recommend antipsychotics for the new diagnoses and that there is no FDA approved indication for their use. This misses the crucial point that new DSM categories, once made official, take on an independent life. If they can possibly be misused (and clearly these can), they will be misused. And experience teaches the clear lesson that antipsychotic overuse will insinuate itself insidiously and inappropriately whenever any crack of opportunity opens up.

A recent paper by Mojtabai and Olfson1 presents a chilling testimony to the spreading creep of antipsychotic misuse. In 1996, antipsychotics were prescribed for patients with an anxiety disorder in 10% of office visits. One decade later, this had more than doubled despite there being no evidence that antipsychotics work for anxiety disorders and clear evidence that they cause dangerous side effects. Because antipsychotics have no FDA indication for anxiety disorders, all this massive overprescription was done completely off-label.

This is truly alarming, but unfortunately it is not really surprising. Antipsychotics have managed to become the top class of drugs– generating the highest revenue with sales of $15 billion per year– despite the troubling facts that much of the prescribing is off label, unsupported by scientific evidence, and likely to cause the dreadful side effect of obesity with all its consequent risks. This is an astounding reflection on the lack of caution in everyday medical practice. Used appropriately, antipsychotics are extremely valuable and necessary tools– but what could possibly justify their becoming such promiscuous best sellers?

DSM-5 cannot off-load responsibility for causing harmful unintended consequences– especially when these are so obvious that they smack you in face. It is foolhardy to risk causing a further wave in the antipsychotic deluge. I continue to despair of a process that allows such smart and well meaning people to make such really dreadful decisions.

 https://member.cmpmedica.com/index.php?referrer=http://member.cmpmedica.com/cga.php?assetID=422&referrer=http://www.psychiatrictimes.com/blog/couchincrisis/content/article/10168/1921927

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‘Former Australian of the Year’ Psychiatrist Patrick McGorry Accused of Conflict of Interest

Saturday, August 6th, 2011

Sydney Morning Herald – August 7, 2011

by Jill Stark

”It’s extremely worrying that the government is listening to professional lobbyists who have a massive personal investment in the programs they’re recommending – and they are undoubtedly overstating the evidence. There’s a massive conflict of interest there,” Professor Castle said.

 

Patrick McGorry Photo: Pat Scala

PSYCHIATRISTS, psychologists and patients’ groups say there is a growing backlash against the federal government’s mental health reforms and have accused its expert adviser, former Australian of the Year Patrick McGorry, of a conflict of interest.

Several mental health specialists have told The Sunday Age the focus on early intervention for adolescents and young adults has been ”massively oversold” by the ”McGorry lobbying machine”.

They claim he used his position on the government’s mental health expert working group to recommend funding for programs he founded.

David Castle, head of psychiatry at Melbourne’s St Vincent’s Hospital, said Professor McGorry, – who founded headspace (Australia’s national youth mental health foundation) and the early psychosis prevention and intervention centres – and Professor Ian Hickie, a headspace board member, had overstated the evidence for early intervention for young people at risk of psychosis.

Headspace is a service for 12 to 25-year-olds with mild to moderate problems such as bullying, stress and relationship difficulties. Patients do not require a GP-referral. The early psychosis prevention and intervention centres provide integrated psychiatric, psychological and social support for 15 to 24-year-olds.

Between them, the two services received almost a quarter of the $2.2 billion mental health package in the May federal budget. Both professors McGorry and Hickie were on the government’s mental health expert working group that advised the Prime Minister.

”It’s extremely worrying that the government is listening to professional lobbyists who have a massive personal investment in the programs they’re recommending – and they are undoubtedly overstating the evidence. There’s a massive conflict of interest there,” Professor Castle said.

The row comes after US psychiatrist Allen Frances – chairman of the committee that produced the Diagnostic and Statistical Manual of Mental Disorders IV, the key psychiatric diagnostic source – described Australia’s investment in early intervention as a ”vast untried public-health experiment”, claiming there was little evidence it had long-term benefits.

The dispute is in part a turf war about where limited funding should go. Some argue traditional GP and psychiatrist-led care has failed teenagers and youths who fall between paediatric and adult services, leading to delays in treatment.

