First steps— finding a better way to respond to psychoses in young people

Aubrey Lewis Unit

The program that became EPPIC began in 1984 at the Aubrey Lewis Unit at Royal Park Hospital, with a special focus on assisting young people who were hospitalised while experiencing a first episode of psychosis. It was hoped that by having a streamed inpatient clinical research unit totally dedicated to young people and enhanced by a comprehensive psychosocial recovery program, some of the institutional causes of secondary morbidity would be reduced and recovery would be maximised. The unit was intended to provide a platform for a new program of research in schizophrenia and psychosis.

The inpatient unit was staffed with nurses, medical, and allied health staff who wanted to work with young people. An atmosphere more suitable to young people was developed. The needs and specific issues that face young people in their first episode of psychosis, and the needs of their families, were focused on and addressed for the first time.

Building on these initial developments, a new service called the Early Psychosis Prevention and Intervention Centre (EPPIC) officially came into being in September 1992, when the primary treatment environment became the community rather than purely an inpatient setting. At the same time the catchment area for the service was greatly extended to include the North Western and Western parts of Melbourne.

This move away from the provision of care only in hospitals saw EPPIC operating from a new location at 35 Poplar Road and services expanded to include the establishment of a number of community-focused service components, such as: Early Psychosis Assessment team, clinical case managers, a comprehensive group program, specialist family work, and a robust program of community awareness. This development underpinned a program where all of these important interventions were offered in an integrated and seamless manner through one organisation. Critically tenure of care was guaranteed for the first two years post onset, a major enhancement of care. 

The Early Psychosis Research Centre, which had preceded EPPIC after being supported through a Victorian Health Promotion Foundation Grant awarded in 1991, was opened in 1992. The research was critical to the formulation of the prodromal focus, the continuing development of novel psychosocial interventions and strategies to further improve the quality of the program.

By 1995 the comprehensive program for young people experiencing their first episode of psychosis was enhanced by adding mobile home based acute care (EPACT) and also by the formation of the PACE clinic for people who were identified as likely to be 'at-risk' of developing a psychotic illness, or who were experiencing low grade psychotic symptoms.

To help contribute to and to learn from international developments in early psychosis, EPPIC hosted the first International Conference on Early Psychosis in Melbourne in 1996, and drew together a group of international experts to form the International Early Psychosis Association (IEPA) in 1997. The secretariat for the IEPA is hosted at Orygen.

A broader focus— innovating in major mental illnesses in young people

The next phase of our development was the 1996 expansion of the youth-focused, early intervention approach of the EPPIC model to providing care to young people with other major mental illnesses (eg. major depression). The name of this new service was the Centre for Young People’s Mental Health which incorporated an existing program working with young people 15–18 years of age with non-psychotic illnesses, called the Older Adolescent Service into the clinical governance structure of the CYPMH.

In 2002, significant philanthropic investment from the Colonial Foundation provided a substantive base for the establishment of Orygen Research Centre. The Research Centre was formed as a charitable company limited by guarantee with three Members - Colonial Foundation Limited, The University of Melbourne and Melbourne Health. At the same time the Clinical Program was reformed to also operate under the ‘Orygen’ banner, further consolidating itself with the implementation of a consistent 15–25 year old age range for the provision of its services to young people with severe mental ill-health.

Orygen Youth Health Clinical Program reception

Over time the Orygen Youth Health Clinical Program continued to develop and grow its service model to become a comprehensive clinical structure that addresses the needs of young people who present with a range of emerging mental health and substance use problems through its sub-programs EPPIC, PACE, Mood Disorders and HYPE (for emerging personality disorders).

It was recognised through research and national data that while providing specialist mental health care to hundreds of young people in the Northwest of Melbourne was a better service model for the more severe forms of mental ill-health, the vast majority of young people were failing to gain any access to care. There was a need for a high volume enhanced primary care response which the existing primary care system seemed unable to provide.

National impact— youth mental health reform in Australia

In 2006 Orygen became the lead organisation in the Commonwealth Government’s National Youth Mental Health Initiative, in a consortium with The University of Melbourne, Brain and Mind Research Institute, The Australian Psychological Society, and The Australian Divisions of General Practice.

headspace Craigieburn

From 2006-2009 Orygen partnered with The University of Melbourne to create and manage the initial $54 million national reform that became headspace: The National Youth Mental Health Foundation.

During this time Orygen was responsible for the establishment and scaling up of 30 new headspace centres across Australia and the development of the headspace model.

In 2009 Orygen supported the transition of headspace to become an independent charitable company with a substantial increase in funding. Orygen continues as one of the five Founding Members of headspace and works closely with headspace on a range of initiatives. These initiatives include the operation of four headspace Centres, the provision of the Centre of Excellence program at headspace and partnership in the roll-out of early psychosis services in a number of sites across Australia.
headspace is now an international unique model of care which has provided access and care to hundreds of thousands of young Australians. By 2016 the headspace model will be operating 100 centres in Australian communities.

In 2006, Orygen’s Executive Director, Professor Patrick McGorry AO, was invited to accept the newly created Chair of Youth Mental Health within the Centre for Youth Mental Health, Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, an initiative that continues to drive the clinical-academic partnership critical to the continuous improvement of mental health services for young people.

In 2007 a new international journal, ‘Early Intervention in Psychiatry' was launched under the editorship of Professor Patrick McGorry AO, involving many of the senior researchers at Orygen as associate editors or editorial board members. This journal continues to go from strength to strength.

In 2008 Orygen hosted the 6th International Early Psychosis Conference and the Australian Schizophrenia Conference. This catalysed a renewed effort to have the early psychosis model scaled up across Australia.

In 2010 Professor Patrick McGorry AO was awarded the Australian of the Year. In his acceptance speech he said:

Patrick McGorry Australian of the Year

'Mental health reform is a team game and I am just one player. Our team needs more recruits, we need a level playing field in the health sector, and we need the Australian public and our governments to back the team. Thanks to a new openness and Australian innovation, I believe we are at the tipping point for a great leap forward. I want to dedicate this award to all of you who suffer or will suffer poor mental health and ask for your deep commitment to help change the landscape of mental health care in Australia.'

In 2010 Orygen and headspace hosted the First International Youth Mental Health Conference in Melbourne, cementing the Australia’s position as a global centre of innovation in the field.

In 2010 and 2011 the Australian Commonwealth Government committed to a range of mental health reforms including the expansion of the headspace platform and critically a $246.8 million dollar investment in scaling up the internationally regarded EPPIC model. Orygen continues to work with the Commonwealth Government and headspace to support the establishment of the EPPIC Model in nine locations across Australia.

In 2013, with Orygen’s leadership, the International Association for Youth Mental Health was formed and the IAYMH hosted the Second International Youth Mental health Conference in Brighton, UK. The secretariat for the IAYMH is hosted at Orygen.

Prior to the 2013 Federal Election the Coalition pledged funding to Orygen to establish a National Centre of Excellence in Youth Mental Health. This funding catalysed an expansion of Orygen’s work, with a particular focus on development the Australian mental health workforce and providing expert policy advice for the improvement of mental health services nationally.

In September 2014, Orygen’s Director, Research, Professor Helen Herrman became the first Australian to be elected World Psychiatric Association President.