The need to do and imbibe as well as debate and discuss

It was emphasised in the first issue of the year (Malhi, 2016) that an important focus of the Australian and New Zealand Journal of Psychiatry (ANZJP) is to voice ideas and express views and opinions to stimulate discussion and debate; bear poking, fire stoking and turkey choking. This month’s issue exemplifies this role.

For example, in this issue, the ongoing debate over the use of stimulants in treating depression is ‘given oxygen’ by Malhi et al. (this issue); the possibility of anti-depressant over-prescribing in patients whose primary problem is an alcohol use disorder is presented by Foulds et al. (this issue); the practical advantages of using transdiagnostic psychological treatment for anxiety and depression are crticially discussed by Bell et al. (this issue); and the ongoing discussion on the evidence for efficacy of Headspace is given further headroom (Jorm, this issue; Allison et al, this issue).

These issues are important because they are all relevant for clinicians and the practice of our profession as a whole. It is encouraging that we wish to question current clinical practices and ask for better evidence of efficacy. As co-author on two of the debate pieces in this issue, I champion this approach. However, we must not forget that the most important work is done by those who actually produce the evidence in the first place for others to evaluate and debate its worth. Regardless of its efficacy, Headspace has been an important beacon for psychiatry. It has brought awareness of the extent of suffering young Australians are subjected to because of some form of mental illness or stress and the poor access to appropriate care in the public domain. From a New Zealand perspective, Headspace significantly enhanced interest and support for mental health services for young people both among politicians and the general public.

Debate is good, but designing and testing interventions to improve the mental health of our populations is better. This is why papers evaluating treatments are sought after by the ANZJP. Hence, the article by Chambers et al. (in this issue) evaluating the National Perinatal Depression Initiative is most welcome and will no doubt be well received, especially as it reports that there was increased access, albeit not statistically significant, to medical funded mental health services by both younger and older mothers. However, of critical importance, the effect of increased access on the mental health of mothers remains to be evaluated.

Kisely et al. (in this issue) highlight an area where well thought out initiatives to help our patients are needed. They note, yet again, that psychiatric patients receive poor care from general medical services. The study reports that, while cancer incidence is similar or even lower in psychiatric patients than the general population, mortality rates are higher. Our patients with psychiatric disorders appear less likely to receive screening, early investigation and surgical treatment. Clearly specific and testable strategies are needed to improve the physical health of people with severe mental illness. As the authors point out, these may need to include collaborative arrangements with primary care such as Healthright (Stanley and Laugharne, 2011). Clearly, robust evaluations of interventions trying to improve the physical health of psychaitric patients are needed.

The possible rise in the autism spectrum disorder reported by Williams et al. (in this issue) also raises implications for service delivery and circulation. Should services be generalised or specialised? At what age should services intervene? What treatments should be offered? These are all testable questions, but who is going to test them and how will they be funded to do so?

This issue of the journal, like all good reads, perhaps raises more questions than it answers. However, we need to continue to point out to anyone who will listen that answering important questions is difficult and requires well designed and well-funded intervention studies which can then be evaluated for their effectiveness – and of course we aim to bring the outcomes of such high quality research to the readership of the ANZJP.

The discussions featured in this issue of ANZJP highlight the lack of evidence in important areas within psychiatry and why this makes it difficult to formulate effective management strategies that actually benefit our patients – we sometimes don’t know what works and what doesn’t. In a similar vein, it’s difficult to know what impact debating these issues has, but it is certainly an interesting process and one that is likely to generate some healthy discussion. One finding I am happy to accept without much debate is that from Wang et al. (in this issue), that having a coffee is healthy because it is good for your mood. So read on and remember to have a coffee now and again.