About 14 per cent of children aged four to 17 have mental health problems, with depression and anxiety disorders the most common. About 2 per cent suffer from a psychotic illness.

George Patton, professor of adolescent health research at Melbourne’s Royal Children’s Hospital, praised Professor McGorry’s work but said his faith in early intervention was not shared by everyone. ”There’s a real groundswell of concern amongst the senior psychiatric community that we are running ahead of the evidence,” he said.

Professor McGorry rejected the claims, accusing critics of being a small minority who are ”disaffected, destructive and irresponsible”, and who are misusing scientific evidence to protect their turf and the ailing traditional mental health model.

”The reforms around early psychosis and headspace advantage patients and families, and have 20 years of solid evidence behind them, with successful upscaling in hundreds of communities worldwide,” Professor McGorry said.

He said there was no conflict of interest as he and Professor Hickie headed non-profit organisations, and while ideally all services would have received more funding, young people had the most acute needs.

Peter Birleson, former director of mental health services at Melbourne’s Royal Children’s Hospital, disagreed. ”The McGorry machine is distorting things in Australia. There’s people in the UK who look at what’s happening in adolescent and youth psychiatry here and think that it’s completely mad. While McGorry champions the cause of youth and young adults, actually 50 per cent of lifelong mental disorders appear before the age of 14, so there should be a massive shift towards strengthening services to children,” Dr Birleson said.

Professor Hickie said he and Professor McGorry had long advocated for services outside the youth area, and had no more influence than anyone else on the government’s working group.

”People taking cheap shots is disappointing but it’s characteristic of the mental health area. When there’s been very little investment, people end up fighting over the crumbs,” he said.

Louise Newman, past president of the Royal Australian and New Zealand College of Psychiatrists, said the focus on early intervention was too narrow and could lead to young people being overmedicated, prematurely diagnosed and stigmatised.

However, David Crosbie, chief executive of the Community Council for Australia and former head of the Mental Health Council of Australia, said professors McGorry and Hickie were being targeted for challenging current practice. ”I have nothing but admiration for Pat and for Ian, who are prepared to go well beyond what their roles are to try and make a difference – and it’s a pity that other people in the sector couldn’t support improvements for the greater good of mental health.”

Another supporter, SANE Australia’s executive director, Barbara Hocking, said Professor McGorry had championed services he wasn’t involved with and was instrumental in getting more funding for the sector overall.

Money for the early intervention programs came from cuts to the over-budget Better Access scheme, which provides psychological services through GPs, psychologists and social workers.

The cuts were opposed by the Australian Medical Association, the Royal Australian College of General Practitioners, and the Australian Psychological Society, which claim people with anxiety and depression now will be priced out of treatment.

Professor Hickie and Monsignor David Cappo, who is also on the government’s working group, opposed the Better Access scheme. Prior to the budget they, along with Professor McGorry, released a blueprint to transform mental health. It listed 30 ”best buys” in mental health – Better Access was not among them.

Ben Mullings, head of the Association of Counselling Psychology, said the government’s working group could not claim to be independent when panellists were direct beneficiaries of funds.

Victorian Mental Illness Awareness Council director Isabell Collins said she respected Professor McGorry’s commitment to youth but felt other age groups were being neglected.

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DSM 5 Will Further Inflate The ADD Bubble

Tuesday, August 2nd, 2011

Psychology Today
by Allen Frances, Former Chairman, DSM Task Force

Video: ADHD Labeling Normal Kids "Mentally Ill"

The Child Work Group Fails Again To Learn From Its Experience

Martin Whiteley is an MP who represents Perth in the Australian parliament. He has been actively involved in mental health issues and succeeded in a crusade to curb what had been Perth’s alarming overdiagnosis and overmedication of  Attention Deficit Disorder Disorder (ADD). Mr Whiteley has become expert in the intricacies of ADD and is alarmed that the changes suggested for DSM 5 will greatly exacerbate the ADD fad he worked so hard to tame. Read Mr Whiteley’s careful item by item review and you will be alarmed too:

