Julian Hill (Bruce, Australian Labor Party) Share this | Hansard source

Youth mental health and suicide are critically important to all of us. They're not partisan issues. Every life lost to suicide is a tragedy for the person who dies and for all who loved that person. Suicide reverberates over years and a lifetime. The motion talks to the money allocated, which is well and good, but it's not the point; it's the outcomes that matter. The fact is that, despite more than a decade of focus, youth suicide rates in Australia are still rising. The outcome that really matters is going in the wrong direction. In the decade to 2018, Australian per-capita suicide rates for people aged nought to 24 years have increased approximately 49 per cent, from 279 lives lost in 2009 to 458 lives lost in 2018.

The causes of suicide are complex, but, in considering what we should do as a society, there can be no sacred cows or practices that can't be challenged. In that spirit, I draw to the House's attention an important peer reviewed academic paper by Whitely, Raven and Jureidini, published this Monday. The paper finds that, over the same decade that suicide rates for young Australians have steadily increased, the prescribing rates of antidepressants for child adolescents and young adults have also increased, by 66 per cent. From 2008-09 to 2018-19, the proportion of Australians aged nought to 27 years using antidepressants grew from 2.9 per cent to 4.8 per cent. Especially concerning is the fact that not one antidepressant has been approved by the TGA for use by children in Australia to treat depression, yet in 2017-18 at least 101,000 Australian children—that is, 1.8 per cent of all Australian children—were dispensed an antidepressant. The overwhelming majority are prescribed by GPs, not by psychiatrists. All the while, youth suicide rates are rising.

As of 2015, the explosion in the prescribing of antidepressants has made Australians the second-highest users of antidepressants of any country, behind only Iceland. Correlation is not causation, but, with 10 years of data going in the wrong direction, we can't ignore this issue. The paper states:

These results do not support claims that increased antidepressant use reduces youth suicide risk. They are more consistent with the FDA warning and the hypothesis that antidepressant use increases the risk of suicide and self-harm by young people.

That is in aggregate, obviously. The FDA reference refers to the action by the US Food and Drug Administration in 2004 and 2007, when it controversially issued a 'black box' warning—its highest warning level—that antidepressants were associated with the increased risk of suicidal thoughts and behaviours in young people. The Australian TGA, though, is taking a far softer approach.

Raising this, saying this, is controversial. It seriously questions the whole of Australia's mental health establishment. People like Professors McGorry and Ian Hickie, and organisations like headspace, Beyond Blue, Suicide Prevention Australia and Orygen are no doubt good people and organisations genuinely striving to improve the situation, but they must never be beyond challenge or question. It is time to ask some confronting questions. Have Australia's leading suicide prevention organisations, experts and psychiatric thought leaders got it horribly wrong? Despite their good intentions, could the current prescribing epidemic have contributed to the avoidable deaths of young Australians?

I'm not an expert, and I don't pretend to know the right answers, but this peer-reviewed paper published this week should ring alarm bells. It contains numerous specific examples which raise serious concerns that the elite of Australia's mental health establishment have, for years, made up their minds that antidepressants reduce suicidality risks. They refuse to even discuss mounting evidence that challenges their longstanding view. I'm told that it's taboo to even talk about it in the sector. We cannot draw conclusions based on this new data, but the established wisdom must be re-examined by open minds through an inquiry that is not led or comprised solely by the current elite and vested interests. It's to his credit that the Prime Minister told his first meeting of his new cabinet in June last year that this government would be the curse-breakers of youth suicide. But rather than congratulating themselves for spending money, government MPs should focus our debates on why the rates of youth suicide are increasing.

In closing, I want to touch briefly on the fact that no antidepressants are approved for use to treat depression in children—of course, it's difficult to get ethical approval for clinical trials on children, so off-label prescribing is widespread—and appropriately so. I believe we need an urgent re-examination of the real-world evidence, which, in discussions with the experts, will require better systems to collect the relevant data. You can have a look over the last 10 years and effectively do something approximating a clinical trial in retrospect. Off-label prescribing is a much broader problem, which requires its own examination.

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