McGorry et al. debate on the ‘ National Mental Health Commission Report: Evidence based or ideologically driven? ’

To the Editor

The rejoinder by Professor McGorry et al. (2016) to our Debate article on the National Mental Health Commission (NMHC) Report was unexpected. Their response focused almost exclusively on headspace and the youth early psychosis program (YEPP); issues that we did not address specifically. We were primarily concerned with the NMHC proposal to reduce mental health funding for Australia’s acute hospitals, and transfer the savings to community programs. Our central argument was that Australia’s psychiatry bed numbers are already very low by international standards, and further bed closures would compromise patient care and outcomes.

Nevertheless, there is a valid connection with our Debate article. Considerable funds, including those provided by the federal government, which has traditionally not delivered public mental health services, have been allocated to the new community programs linked to the organization with which the authors are affiliated. Naturally, these funds have not been available for the conventional services delivered by the states and territories.

McGorry et al. (2016) emphasize the need for evidence-based services, but the available evidence for headspace is not encouraging. Indeed, the NMHC Report raised significant concerns, and both Jorm (2015), and we (Allison et al., 2015) have also drawn attention to shortcomings in the reported outcomes.

The ‘evidence versus ideology’ debate in our article was related to the best use of finite funds for patient care, and better utilizing the data available for psychiatric bed numbers and the subsequent waiting times in acute hospital emergency departments. It was not an argument for reducing services in any area. Nevertheless, although the rebuttal of McGorry et al. (2016) is confined to their early psychosis intervention and headspace work, their contribution is a good illustration of why questions need to be raised about the appropriate use of scarce resources.

As a final point, we question Australia’s tendency to establish large new mental health programs in the absence of convincing evidence that they actually provide better patient outcomes. As a nation, we need to be wary when advocacy goes beyond the science, and the federal government should ensure that careful preliminary studies are undertaken before extending services, particularly at the expense of already inadequate inpatient facilities.