Breaking through to the other side

| December 12, 2021

In 2019, the Royal Commission into Victoria’s Mental Health System was announced by the Premier, Daniel Andrews. This, as the eventual report’s summary states, “signalled that the state’s mental health system was failing to support those who needed it”.

The findings – published earlier this year – outlined that the system, since moving out of mental health institutions from the 1980s, hadn’t kept pace with human rights and consumer rights.

It’s a huge and complex system trying to manage the fact that nearly half of all Australians aged 16 to 85 experience a mental disorder during their lifetime, usually either anxiety or depression, or both at the same time.

Eight people a day take their own lives. Mental illness is estimated to cost the country’s health system more than $A200 billion a year.

A significant part of the puzzle is medications.

In volume five of its exhaustive report, the royal commissioners devoted considerable space to this in a section titled “The importance of research and innovation in pharmacology” – finding, testing and developing frontiers for potential medications.

The data on medications here is stark. One in eight Australians are on antidepressants (and one in four older Australians), yet only around half, at best, report improvement.

In the report, Monash’s Professor Arthur Christopoulos, the Dean of the Faculty of Pharmacy and Pharmaceutical Sciences, says, bluntly: “There have been no truly novel medicinal breakthroughs in treatments for mental illness or psychological distress over the past 50 years.”

He was backed by Professor Patrick McGorry, AO, of the University of Melbourne and the Orygen youth mental health organisation, who similarly told the commission that new medications were simply not available.

Changing the landscape

The stalemate is now set to change with the launch this week of Monash’s $5m Neuromedicines Discovery Centre (NDC), a unique cross-faculty enterprise to discover psychiatric drugs and investigate new approaches to neuromedicine-assisted psychotherapies for common mental illnesses such as anxiety, post-traumatic stress disorder, and depression.

The centre’s inaugural director will be Professor Christopoulos, and its deputy director will be Professor Chris Langmead from the Monash Institute of Pharmaceutical Sciences.

“The past decade has seen a revival of interest in the potential of psychedelics such as psilocybin and related drugs such as MDMA, as fast-acting and potentially more effective therapeutics, when delivered in conjunction with supportive psychological therapy, than existing treatments,” says Professor Christopoulos. “However, while these drugs have the potential to revolutionise mental healthcare, progress has been slow, due in part to the limited resources invested in research to date.

He calls the NDC a “step change”, because it approaches the emerging field of research and clinical trials at scale “in a carefully coordinated and scientifically rigorous manner, drawing upon the resources of world-leading research universities and institutes”.

Clinical trials on the effectiveness of substances such as psilocybin and MDMA, used in conjunction with therapy, are expected to begin soon.

“Although our initial focus will be on psychedelic-assisted psychotherapies,” Professor Langmead says, “the depth and critical mass of cross-disciplinary expertise assembled under the centre’s banner – together with our network of collaborators – has the potential to rapidly expand the pharmacological repertoire of totally new classes of safer and more effective psychiatric medicines.”

The NDC is interested in finding new ways to deal with depression (especially in those who are difficult to treat), post-traumatic stress disorder, obsessive compulsive disorder, anxiety disorders and substance use disorders. It will operate under three themes – Better Medicines, Better Minds, and Better Futures.

“Better Medicines will be based primarily in Parkville at the Monash Institute of Pharmaceutical Sciences,” says Professor Christopoulos, “and aims to deliver new classes of rationally-designed, qualitycontrolled and formulated medications, and to decipher their mechanisms of action at the cellular and molecular level.”

Better Minds is led by the Turner Institute for Brain and Mental Health and the Department of Psychiatry in Monash’s School of Clinical Sciences. “It will focus on the development of new therapy models, implementation of clinical trials to establish the efficacy of neuromedicines for mental disorders, and cutting-edge imaging studies to better-understand drug effects.”

Better Futures, meanwhile, takes the NDC’s objectives and findings out of the lab and into the community. It’s led by the Monash Sustainable Development Institute (MSDI) and BehaviourWorks Australia. It’s about behavioural and policy change.

“There have been no truly novel medicinal breakthroughs in treatments for mental illness or psychological distress over the past 50 years.”

MSDI’s Professor Rod Glover says this NDC pillar is “critical” to the ambitious end-to-end nature of the centre, because the innovations the NDC discovers need to be supported by governments, policymakers, professionals, and society in general to make the greatest impact.

The NDC will rely on a “supportive authorising environment”, he says, a result of partnerships with a range of groups with an interest in who can benefit from new neuromedicines, such as veterans’ groups representing those with PTSD.

Dean of the Faculty of Pharmacy and Pharmaceutical Sciences and inaugural Director of the Neuromedicines Discovery Centre, Professor Arthur Christopoulos, speaking at the Centre launch.

Dean of the Faculty of Pharmacy and Pharmaceutical Sciences and inaugural Director of the Neuromedicines Discovery Centre, Professor Arthur Christopoulos, speaking at the centre’s launch.

Influence spread

Professor Christopoulos agrees that behavioural change will need to be understood and then influence spread “across patients, psychologists, doctors, GPs, pharmacists and others”, and believes this is an aspect of the NDC’s ambitious research program that differentiates it from similar centres around the world.

There’ll also be a shaping and communicating of the public narratives relating to potential new classes of neuromedicines from substances that are currently stigmatised in the community. In order to build support, Professor Glover says, a “robust articulation of the health, social, commercial and economic benefits and costs of new approaches” needs to be transparent and clearly communicated.

Professor Glover warns that even with a solid evidence base, there may be hurdles in uptake and within the medical and mental health communities, that would limit the impact.

“Early consideration of such challenges is essential to ensure the considerable work that goes into drug discovery and clinical trials is not wasted, but translated into practice change,” he says. “The wider social, policy, and institutional landscape also needs consideration so that the behavioural change needed is encouraged and supported.”

Monash University Vice-Chancellor and President Professor Margaret Gardner, AC, says the NDC offers a “globally unprecedented” opportunity.“Our world-leading researchers across psychiatry, psychology, pharmacology, medicinal chemistry, drug discovery, behavioural science and policy development are working to stimulate innovation in treatments for mental illness, bringing hope to those for whom current treatments are only partially effective, or don’t work at all.”

This article was published by Lens.