Professor Pat McGorry on Australia's mental health breakdown, the Royal Commission, and reasons for optimism

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Professor Patrick McGorry AO is an Irish-Australian psychiatrist, leading international researcher, clinician and advocate for mental health reform. Many Australians will recognise him as the 2010 Australian of the Year and for his leadership of mental health organisations such as Orygen Youth Health and Headspace. Pat is Chair of the Expert Advisory Committee for the Royal Commission into Victoria’s Mental Health System.

In this conversation, Pat reflects on his early life and journey into medicine and psychiatry, his work in founding and leading pioneering youth mental health organisations, the scale of the mental health crisis in Australia, and the Royal Commission into Victoria’s Mental Health System. It’s a wide-ranging conversation with a deeply humane and intelligent individual, who has devoted his life to solving one of humankind's greatest afflictions.

E quindi uscimmo a rivedere le stelle.
And so we came forth, and once again beheld the stars.

Professor Pat McGorry AO, Melbourne, 19 July 2019

Professor Pat McGorry AO, Melbourne, 19 July 2019

Interview with Professor Pat McGorry AO, 19 July 2019 

00:00 Nick: Welcome to Bloom, a podcast about anything and everything, which features conversations with people who lead meaningful, interesting and flourishing lives, in order to better understand each other, ourselves and the world around us.  

00:12 I'm very fortunate and honoured to be joined today by Professor Pat McGorry. Pat is an Irish Australian psychiatrist, leading international researcher, clinician and advocate for mental health reform.

00:22 Many Australians will recognise Pat as the 2010 Australian of the year and for his leadership of mental health organisations such as Orygen Youth Health and Headspace.

00:30 Pat is also the chair of the expert advisory committee for the Royal Commission into Victoria's mental health system. Thank you so much for being here today, Pat.

00:38 Pat: Thank you, Nick.

00:39 Nick: So, Pat, you're one of the most influential and recognisable faces of mental health advocacy and reform in Australia. For our listeners who aren't as familiar with you or your work, could you please outline the key moments of your life and career journey which brought you to this point? 

00:52 Pat: Well, I guess it goes back to my own adolescence really. You know, I suppose I was - this was in the 1960's and it was a time of great idealism I think in the world. You know, 1968 was the year of revolutions and I was very affected by that. Maybe temperamentally, I was already predisposed; I'm not sure about that actually, but the times certainly were good for that mindset and that aspiration I suppose in terms of what you could do with your life. 

01:28 I immigrated to Australia at the age of 15 with my family. I was born in Ireland but had grown up in South Wales and we came to Australia. So, in a way Australia had a delayed sort of experience of those, you know, geopolitical changes in the late sixties. It didn't really happen in Australia until the early seventies but in my own family, you know, my father was a doctor. He had been a TB physician and was a doctor looking after people with chest diseases and coal miners and those sorts of jobs and he thought - he had a limited view of what was possible in a life. You know, being an Irishman - you know, the secure sort of things to aim for were the professions like, you know, medicine especially and these were chosen to avoid I suppose financial insecurity and to avoid the immigrant ship really.

02:27 So, they had a mindset that you had to do something safe. So, I had a lot of pressure on me in late high school because I'd always been a high achiever at high school. I always tended to come like first in the year, you know, in exams and stuff like that and I was dux of the school, Newcastle Boys High. So, I could get into medicine, so there was huge pressure to actually do it, you know?

02:50 I actually had a much greater interest in humanities and, you know, I suppose, you know, languages and those sorts of things. So, I wasn't - it wasn't really my first choice but he kind of talked me into it and I gave it a go, and I sort of was able to do it. You know, like I succeeded in the first few years of medical school in terms of exams and stuff like that, but it didn't inspire me. It was pretty dull, you know? 

03:24 It wasn't really until I actually got into the more clinical period and especially when I saw the state of psychiatry, you know, which I had been very interested in intellectually because it was like a blend of the arts and the sciences really, ranging from philosophy right through to I suppose clinical care, and even neuroscience too. So, it had an amazing sort of blend of, you know - what's the word - disciplines within it.