http://speedupsitstill.com/dsm-5-proposal-adhd-%e2%80%93-making-l…

We are already in the midst of a false epidemic of ADD. Rates in kids that were 3-5% when DSM IV was published in 1994 have now jumped to 10%. In part this came from changes in DSM IV, but most of the inflation was caused by a marketing blitz to practitioners that accompanied new on-patent drugs amplified by new regulations that also allowed direct to consumer advertising to parents and teachers. In a sensible world, DSM 5 would now offer much tighter criteria for ADD and much clearer advice on the steps needed in its differential diagnosis. This would push back ,however feebly, against the skilled and well financed drug company sell. DSM 5 should work hard to improve its text, not play carelessly with the ADD criteria in a way that may unleash a whole set of dreadful unintended consequences- unneeded medication, stigma, lowered expectations, misallocation of resources, and contribution to the illegal secondary market peddling stimulants for recreation or performance enhancement.

The DSM 5 child and adolescent work group has perversely gone just the other way. It proposes to make an already far too easy diagnosis much looser.

How puzzling and troubling. Child mental health has already promoted no fewer than three false epidemics in just 15 years- ADD, childhood bipolar, and autism. Any reasonable group would now be learning from this past experience. For the future, it would be chastened, cautious, and eager to correct the damage it has done- rather than embarking on any reckless new adventures. A prudent DSM 5 would tighten its criteria for ADD and put in a black box warning against the blatant current off-the-DSM-label diagnosis of childhood bipolar. DSM 5 instead does everything wrong it possibly could with ADD and then remarkably takes the mischievous further step of adding yet another new candidate for diagnostic fad (Disruptive Mood Dysregulation Disorder) likely that will increase the already scandalous overprescription of dangerous antipsychotic medication to children. Go figure.

In many circles, the accepted wisdom is that DSM 5 workers are making such unaccountably bad decisions because they want to promote drug sales to kids. To support this accusation, cynics raise the Biederman affair and also APA’s previous excessive financial support from Pharma.

This is one time when the cynics are dead wrong. The DSM 5 work group is making simply disastrous decisions for the purist of reasons. These are not people with close industry ties and their conflict of interest is intellectual, not financial. Experts in child psychiatry are dangerously naïve about the likely misuses of their well meaning suggestions. They are blind, not corrupt.

What is needed is outside supervision to curb child psychiatry’s seemingly endless taste for diagnostic excess. And APA should also realize the grave harm done to its credibility by the appearance that DSM 5 is far too Pharma friendly even if this has not been the real motivation behind the bad DSM 5 proposals.

To make matters worse, the DSM 5 field trial will be completely worthless- providing no information at all about the magnitude of the rate increase in ADD that will occur once DSM 5 opens the floodgates even wider. We did careful field trials before DSM IV to compare the impact on rates of the different possible definitions and predicted a 15% increase for the one finally chosen. Instead, the rates more than doubled- courtesy of pressure from the drug companies. For obscure reasons, DSM 5 is conducting extraordinarily expensive field trials that (again perversely) avoid the only question that really counts- just how high will the rates skyrocket under the even easier to meet new DSM 5 definition.

DSM 5 will be flying completely blind into dangerous territory, unimpeded by adult supervision. The leaders of child psychiatry (who already have the unfortunate track record of producing fads) will now be given a free pass to further feed their blossoming ADD fad. Will they never learn from past mistakes?

http://www.psychologytoday.com/blog/dsm5-in-distress/201108/dsm-5-will-further-inflate-the-add-bubble

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Australia’s Outrageous Mental Health Agenda Under Attack from Leading U.S. Psychiatrist

Thursday, June 16th, 2011

The 'Pre Psychosis Risk' Scam

While the United States unfortunately leads the world in labeling its children with mental ‘disorders’ which cannot be scientifically proven to exist as medical conditions,  Australia seems determined to take over  the [dishonorable] title.  And they just might do it.   For poised to carry them into the winners circle is none other than psychiatrist and former “Australian of the Year”  Patrick McGorry.   The scam is called “pre-psychosis risk syndrome” which simply translates as this:  Despite the fact there is not one proven scientific or medical test to prove any child has a mental “disorder,”  Patrick McGorry maintains he can determine who will develop one.  That’s right.   He can determine who will develop a mental disorder before they develop a mental disorder that cannot be medically proven to exist.   If that sounds a little crazy to you,  rest assured, you’re not alone.    In fact,  the logic is so backwards that McGorry’s plan has come under fire from U.S. psychiatrist Allen Frances, who chaired the committee that produced the psychiatric diagnostic bible of “mental disorders” used the world over, ‘The Diagnostic and Statistical Manual of Mental Disorders (DSM) IV.    If you’re in the mental health “business,” like McGorry is,  then that is called being attacked from altitude.

