Abstract
This issue of the Australian and New Zealand Journal of Psychiatry (ANZJP), as with a number of recent issues, highlights one of the critical functions of this journal. The ANZJP is the optimal forum for a vigorous, active and informed debate about service priorities and therapeutic directions. The paper by Pirkis et al [1] debating with Hickie [2], Jorm [3] and Allen and Jackson [4] the issue of the Better Access Initiative [5] is a prime example of this essential role.
Psychiatry is in an unusual position. For the first time in recent memory, mental health is at the forefront of political and public health issues. It is receiving unprecedented media attention and there is the potential for real investment from Federal and State Governments. Unsurprisingly and quite appropriately, there is robust debate about therapeutic priorities and the best service structures. Such debate indeed warrants encouragement and should not be stifled but it has to be conducted in a structured, professional and evidence-based environment. This is the context the ANZJP can provide, in contrast to the many modern-day media formats, where faux drama is an imperative, and casts of heroes and villains are interchangeably drawn from equally motivated and dedicated individuals holding divergent views. There is a real risk that public divisiveness will weaken this opportunity that has been afforded psychiatry. If a public perception is created that mental health treatment or service is of unclear value, it is less likely to be supported. In an environment of economic contraction, reasons not to invest are easily grasped, and the most needy in our communities risk losing the most. Recognising this and understanding the importance of such discourse the Journal welcomes debate and discussion [6].
In discussing the emergence of translational medicine as a novel imperative for the field, Henderson [7] notes the paucity of novel therapies and the fact that the discovery of existing treatments has largely been serendipitous. Within this context, the review by Fitzgerald [8] on novel brain stimulation techniques is particularly timely. This up-to-date account reviews vagal nerve stimulation, repetitive transcranial magnetic stimulation (rTMS) and magnetic seizure therapy. The uptake and application of any therapy is contingent on its risk/benefit ratio and with this in mind rTMS is emerging as a particularly attractive option given its relatively benign safety and tolerability profile. It is a technique that is beginning to be widely available as a clinical service and against this background this comprehensive and thoughtful review is likely to be of particular value to practicing clinicians.
The National Survey of Mental Health and Wellbeing is a rich database exploring mental and physical disorders in a representative sample of Australians. Teesson and colleagues [9], in this issue of the journal, explore the relationship between chronic physical and mental disorders. The authors report that mood and anxiety disorders are disproportionately prevalent amongst those with physical conditions. The study also emphasises high rates of disability as well as high levels of service use amongst those with co-morbidity. Such studies are necessary both to inform service delivery, but also shed light on common underlying risk and pathophysiological pathways. Models such as systems biology are a potentially rich source of understanding of these shared risks, and are capable of suggesting novel therapeutic approaches.
The first step in accessing effective treatment is the recognition that a problem is present. In this context, Reavley and Jorm [10] conducted a national survey in which members of the community were surveyed about their ability to recognise common psychiatric disorders, and rate what interventions are likely to be helpful. Interestingly, they found high rates of recognition of depression and far poorer rates of recognition of schizophrenia, PTSD and social phobia. Australia has had a series of highly effective public education and destigmatisation campaigns for depression, but anxiety and psychotic disorders have not received equivalent attention. This study highlights both the impact of such public campaigns on public literacy and suggests that comparable campaigns for anxiety disorders and psychotic disorders may be fruitful. The importance of such literacy is underscored by the high prevalence of anxiety disorders, the fact that recognition is a necessary first-step to treatment, that early recognition improves long-term outcomes and that an individual's recognition of the presence of a disorder enhances the likelihood that their practitioner will recognise and appropriately manage that disorder.