03:50 Also, you could see the human rights challenge; you know, the incredible mistreatment and stigmatisation and even abuse in the institutional area of patients, and it was like sort of being in the 19th century at the same time as the 20th century.

04:10 So, massive challenge and really an outlet for that sort of idealism that I had spoken about and been influenced by during my, you know, adolescence, but I kind of felt I couldn't - initially I couldn't really be part of it because then you're kind of colluding with this kind of coercive and terrible system that people are being treated within, and I read a lot of anti-psychiatry material and explored other ways of working in the mental health field apart from traditional medical specialisation.

04:44 But I had returned to Newcastle after where I'd been at school and I was an intern there, and then a few years after that, a medical school was set up and I was actually a medical registrar at the time and the medical school had a very inspirational professor of psychiatry called Beverley Raphael who was very much a humanitarian person, kind of exuded all the kind of qualities and values that psychiatry should be about, you know?

05:17 So, I went and had a talk to her and she encouraged me to give training a go in psychiatry so I did actually go down that track. While the conditions of work were very brutal, I would say, the training and the kind of role models that I was exposed to were much more hopeful and showed a way forward and very preventative focused, and I could see a way that I could actually make a difference.

05:45 Nick: As a millennial looking back, I find it astonishing that there was an anti-psychiatry movement at all and considering the changes from when you were starting out as a student to now, the field of psychiatry and medicine must seem like two different worlds.

05:57 You mentioned the human nature of the clinical work really animated you as a student but I'm interested to know what keeps you motivated now working at the strategic leadership level of the profession?

06:05 Pat: Yeah, well you can see all the anti-psychiatry books right over there, R.D. Lang, and, you know, on my bookshelf still 'Psychiatry and Descent'. I've always been powered by that kind of activism I suppose. I still am. I might look like an establishment figure but just beneath the skin, I'm a very different kind of person.

06:28 So, what I kind of learnt was there's a way of actually using the power of scientific approaches and the health system, if you can actually credential yourself within that world then you have a much better chance of reforming things, providing you don't end up getting institutionalised yourself in the process, you know, which is a risk or getting seduced by status and power and those sorts of things. I've seen that happen to many people who ended up doing very little.

07:07 So, I think that's how I've dealt with it and I never imagined when I was starting off that I would, you know, be successful in those ways but - so, it's a bit like in football. If you work on your skills and you focus on the thing right in front of you and don't get ahead of yourself, then all these other things seem to take care of themselves.

07:32 So many people ask you for your five-year plan. It's not a very good thing to ask because you've just got to focus on the basics in a sense. I mean, you'd have to have a vision about what you want the world to be like and it has to be fairly utopian in a way, and I heard the editor of Lancet last week who we had a meeting with in London, use the term 'realistic utopianism'. In other words, you know, you're aiming for an ideal but it has to be a realistic, you know, sort of vision in a sense.

08:02 Nick: Tempered by, yep.

08:03 Pat: Yeah, and I think that's sort of what I and my colleagues have been working on, you know, and we have achieved I would say an oases of realistic utopia. Like you mentioned, Headspace, Orygen and previously the EPPIC program, and they're very simple propositions, you know; really intervening early in a humane and expert way with conditions that are potentially very serious, you know?

08:28 That's the one thing I did learn in my early days working in psychiatry, that while the philosophy and the human rights perspective of anti-psychiatry was actually spot on, their understanding of the nature of the illnesses that we are dealing with was off, you know? These were very serious problems which were health problems, they weren't kind of social problems. They had social determinants and social influences and impacts but fundamentally, a health model was the right way to think about them. 

09:03 Nick: Yep, and if you sort of come back to centre frame with EPPIC, Orygen and Headspace and your efforts there of your last 35 years in Victoria alone, why are targeted mental health services so critical for that discreet young period of life in those particular conditions, and I guess why is Orygen, Headspace and EPPIC had so much traction in the community? 

