A challenge to prominent mental health advocates: your claims do not reflect the evidence

Melissa Raven, a psychiatric epidemiologist and policy analyst who is an Adjunct Lecturer in the Department of Public Health at Flinders University, and a member of Healthy Skepticism, recently argued at Croakey that some of the alarming headlines about youth mental health are overstated.

In the post below, she takes issue with recent comments at Croakey by Sydney psychiatrist Professor Alan Rosen and others.

She writes:

“Alan Rosen dismisses objections to the mental health reform campaign initiated by Professor Patrick McGorry as turf-war debates about ‘subtleties of evidence’, and admonishes anyone who objects in public.

In other words, he seeks to silence dissent, regardless of its merits.

In recent days, Jon Jureidini and I have publicly explained in detail why two key claims made by Patrick McGorry and John Mendoza are inaccurate.

Jureidini outlined the problems in a much shorter article in The Australian, which was discussed and elaborated on in The Age. We have had many positive responses to the three articles.

John Mendoza has repeatedly claimed that ‘more than a third’ of suicide cases in Australia involve ‘people discharged too early and/or without care following hospitalisation’. This claim has been on the GetUp website for many weeks, and was also emailed by GetUp to its members.

However, this claim is wrong by a factor of at least 30.

There is some evidence from the 2007 ‘Tracking Tragedy’ report  that about one third of suicides among people who have been receiving treatment for depression in community mental health settings might have been prevented with better care. However, these cases represent only about 2% of suicides in the population, the majority of whom have never been hospitalised for mental health treatment.

Furthermore, combining Australian Bureau of Statistics data with the 2005 ‘Tracking Tragedy’ report reveals that only about 2.7% of people who kill themselves have been discharged within the previous month, and only one quarter to one third of them (less than 1% of cases) could be considered preventable. This more than 30-fold discrepancy is not a ‘subtlety’ of evidence.

Patrick McGorry has repeatedly claimed that there is a ‘waiting list of 750,000 young Australians currently locked out of the mental health care they and their families desperately need’.

This claim was made verbatim on Croakey twice, and variants have been widely publicised by the media, including the ABC. Variants have been incorporated into the report of the Senate Inquiry into COAG health reforms  and the Coalition’s mental health policy.

Again this claim is seriously wrong.

The 2007 National Survey of Mental Health and Wellbeing, which McGorry has cited as the basis of his claim, found that only 17% of young people with mental disorders had severe disorders, and 51% of them accessed treatment. Applied to the 1 million young people with mental disorders in the 12-25-year-old age-group that McGorry focuses on (whereas the NSMHW data include 16-24-year-olds in the youngest age-group), the 8% of young people with severe untreated disorders represent about 80,000, not 750,000. Again this is not a ‘subtlety’ of evidence.

McGorry has responded by saying ‘the figures I have used are official data and thus far from “dodgy”‘. However, evidence from impeccable official sources is misleading when it is misrepresented, as in his grossly exaggerated estimate of ‘desperate’ need for treatment.

Mendoza has responded by saying that Jureidini ‘notably chooses not to quote my words directly’, despite a perfectly reasonable paraphrase (‘more than one-third of Australians who take their own lives have been discharged inappropriately from hospitals’) of the two similar statements Mendoza made on the GetUp website and in his email.

Neither McGorry nor Mendoza has explicitly justified his claim. I challenge them to do so.

GetUp – an enviably influential advocacy organisation – has refused to remove or retract Mendoza’s claim, despite now knowing that it is incorrect.

I challenge them to do so, or to explain why, having initially been misled, they are now knowingly misleading the public.

Alan Rosen’s rationale for silencing dissent is that it might ‘confuse the pollies and the public’. We have pointed out that the pollies and the public have already been seriously misled, and we do not believe that silence about this is in the public interest.”