Abstract
ANZJP has undergone a dramatic transformation in recent years. Whilst continuing its mission to disseminate high-quality research and reviews on the science of psychiatry, it has also increasingly promoted discussion and debate about current issues in psychiatry. The Editorial Board has been open to the airing of some controversial opinions, while always ensuring that all sides have the opportunity to present their views. In some cases, where there has been considerable interest in a topic, the discussion has continued over several issues of the Journal. Feedback from readers has been that this change has resulted in a far more interesting and relevant publication.
This month’s ANZJP illustrates this trend very clearly. There is a continuation of the discussion of the merits of early intervention, which has been a major focus of the Australian Government’s mental health reforms. Previous issues of the Journal have debated the long-term therapeutic effects of early intervention (Castle, 2012; Yung, 2012), the economic benefits (Amos, 2012; Mihalopoulos et al., 2012), and the ethics of intervention with at-risk youth (Frances, 2011; McGorry, 2012). In this issue, there is a critique by Melissa Raven (2013) of the evidence on the EPPIC program, which is a pioneering Australian service for early intervention in psychosis. She argues that this program has never been compared to standard care and that this has not always been clear in scientific articles and advocacy for reform. Raven’s critique is rebutted by Patrick McGorry and Cathy Mihalopoulos (2013), who argue that early intervention has been unfairly targeted by critics and has better supporting evidence than many other programs funded by Australian governments. Related to this theme, a letter by Raven and colleagues (2013) continues the discussion of the ethics of using antipsychotic medication to reduce the risk of psychosis.
Other articles this month also suggest a number of areas where positive action could be taken to improve the lives of people experiencing mental disorders. Allison et al. (2013) acknowledge the pioneering efforts of McGorry and colleagues to develop youth mental health services and argue for an extension of this approach to cover youth consultation-liaison psychiatry. Ilchef (2013) agrees with the merits of such an extension, but calls for a more detailed and specific proposal for how it would actually work.
Henwood and Whitley (2013) argue that the goals of the recovery movement need to be extended beyond the realm of mental health services to the whole of society. This would involve removing societal barriers to recovery and could include legislation against discrimination, provision of adequate housing and public transport, and efforts to reduce stigmatising attitudes.
This month’s Journal also presents evidence for a number of programs that would provide practical benefits to psychiatric patients. Ashton and colleagues (2013) report that most smokers with a mental illness want to quit and that Tobacco Free programs can help them to do so. Siskind et al. (2013) provide evidence that some acutely unwell psychiatric patients can be managed in a community crisis house, resulting in a reduction in psychiatric bed-days and a cost saving to mental health services. Finally, Taylor and Ng (2013) present a systematic review of studies on the use of long-acting antipsychotics in the treatment of people with early schizophrenia. They conclude that long-acting (depot) antipsychotics may be of benefit for symptom control and relapse prevention, particularly where the person wants this type of treatment and medication adherence is a priority.