09:25 Pat: Well, I think one of the first things I learned was I came down to Victoria with Professor Bruce Singh who gave me the role of setting up a research unit at Royal Park Hospital which was one of the old mental hospitals just down the road from here, where John Kade had been the superintendent who discovered lithium, so a kind of inspirational sort of history. 

09:45 But it was the first time a research unit had been established there and we decided to focus on first episode psychosis. Eventually, we saw that the model of care which was a chronic pessimistic model; you know, someone once described it like the management of the British Empire, the orderly management of decline. You know, that's what the management of schizophrenia was like because no one expected people to get better. They thought it was a deteriorating illness and we saw these young people brought in with their first episode of psychosis into these environments and they were sort of contaminated with this incredible pessimism, and they were traumatised because they saw their futures laid out before them.

10:29 They were treated in crude and unhelpful ways with massive amounts of medication which they didn't need. They needed only very tiny amounts and they needed a whole lot of psychological and social kind of help and support which had to be expert and evidence based too, but it wasn't. So, and the families were distraught as well. Often the admissions were involving police, which sadly even today is the rule rather than the exception. So trauma was being inflicted on these young people.

11:00 So, the first thing to do was to try to, you know, reduce the harm, the iatrogenic aspects and then start to take the opportunity of, you know, the intervention approach and recovery orientated approach which we did for a number of years leading up to the establishment of the EPPIC program which was much more of a community based, early detection and intensive care approach in the community. It wasn't rocket science. It was - it's absolutely obvious when you saw what the needs of the patients were, if you listened to them and you could imagine what was needed.

11:38 It was really applying the principles that you would apply in cancer or heart disease to psychiatry. I actually got the idea for that from Newcastle, from working in a diabetic education and stabilisation centre run by Dr Paul Moffatt of Royal Newcastle Hospital, where newly diagnosed diabetics were brought in on an outpatient basis for an education program for a whole week, and their diabetes was stabilised and they were educated about how to manage the illness.

12:07 Nick: A one stop shop kind of thing...

12:08 Pat: Yeah, yeah, comping it with dieticians and, you know, other professionals. By the end of the week, their illness was in much better shape and they felt much more empowered to manage it. So, that was a very simple thing.

12:23 Now, same approach we tried with people with newly diagnosed psychosis. Much more challenging because their ability to sort of learn and understand was comprised by the illness itself because the brain is obviously involved and the mind. Never the less, the health psychology of it was very similar and most of what we regarded as abnormal behaviour or insight, in relation to insight, was actually just due to the massive challenge of adaptation to the diagnosis as much as the illness itself. So, working in those ways, we just tried to apply the principles that would be normal of other areas of healthcare.

13:05 Nick: Yep. So, to get a sense of the scope and severity of what you've called “the Australian health system's mental health breakdown”, there's a really helpful summary on the Australians for Mental Health website which you cofounded, and it strikes me as a really excellent distillation of the key issues in the Australian mental health ecosystem.

13:23 It says mental illness affects 4 million Australians. Every day, eight Australians take their own life. Australia's mental health services are fragmented, underfunded, hard to access and of poor quality. People who need help can't get the care they require. Can you expand upon this and perhaps give a more detailed accounting of the size of the problem and the inadequacy of the current model to meet the needs of the population?

13:47 Pat: Well, this is a worldwide problem. The Lancet produced a global mental health commission late last year and it showed the state of the problem around the world where even though mental illness is, you know, the number one non-communicable disease in terms of its impact upon the economy, the global economy, and GDP reduction of 4% across the board; much more than - twice as much as cancer, and the reason for that is because it affects people in the prime of life, unlike cancer. 

14:24 Despite that and despite the prevalence of the problem, it's treated like a minor issue by the health system. So, in something like 14% or 15% of the burden of disease, if you count it carefully in Australia then it receives about 6% or 7% of the health budget.

14:44 Nick: In the UK, it's double that in terms of the health budget as well, isn't it? 

14:47 Pat: Yeah, that's right, but even there it's still - then it's the model of care that's the problem too and the quality.

