To the Editor: I am concerned that the Journal supplement “Early intervention in youth mental health”, published on 1 October 2007, may contravene the MJA policy on sponsored supplements. Item 9 of that policy (http://www.mja.com.au/public/information/instruc.html#Supplements) states:

While many of the articles in this supplement are clearly scientific papers, a minority read more as advertorials and promote the interests of two of the supplement’s sponsors.1-3

The ORYGEN–headspace approach to adolescent mental health differs from the approach of other expert organisations, including the Faculty of Child and Adolescent Psychiatry of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and the Australian Infant, Child, Adolescent and Family Mental Health Association.4 Both these organisations support ORYGEN and headspace in seeking to enhance mental health services and transition to adult services for adolescents, but not in the proposed “specialist youth-specific (12–25 years) mental health services providing comprehensive assessment, treatment and social and vocational recovery services”2 (Dr Phill Brock, Chair, Faculty of Child and Adolescent Psychiatry, RANZCP, personal communication). This arrangement does not fit with the way in which other service providers (education, juvenile justice, medicine) are organised, or with the legislative framework that protects the rights, welfare and safety of children (0–17 years of age).

Children are not young adults, and child and adolescent mental health service models differ significantly from the traditional focus of adult mental illness. Most teenagers require a family-centred, developmentally appropriate, contextually sensitive, multimodal and systemic model that is less well developed in adult mental health services, including ORYGEN.

In spite of claims to the contrary in the supplement, these different approaches are in competition for resources. ORYGEN and headspace have a product to sell (to government and to the medical and lay community). The publication of this supplement has provided them with a platform without presenting an alternate view.

In reply: Dr Jureidini’s response to the “Early intervention in youth mental health” supplement is puzzling and idiosyncratic. He asserts some kind of impropriety on our behalf or that of the MJA — an assertion we strongly reject.

All articles were peer reviewed by experts in the field, including the editorial,1 which is obviously and explicitly the authors’ point of view and therefore open to debate, which we welcome. Other articles Jureidini characterises as “advertorial” are genuine descriptions of new models of care.2,3 Far from selling a product, we are advancing legitimate clinical and scientific arguments, and describing active reforms in mental health. Our “interests” are the pursuit of better mental health care and outcomes for young Australians, pure and simple.

No evidence is provided for the assertion that the models described are in competition for resources. headspace has been fully funded with a completely new allocation of federal resources, with no funding redirected from other programs to support it. Furthermore, the youth mental health reform model was selected by the Australian Government through a nationally competitive tender process, in which anyone with a different approach was free to put it forward; indeed, several other submissions were considered and rejected.

Similarly, no resources have been diverted to create the ORYGEN model; it is simply a successful restructure of existing resources that is demonstrably better accepted and more effective. Evidence shows that young people and their families find services structured in this way much more user-friendly, and levels of access, engagement and retention are substantially increased over traditional models.

One of us (P M) is a member of the Faculty of Child and Adolescent Psychiatry of the Royal Australian and New Zealand College of Psychiatrists (RANZCP), and neither we nor headspace are aware of any official position of the RANZCP that is inconsistent with or unsupportive of the headspace development. Most of the 30 new headspace services across the nation are being established in partnership with local child and adolescent psychiatrists and public mental health services. While many psychiatrists are supportive of and working within the headspace and ORYGEN models, a small subset have expressed a fear that strengthening the focus on adolescents and young adults will somehow disadvantage children. Where is the evidence to support this fear?

We are wholly supportive of further investment and improvement in mental health services for children. Unnecessary division on this issue will hamper all progress and is against the interests of patients and families. We strongly agree that there is clearly unmet need in the 0–12-years age group, as well as a further need for preventive interventions beyond the clinical service system, which may in time reduce the surge of incident cases of adult-type disorders.

We call on Dr Jureidini to put his efforts into increasing resources and developing innovative service models to improve the mental health of both children and young people, rather than engaging in sterile arguments over professional territory and distribution of existing resources that will benefit no-one.

In reply: I welcome Dr Jureidini’s criticisms regarding the publication of the MJA supplement “Early intervention in youth mental health”.1

Dr Jureidini has two major concerns. First, a number of articles in the supplement are deemed to unilaterally advocate concepts arising from the ORYGEN–headspace program, with the suggestion that this exclusivity contravenes the MJA policy for publishing sponsored supplements. Second, he claims that the general framework of the ORYGEN–headspace program does not have the endorsement of professional bodies such as the Faculty of Child and Adolescent Psychiatry of the Royal Australian and New Zealand College of Psychiatrists (RANZCP).

Eminent mental health experts reviewed the articles in the supplement and, interestingly, not one of these authorities raised the RANZCP’s misgivings. This could mean that propagation of the Faculty’s concerns in the psychiatry fraternity may be selective, or that the rationale for its position has not convinced psychiatrists at large.

Dr Jureidini’s other concern — that the supplement favoured the ORYGEN–headspace approach at the expense of other interventions, views or products — reflects the very essence of supplements. The fundamental purpose of publishing research or commentaries is to enter information into the publishing–evidence–integration cycle, wherein the dissemination of evidence or ideas is intended to promote change by influencing other researchers, health care professionals, the public and, ultimately, policymakers.

Indeed, the ORYGEN–headspace program must have influenced policymakers, as the federal government recently announced grants totalling $19 million to support the national roll-out of the headspace program, especially in rural communities.2

Even if the publication of the MJA supplement played little or no part in this political endorsement, I am content that it has, at least, fostered debate and may well play a part in improving mental health services for young Australians.