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Cure for most mental disorders ‘possible’, award-winning psychiatrist says


Neelima Choahan


22/10/2018 1:37:23 PM

After a career spanning 60 years, Professor Gavin Andrews is a dual winner of the Australian Mental Health Prize. He talks to newsGP about what’s changed when it comes to managing issues of mental health.

Emeritus Professor of Psychiatry Gavin Andrews says the community as a whole is starting to talk about mental disorders in no different terms than they talk about diabetes or asthma.
Emeritus Professor of Psychiatry Gavin Andrews says the community as a whole is starting to talk about mental disorders in no different terms than they talk about diabetes or asthma.

Emeritus Professor of Psychiatry Gavin Andrews believes many people who develop a mental disorder today can be cured.
 
The 87-year-old clinician, teacher and researcher has had a career in mental health spanning 60 years. And in those years, he said the prognosis for mental health care has improved far more than diseases like diabetes.
 
‘I believe the majority of people who develop a mental disorder today can be cured,’ Professor Andrews told newsGP.
 
‘Essentially, they will be able to say, “That’s not a part of my life anymore”.
 
‘Clinicians often doubt their own effectiveness because we’re all subject to the “clinician’s illusion” of basing judgements of effectiveness on who’s in the waiting room today. Naturally, it contains people who are waiting to get better, and the people who have recovered are gone.’
 
Professor Andrews retired from the University of NSW earlier this year, where he has been an academic staff member of the School of Psychiatry since 1964.
 
On Friday, Professor Andrews became one of the dual recipients of the 2018 Australian Mental Health Prize.
 
A spokesman for the Australian Mental Health Prize said Professor Andrews is among the world’s most highly cited scientists in this field. He is responsible for preparing the first ever set of clinical practice guidelines in psychiatry, the first National Survey of Mental Disorders, and a range of online courses for people experiencing common mental disorders.
 
‘The lifetime work of Professor Andrews has had a fundamental impact on the way mental disorders are diagnosed and treated in Australia and around the world today,’ he said.
 
Professor Andrews’ research interests began with stuttering, a neurodevelopmental disorder, extended to depression, epidemiology, treatment of common mental disorders, classification of mental disorders, cost effectiveness, and internet treatment of internalising disorders.
 
‘I liked people’s stories,’ Professor Andrews said.
 
‘I was looking for what specialty I would go into, and I looked at all the options and I thought, “Well, you like people stories, and this field looks like it will develop rapidly. Let’s go”.’
 
Professor Andrews has seen huge changes in the field since he started in 1959.
 
‘We have got better drugs than we had in 1960, we have got drugs for conditions we didn’t have,’ he said.
 
‘We have got psychological therapies that work, which can be done over the web. We have got treatment outside mental hospitals and into general hospitals and into the community generally so that access is very practical.’
 
He described the changes as radical.
 
‘When I joined … they were only interested in people who were psychotic … and they were only interested in hospitalising them,’ he said.
 
‘When I began training in Melbourne … [British psychiatrist] Cunningham Dax was revolutionising psychiatry in the late 1950s and the late 1960s.
 
‘And Victoria was leading the whole country by a mile at that stage, and all the things I was wanting him to do have probably come to fruition nationally. Of course, we have progressed on from there.’
 
Since then, Professor Andrews said, there has been more progress with lot more services available.
 
‘One of the problems we have got is the split between state and commonwealth funding,’ Professor Andrews said.
 
‘The commonwealth funds fee-for-service medicine, but takes no responsibility for individual patient care. And the states run the inpatient psychiatric unit and the consequent care of people who are sick enough to need hospitalisation.
 
‘Somehow or other it would be nice if Australia could undo that split.’
 
Professor Andrews said attitudes towards mental illness and mental health have also changed, with a lot more discussion, especially in the media.
 
‘I think the community as a whole is starting to talk about mental disorders in no different terms than they talk about diabetes or asthma,’ he said.
 
‘[When I started] I don’t think people had any concept that they should take care of their mental health. They had very little concept that they should take care of their physical health.
 
‘People were smoking, exercise wasn’t fashionable. Things have changed just in general as people live longer, they are taking much greater care of themselves, and that’s [both] mentally and physically.’
 
Professor Andrews believes further change will come from new clinical practice guidelines and ways of determining which treatments will suit individuals, but mostly it will come from collaboration between clinicians and patients about the possibility of recovery.
 
‘Improved clinical outcome measurement will enable clinicians to know how effective they are, and patients will be keen to know about their own progress and will expect to recover,’ he said.
 
‘If you are not improving after 30 days, ask “Why?”

‘Cure is possible, and we as clinicians, patients and their families must pursue it energetically.’



Australian Mental Health Prize National Survey of Mental Disorders



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