14:56 So, it's not being taken seriously. I mean, another figure that's on the website is the contrast with the NDIS. Here, we have 400,000 people with physical disabilities and the society and the government have decided to spend $22 billion a year on looking after those people in a better way which is good, but you contrast that with mental illness where 4 million Australians are every year affected, probably close to 2 million of those in a moderate or severe way and yet we're spending something like $9.6 billion a year on those people.

15:32 So, the mismatch and the underspend is catastrophic and it means that access is poor, the timing of access is poor, there are long delays and even if you get access, the quality is very patchy and inconsistent in a sustained way.

15:49 So, all that means that a lot more disability results and preventable deaths result, not just from suicide which you mentioned but also as we saw earlier this week when The Lancet commission on physical health in mental illness was published in terms of physicalness, where people are dying up to 20 years earlier as a result of cardiac disease and cancer in - people with mental illness are dying up to 20 years earlier than everybody else.

16:18 Nick: Extraordinary, isn't it?

16:18 Pat: It's an incredible, you know, denial of human rights and, you know, I suppose equity. The surprising thing, we have Alastair Campbell coming out to Australia next week to try to help us analyse in public forums and the media why that is the case; why are the Australian public, why are the societies all around the world tolerating this state of affairs? What are the reasons whereby our politicians - you might say how can they get away with it, but I would say how are they not empowered by the public to deal with it? That's probably a more charitable way of putting it because I think most politicians I've met - if there was a groundswell of public pressure and support for doing something more definitive like what happened with the NDIS, they would do it. It's not like...

17:09 Nick: A tipping point of public activism and pressure, I guess.

17:12 Pat: Exactly. The social movement is weak in mental health and has divided some of the consumers because of the bad experience they've had, don't support what we're trying to say and what we're trying to do. They undermine it actually.

17:25 Nick: Yet, there's an incredible potentiality there I suppose for such a social movement because mental ill health does affect everyone personally or in terms of the people that they know, it's one of the most proximate...

17:36 Pat: Everyone knows someone or they've had problems them self or there's someone in their family but - and the social movement, this is the whole idea behind Australian's for Mental Health; to create and sort of mobilise and engage the public to create that social movement too because that's the only thing that's missing. We have all the facts; we have all the evidence. We know that mental health interventions work just as well as physical interventions if they're delivered properly.

18:02 Politicians and the public know all this. We've got great awareness now and we've got great talent, you know, as well but the missing ingredient is the public's demand for equity.

18:15 Nick: Yeah, and I think even when you sort of pitch it in those economic terms, these people pay taxes ultimately, and if they're dying 20 years earlier than they might otherwise, had they received appropriate treatment and care, then that sort of pays for itself in terms of economic terms. That's a hard argument to make to the public or to politicians but... 

18:32 Pat: Not really. We had a productivity commission enquiry now, as you know, which is looking at this. It was set up partly to look at efficiencies and the current spend which is fair enough, but they're also looking at the consequences of the underspend which is huge expenditure in other areas like, you know, welfare payments. Here in Victoria, we're building prisons at a rate of knots and those prisons are full of people with untreated mental illness. So, there's a whole lot of money that could be saved if we actually funded direct care in a better way.

19:05 Nick: So, what would that ideal future state mental health system look like if it was fully funded in the matter, we do services for other non-communicable diseases like cancer or heart disease? I suppose you've already alluded to it, but what would be the social, medical and economic impacts or dividends that we yield from such an investment

19:21 Pat: Well, I think for a start, just on the humane argument, people would - there would be a lot less suffering and there would be a lot less disability and you’d see more flourishing lives rather than blighted and, you know, burdened lives.

19:38 But I think if we look at what went wrong here and this is what was part of my witness statement to the Royal Commission and the term ‘Victoria's mental health breakdown’ is relevant here; 25 years ago around Australia in the wake of the Burdekin enquiry, we dismantled the old mental health system of the 19th century and the promise was we would build, you know, a fit for purpose, integrated system, mainstream with general healthcare. So, the beds were reduced dramatically, a huge amount of money was saved by state governments and then the small number of beds left were put into general hospitals and they promised to build a proper community-based system, a platform of care that would enable us to work without so many beds.