Frances calls McGorry a “false prophet” and says “Australia, led astray by his impractical hopes, is about to embark on a vast and untried public health experiment that will almost surely cause more harm to its children than it prevents.”

We agree.  And it looks like Australians are starting to catch on….

from The Australian—June 16th, 2011

Schism opens over ills of the mind

PATRICK McGorry is the face of mental health in Australia. He put the subject on the public agenda through his GetUp! ads at last year’s federal election and was instrumental in securing $2.2 billion in government funding for his cause in last month’s budget.

But now he and his early psychosis prevention and intervention centres are under attack from members of his own psychiatric profession.

At stake is the credibility of the centres that treat people aged 15-24. A $222 million program to establish 16 EPPICs is an important plank in Julia Gillard’s mental health reforms. Tony Abbott also wants to expand the centres as part of his mental health policy.

McGorry is no stranger to controversy. In 2006 Time magazine in an article headlined “Drugs before diagnosis?” was critical of his work testing the use of anti-psychosis drugs on pre-psychosis patients in the late 1990s.

West Australian Labor MP Martin Whitely has been conducting a campaign against McGorry on his blog Speed Up and Sit Still.

Many of McGorry’s mental health colleagues have questioned whether his centres got the bulk of extra money in the budget’s mental health reforms because the government wanted to silence its biggest critic. There are other models and other priorities for mental health funding, they say.

This week McGorry came under fire from US psychiatrist Allen Frances, the man who chaired the committee that produced the psychiatric diagnostic bible Diagnostic and Statistical Manual of Mental Disorders IV.

Underlying the attack on McGorry is a dispute dividing psychiatry worldwide: is there a danger that attempts to define mental illnesses are making a disease out of everyday suffering resulting in the unnecessary medication of patients?

Frances says he was very conservative when he produced DSM IV, including only two out of 84 suggested new mental illness diagnoses. After its publication, diagnoses of autism, attention deficit hyperactivity disorder and bipolar disorder skyrocketed.

“Once the genie was out of the bottle and heavy drug marketing followed and the internet and ADHD and school services [began] being tied to a diagnosis, the manual gets used differently to the way you thought it should and you have no control over it,” he says.

Frances says anti-psychotic drugs are now the leading revenue producing drugs in the US.

“It’s an astounding fact that 5 per cent of all scripts in the US are written for anti-psychotics. The industry in America is $US15bn and it is the No 1 seller of all drugs and anti-depressants are the fourth biggest sellers,” he says.

“What we’re talking about is a massive worldwide experiment in the use of anti-psychotics.”

Frances fears a similar outbreak of over-diagnosis of mental illness and unnecessary medication of patients could follow the new DSM 5, due out in 2013.

The root of Frances’s dispute with McGorry is the Melbourne psychiatrist’s work in trying to develop a tool that can diagnose patients before they develop full-blown psychosis and finding ways to treat them to prevent the illness.

This tool has various names: psychosis risk syndrome, attenuated psychotic syndrome or ultra high-risk syndrome.

This new diagnosis is a candidate for inclusion in DSM 5. But it is a highly controversial issue in the psychiatric profession and its listing is opposed by one of McGorry’s research partners, Melbourne University psychiatrist Alison Yung.

Yung and Frances fear listing the disorder will lead to teenagers being labelled and stigmatised and given powerful anti-psychotic drugs that have side effects including substantial weight gain.

