Deserved national recognition for an international clinical scientist

Each January in this great Southern land, our Prime Minister bestows the honour of ‘Australian of the Year’ on one of our citizens. Typically, the recipient is a Nobel Prize winner, an international sports star, a world-renown scientist, a celebrity or a social activist. In 2010, to the absolute delight of our wider community, this prestigious award was made to our esteemed colleague and editor-in-chief of this journal, Patrick Dennistoun McGorry. Although the award specifically recognized Pat’s personal commitment over the last 25 years to the development of youth mental health services, it also signalled his wider impact on our community. In this country, we have witnessed a remarkable shift in the public understanding of the nature of mental ill-health, resulting in a recognition that mental health problems deserve to be treated in the same way as other physical health conditions. Although a broad range of factors have underpinned this change, there is little doubt that one of the more profound contributions has been a shift away from therapeutic nihilism, particularly with regard to the management of more severe disorders among young people. The establishment of the Early Psychosis Prevention and Intervention Centre service model in Melbourne in the 1990s was an essential driver of this movement. Through its modelling of best-practice care and its willingness to share openly with other centres, it served as a template for a host of other more empowered services across the country. Through the provision of real experiences of compassionate and professional care, it changed outcomes for a generation of young people who might otherwise have been lost within our chaotic and under-resourced mental health system. Over the last decade the Melbourne group has grown rapidly to encompass a much wider framework of clinical practice, service development and academic partnerships led by Orygen Youth Health (http://www.oyh.org.au). As a consequence of Orygen’s partnership with other national awareness and community-based movements that focused on increasing mental healthcare utilization and improving health and social outcomes through enhanced service provision, we have witnessed substantive new national investments in primary care and the provision of more specialized psychological services that are particularly relevant to the needs of young people. The most important new wave of youth-specific services are now linked under a new national framework known as ‘headspace: the national youth mental health foundation’. This represents a major shift in thinking about the optimal way to provide integrated clinical services to young people with emerging difficulties. Most importantly, it has immediately demonstrated a capacity to engage those at risk and provide a better mix of relevant medical, psychological and vocational services. As a result of Pat’s sustained leadership of each of these phases of innovative service development, Australia is now well placed to support and participate in a wider international movement focusing on the systematic evaluation of the impact of such youthspecific service models. Given all this effort devoted to innovation in community development and service enhancement, one might have thought that Pat had little time or energy left for the rigours of systematic clinical research. In reality, the key studies conducted by the Melbourne group, not only described the specific clinical phenotypes associated with the early phases of psychotic disorders but then also demonstrated the specific value of focusing on these early phases of illness as targets for both conventional and novel preventative strategies. The simplicity and elegance of these studies, particularly when complemented by the key neuroimaging studies that support the validity of the ‘at risk’ concept, will ensure that they stand as fundamental turning points in the practice of clinical psychiatry. It will be very hard for future generations of clinicians to imagine a time when such a basic commitment to early intervention and preventative strategies was not standard practice. In more recent years, the early-intervention paradigm has been further enhanced by the development of clinical staging of the various phases of psychotic and more severe mood disorders. Although this may appear to be an obvious step to take, it is underpinned by a more radical hypothesis Early Intervention in Psychiatry 2010; 4: 105–107 doi:10.1111/j.1751-7893.2010. 00181.x