20:30 Of course, that's been a failure really because, you know, and there's been disinvestment so now there are 3% of the community affected by serious mental illness. Only about 1% of those people actually get 1any access to care in Victoria, so two out of three people are turned away or get no care with the most serious forms of mental illness.

20:50 Federal government has actually improved their side of things for primary care by better access and also Headspace and things like that but there's a huge gap in the middle which we call the 'missing middle' which cannot actually get care. It's probably about 10% of the population. 

21:05 So, imagine if 10% of the population with cancer or 10% who had cancer were unable to get care? That would be completely unacceptable, and it's probably about half of the people with mental illness are in that situation at the moment.

21:22 Nick: For example, they were too ill for GP treatment but they're not ill enough to be admitted to hospital or other sort of comprehensive care or...?

21:28 Pat: So, it's like sort of with cancer, waiting until people have got metastatic cancer before providing any type of care and then even then it's just patched up and sent away again. 

21:38 Nick: That would be intolerable in society if that were the case, wouldn't it?

21:40 Pat: Yeah, it would be absolutely intolerable. So, that's why we've got a Royal Commission to look at how that happened. Really, the problem was we just dumped the old type of thinking and institutional thinking into the general hospitals and they'd sat there like a big iceberg sort of melting away over the last 15 years or so and we've been drawing attention to that. I certainly have and other colleagues have over the last 10 to 15 years. The governments have been completely deaf to it and even though we've been developing solutions, modern 21st century solutions like Orygen and Headspace alongside of that, they've disinvested in things that work actually in general.

22:23 So, there's a complete rebuild needed, redesigned with lived experience heavily involved as is happening now, but a complete redesign; not a patching up. Some of the submissions to the Royal Commission are suggesting all we need to do is just, you know, strengthen the existing, it’s fundamentally correct the design but it just needs to be, you know, reinvested in more heavily. It needs to be properly designed and it needs to have the right age bands, you know, so child up to 11, youth 12-25, adults 25+ and then an old age component, but with community based platforms and the inpatient care as a secondary sort of step, not the primary focus as it currently is.

23:11 Nick: Yeah, and one of the issues you've identified in other interviews I've read is that there's a sort of precipitous drop off from age 25. You can't access services that you had been accustomed to. There's no kind of sense of the continuum of mental health care.

23:25 Pat: That's right. Well, I think those boundaries have to be soft ones, don't they? Whether it's around puberty or around mid-twenties, you want to have a bit of flexibility because people are at different stages of their lives, but the problem is in the youth area we have built an infrastructure, Headspace, which is promising; it's still got a few weaknesses, but the biggest weakness is once you have a more complex problem, there's no more intensive or specialised piece behind it apart from, you know, hospitals and the hospitals are not structured the right way for young people either. So, the reform task is still at base camp. You know, we have built a base camp but we haven't climbed the mountain yet.

24:04 Nick: You can see Everest in the distance, that's wonderful. You are also on record as saying that you're incredibly optimistic. One, because the Victorian state government, the Andrews government has said that they'll accept the recommendations of the Royal Commission's report. There's also a golden opportunity for generational mental health reform of the kind you've alluded to before, with Prime Minister Scott Morrison announcing the government zero suicide goal. Health Minister Greg Hunt has lived experience of a family member with mental health illness and I think a lot of his personal witness to that is quite powerful.

24:37 Of course, we've got the Royal Commission into Victoria's mental health system. So, I guess what's your feeling in the community, now that the stars seem to be aligning and how realistic is some of the sort of generational change that's been spoken of

24:51 Pat: Well, we do have this once in a generation opportunity to grasp it. The question for the Prime Minister and Greg Hunt and Josh Frydenberg on the federal level for Dan Andrews and Tim Pallas at the state level and probably other state governments too is do you understand the scale of the task in front of you?