Read the rest of the article here:

http://www.theaustralian.com.au/news/features/schism-opens-over-ills-of-the-mind/story-e6frg6z6-1226075910650

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US expert slams Patrick McGorry’s psychosis model

Monday, June 13th, 2011

Note from CCHR:   CCHR International was the first organization  to expose  the complete insanity of psychiatrist and “Australian of the Year” Patrick McGorry’s campaign to “pre-diagnose” children before they ‘develop” mental disorders.  But we’re no longer the only ones.   Even his fellow psychiatrists are attacking it.  Let’s just break it down; psychiatrists admit there are no medical tests in existence to prove any child suffers from a mental ‘illness.”  Diagnoses is based solely on opinion, yet more than 20 million children worldwide have been ‘diagnosed’ and prescribed dangerous and potentially lethal drugs based on nothing more than psychiatry’s junk science.     Yet this doesn’t seem to be a problem to McGorry, or Australia for that matter, considering they just allocated $400 million to McGorry’s  crystal ball theory of “pre-diagnoses,”  for ‘psychosis’ adding even  more lunacy to the child labeling and drugging epidemic that is literally killing kids.   Now that, is psychotic – and it’s psychiatrist Patrick McGorry that’s leading the way.

The Australian – June 14, 2011

by Sue Dunlevy

PATRICK McGorry’s model of early diagnosis of psychosis, favoured by the federal government and the Coalition in their mental-health policies, has come under attack from a leading US psychiatrist, who warns that predicting psychosis is unreliable and could lead to patients being wrongly medicated.

Allen Frances, who chaired the committee that produced the current diagnostic bible for psychiatry, the DSM-IV, has warned that Professor McGorry’s Early Psychosis Intervention Centres do not have a reliable early diagnosis tool.

Professor Frances, an emeritus professor at Duke University in North Carolina, fears early diagnosis could lead to people without psychosis being put on medications that have serious side-effects, including massive weight gain.

He has also attacked the Gillard government’s plans to spend $222 million expanding Professor McGorry’s EPIC program by another 16 centres as a “vast untried public-health experiment”.

“The Australian experiment will be flying blind on an airplane that is not at all ready to leave the ground,” he said in a blog posted on Psychology Today in the US.

His concerns are shared by Adelaide University psychiatry professor Jon Juredini, who says the Gillard government should have shared mental-health funding around many different early intervention projects to see what worked best. “A lot of the evaluation of EPIC shows any advantages it has disappear over time, so that tends to suggest that in terms of intervention they are good while they are happening, but they don’t necessarily give long-term protection,” Professor Juredini told The Australian.

Their criticism came as the past president of the Royal Australian College of Psychiatrists, Louise Newman, attacked the $197 million the government will spend on expanding the number of Headspace youth mental health centres from 60 to 90.

“There have been certain statements about the efficacy of  the Headspace approach that have been overstated,” she told Australian Doctor magazine.

Early intervention to prevent mental illness needed to happen at a much earlier stage of development than adolescence, Dr Newman said.

A spokeswoman for Mental Health Minister Mark Butler said the government was making substantial investments in youth mental health and early psychosis prevention services. “We are confident these evidence-based models will be of benefit to young Australians,” she said.

Professor Frances’s arguments have been seized on by Scientologists, who argue against the notion of mental illness.

Although Professor Frances chaired the committee that produced the fourth version of the Diagnostic and Statistical Manual of Mental Disorders in 1994, he has been left off the panel developing the fifth version.

He has written extensively of his concerns about how strict medical definitions of mental illness can lead to misdiagnosis by non-experts.

Professor McGorry dismissed Professor Frances’s attack as a “beat-up”, and said no one received anti-psychotic drugs at his centres unless they had had a psychotic episode.

While Professor Frances agreed that Professor McGorry did not recommend anti-psychotic medication as a preventive measure, he feared general practitioners might overuse the drugs if they started using Professor McGorry’s diagnostic tool for early psychosis.

Professor Frances said in his Psychology Today blog that early intervention to prevent psychosis required first that there be an accurate tool to identify who would become psychotic.

“The false positive rate in selecting pre-psychosis is at least 60-70 per cent in the very best hands and may be as high as 90 per cent in general practice . . . these are totally unacceptable odds,” he said.

Professor McGorry agreed that false positive rates of diagnosing prepsychosis were high, but said the first line of treatment for people who had sub-threshold psychosis was supportive care.

http://www.theaustralian.com.au/national-affairs/us-expert-slams-patrick-mcgorrys-psychosis-model/story-fn59niix-1226074544901

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Australia’s Reckless Experiment In Early Intervention

Wednesday, June 8th, 2011

Note from CCHR: The article below was written by Allen Frances, a psychiatrist, and former Chairman of the DSM IV task force.  The subject of the article is Australian psychiatrist Patrick McGorry and his agenda to pre- diagnose kids with mental ‘illness’ before they develop it, which  Frances calls  a dangerous and risky proposition.    It is.  Yet Frances seems to be making excuses for the fact that McGorry’s plan is not only dangerous – its criminal.    He calls McGorry a charismatic psychiatrist, which may be true, but this is exactly what makes him so dangerous.  Because the Australian government has just funded a program so controversial and dangerous to children that even other psychiatrists, leaders in the field, are speaking out against it.  And why did they fund it?   Because “charistmatic” Patrick McGorry sold them  a $400 million bill of goods.

“Charisma is a tricky thing.  Jack Kennedy oozed it–but so did Hitler and Charles Manson. Con artists, charlatans, and megalomaniacs can make it their instrument as effectively as the best CEOs, entertainers, and presidents.” Patricia Sellers, FORTUNE Magazine


prevention that will do more harm than good

Psychology Today
By Allen Frances
May 31, 2011

Patrick McGorry is a charismatic psychiatrist who has recently gained heroic status. First he was chosen to be Australia’s Man Of The Year. Now, he has convinced the Australian government to spend more than $400 million over five years to fund his plan for a nationwide system of Early Psychosis Prevention and Intervention Centres. McGorry is the visionary prophet and pied piper of preventive psychiatry. His goal is to diagnose mental disorders early and treat them expectantly- before they can do their worst damage.

McGorry’s goal is certainly great. But its current achievement is simply impossible and Australia’s plans are patently premature. Early intervention to prevent psychosis requires first that there be an accurate tool to identify who will later become psychotic and who will not. Unfortunately, no such accurate tool exists. The false positive rate in selecting prepsychosis is at least about 60-70% in the very best of hands and may be as high as 90% in general practice. That’s right, folks, nine misidentified non patients for one accurately identified truly prepsychotic patient. Those are totally unacceptable odds.

What are the costs? McGorry does not recommend antipsychotic medications as a routine part of his prevention regimen. But experience teaches us that they will be overused despite having no proven efficacy and posing the risk of massive weight gain (and its consequent array of serious complications). The false positives will also suffer unnecessary stigma and worry and will undergo unnecessary and misdirected treatment. And surely there are many more productive ways to spend $400 million doing a better job of managing the mental health needs of those who have real and treatable psychiatric disorders.

Unfortunately, Mcgorry is a false prophet who’s visions are offered at least a few decades before their time. Australia, led astray by his impractical hopes, is about to embark on a vast and untried public health experiment that will almost surely cause more harm to its children than it prevents. Before embarking on this headlong and reckless rush, the following research steps need to be accomplished:

1)Developing a proven and reliable definition of “Psychosis Risk”

2)Learning how to use it in a way that reduces current outrageously high false positive rates to levels that are tolerable.

3)Demonstrating that the interventions chosen are indeed effective in preventing psychosis.

4)Determining the likely rate of antipsychotic use and how this influences the overall risk/benefit balance sheet of early intervention.

5)Studying the beneficial and harmful impacts of early diagnosis on stigma and self perception.

6)Comparing the marginal utility of a dollar spent trying to prevent an alleged future disorder vs a dollar spent treating an already clearly established one.

This is a research enterprise that will take many groups around the world many decades to complete. But it is an absolutely necessary precondition before spending $400 million on what is likely to be a failure. The Australian experiment will be flying blind on an airplane that is not at all ready to leave the ground. Doing prevention prematurely and poorly will give a good idea an unnecessary bad name.

McGorry’s intentions are clearly noble, but so were Don Quixote’s. The kindly knight’s delusional good intentions and misguided interventions wreaked havoc and confusion at every turn. Sad to say, Australia’s well intended impulse to protect its children will paradoxically put them at greater risk. Let’s applaud McGorry’s vision but not blindly follow him down an unknown path fraught with dangers.

Read article here:  http://www.psychologytoday.com/blog/dsm5-in-distress/201105/australias-reckless-experiment-in-early-intervention

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