25:15 It's not going to be a question of spreading modest amounts of money, millions of dollars or even hundreds of millions of dollars around the mental health sector to patch things up. It's a radical change that's needed. It's going to need state and federal governments working together and I'm encouraged by the fact that Greg Hunt has met with Martin Foley recently. I encourage that and I think reaching out to the New South Wales government. If those three governments were able to come up with a commitment to this from both sides of the river, you know, the state and federal, then I think we could really see some significant change but they have to listen to the small group of experts that really know what needs to be done. It's not a very big group in Australia. Lots of stakeholders are pushing their own vested interests but there's a consensus amongst the people who really understand the nature of what's needed in the system and that obviously includes, you know, key leadership from lived experience from families. 

26:20 The families and the people who have experienced mental illness really know what they need. They know that we have the ability to provide that too if the cultures of care are right which involve lived experience, having power and influence in those structures, but we've got to have respect for scientific evidence as well and for the leadership of professional groups that can contribute in a multidisciplinary sort of way.

26:44 So, it does need a decisive process such as we saw in the nineties with the reforms of the nineties. That wasn't done by consensus, that was done by really having a plan - a clear plan.

27:01 I think where the consensus needs to sit is with the public. The public consensus needs to be built and this is why these commissions are so important because the only way you're going to build a public consensus that's going to overwhelm vested interest and inertia and history is with the public being, you know, convinced that there is a plan that's going to work. 

27:23 Nick: Yep, which is why I think a lot of the reporting that the ABC and Fairfax have done on this Royal Commission is so powerful and potent because of all the striking personal testimonies that have emerged and have been covered really well.

27:36 They've also kind of - you know, which is I think crucial in terms of building up that public demand or consensus for a significant investment of public monies into this fundamental system redesign you've spoken about. It is quite disheartening or difficult to listen to I guess the disproportionate ways in which vulnerable minority groups in particular such as Aboriginal and Torres Strait Islander Australians, recent migrants, the LGBTQI community and other communities of colour have been affected by the failures and flaws of the mental health system, and of course that has debilitating, compounding negative effects on their lives, especially when it's the young because it tends to ripple throughout their lives.

28:19 Pat: Absolutely.

28:20 Nick: Could you maybe reflect on the nature of these challenges that mental ill health presents generally, particularly on these vulnerable communities?

28:29 Pat: Yeah, well, I suppose as LGBTIQ we've made a special effort within these mental health field, you know, Orygen and Headspace, to actually create a safe space for them, and that's been represented in the data. You know, so people are voting with their feet there that they do come and they will seek help in these safe spaces, Headspace centres for example. 

28:51 A lot more work needs to be happening in the multicultural communities to make that a reality, you know? I was in Bankstown recently for Headspace when I saw some incredibly good clinical work being done with young women from Islamic backgrounds, helping them deal with the cultural adaptation. You know, they were in suicidal crisis because of this, you know, two world problem that they're in, you know, and the adaptation to that. 

29:17 So, a lot more could be done there. Indigenous of course as well. Mental health in the indigenous communities has not been taken seriously and not been integrated properly or dealt with properly.

29:30 So, lots of challenges but I'll just make the point that even affluent people, even middle class and affluent people, when it comes to mental illness, they cannot get the quality of mental care that they need either. You know, you see these people trying to construct their own health teams. You know, they have means so they can probably do it but it's fragmented and the degree of difficulty is high. The professional groups are not organised in such a way as to meet the needs of the consumers properly. The consumers don't really - they're not really in control of the situation.

30:04 Nick: But isn't that extraordinary because even with all the resources and privileges that wealth I suppose would afford you, it's still incoherent and difficult to actually find treatment. I find it remarkable.

30:15 Pat: Absolutely. I can't tell you how many people contact me, you know, over the years to try to get help with that and it ranges from people, you know, from disadvantaged backgrounds in our catchment area here, but people from highly affluent backgrounds and who are struggling to find, you know, quality care.

30:34 You know, that's what the challenge is, developing financial models and incentives so that we can build a system that's fit for purpose. The expertise is there in pieces, you know, but it hasn't been put together, except in places like Headspace and Orygen and even then, it's still a struggle because we haven't got all of the pieces but that's the challenge. A financial model that's appropriate, a little bit like the NDIS was a financial model, although I wouldn't necessarily go with that one but a financial model that will enable multidisciplinary team care in a seamless sort of way for as long as people need it.

31:13 Yeah, so it's all doable. That's where the optimism comes from. You know, I'm very confident that we know what to do. Whether we'll get the support to do it, whether - will we get the consensus? Will we get the follow through from Daniel Andrews and Scott Morrison? I know both of them personally. I believe that they're sincere and the recommendations of the commission here will be very important, but the best and surest policy to strengthen their arm is mobilising the public. So, these political leaders who want to do the right thing realise that the public will expect that of them now and if they don't do it, then there will be consequences too.

31:57 Nick: Yeah. So, I think before I mentioned that the power of personal testimony and storytelling and narrative about these extraordinary experiences with the mental health system and mental ill health in general which I think are lost in the kind of blizzard of statistics which are often inevitably anonymous, right? 

32:19 I think one of the most powerful memoirs I've read about mental ill health is William Styron’s Darkness Visible which I think is one of the most accurate, moving and compelling testimonies I've read about lived experience of mental ill health challenges and the fact that what seems like an overwhelming affliction is actually surmountable. So, Darkness Visible concludes on a hopeful note that I think it might be a nice way to wrap up our conversation today.

32:41 It reads as follows. “One need not sound the false or inspirational note to stress the truth that depression is not the soul's annihilation. Men and women who have recovered from the disease and they are countless bear witness to what is probably it's only saving grace, it is conquerable.”

32:55 The final quote of the memoir is a line from Dante's The Divine Comedy where he finds his way out of the darkness of hell and the dark wood, and it concludes: “And so we came forth and once again beheld the stars.”

33:09 So, how do you interpret that kind of sentiment in the context of your work with young people who feel that overwhelming sense of hopelessness and helplessness, and that their mental health condition would never get better? What would be your final message I suppose?

33:21 Pat: It's great that you've brought that up, Nick, because that was the thing which struck me. It was more in the realm of schizophrenia and psychosis that I struck that. I suppose corrosive pessimism is the term I used for it which the system was imparting to the patients actually. It wasn't just the person felt that, but they were told that was going to be the situation.

33:45 I mean, a cancer physician would never tell a patient no matter what stage of cancer they were at that there was no hope but that's what psychiatrists were saying to patients who were diagnosed with schizophrenia back in the 1980's. You still hear that occasionally today.

34:00 Depression obviously hopelessness goes with the condition, so it's incredibly important to impart hope to people with depression and also psychosis and every mental health condition. It's not deceiving the patient either. It's not pathological honesty we're talking about here because most people do get better and especially now - William Styron was writing in the era before there were any scientific treatments and even then, depression tended to resolve in most cases if the person didn't die from suicide.

34:30 So, these days we can get the vast majority of patients better with the treatments we have, plus their own resilience and their own, you know, ability to learn to adapt, a combination of those two things. So, I've got tremendous respect for people with mental illness, the resilience they show and the courage they show and you hear that from the Royal Commission every day, and I think in their testimonies.

34:55 So, that's what I - I do feel very optimistic and it's also why I hate the term resilience to be honest because, you know, people often say, you know, if we teach people to be resilient, they won't get mental illness. That's really victim blaming because mental illness happens to people not because they're not resilient, because of a whole range of other factors.

35:17 I think most people who are afflicted by mental illness and the suffering that goes with it are highly resilient. I've seen that in my own family. I've seen it every day in my patients and I think we do have something to offer and research is obviously a pathway to looking at cure even. You know, people don't like to talk about cure in mental illness for some reason but I've seen many people cured and I think it's something that we should aspire to in every patient really, if we can. If we can't, we help them to recover and lead the best possible life they can and even if they still have symptoms, that's very, very possible.

35:55 Nick: Yep. Pat McGorry, thank you very much for your time today.

35:57 Pat: Yeah, thanks Nick.