Volume 218 - Issue 11
Latest evidence casts further doubt on the effectiveness of headspace
Authors: Debra J Rickwood, Jason Trethowan and Patrick D McGorry
Med J Aust 2023; 218 (11): 542-542. || doi: 10.5694/mja2.51945
Published online: 19 June 2023
Published online: 19 June 2023
Comment
To the Editor: An MJA perspective by Kisely and Looi claims to cast doubt on the effectiveness of headspace,1 but we contend this is an incomplete, and at times inaccurate, critique of Australia's reform in youth mental health through the National Youth Mental Health Foundation, headspace.
First, the authors omit relevant evidence. For example, they claim “limited evidence of effectiveness”, while not citing the three comprehensive external evaluations commissioned by the Australian Government. These showed positive outcomes for young people, families and communities including, recently, evidence of cost‐effectiveness.2,3,4 Each evaluation concluded that headspace is achieving its objectives overall, although more is needed to address unmet demand and attain better outcomes for all young people, including those from First Nations and culturally diverse backgrounds.
Second, the authors make some incorrect claims. For example, they state that “available evidence is further limited by the relatively small sample sizes, the highest of which was 2222 participants from 2008–09, less than 0.5% of the 700000 young people seen by headspace since 2006”. This statement uses a numerator from a one‐year period at the commencement of headspace when only ten headspace centres were open (2008–2009), but a denominator from a 16‐year period (2006–2021), thus erroneously calculating a very small percentage. The statement is also incorrect as there are published outcome data for 15496,5 17337,6 and 582337 young people who have accessed headspace services.
Importantly, no alternative solutions are offered other than increased use of traditional mental health care, which is not fit for purpose as determined by the Productivity Commission8 and Victorian Royal Commission.9 The authors defend standard care, which headspace was deliberately designed to redress the failings of for young people.10 The inability of standard approaches to meet young people's mental health needs is widely acknowledged internationally, and major reform initiatives are taking place in many western countries, following the pioneering work of headspace.11,12
We contend that no other government‐funded mental health initiative has the same level of transparency, examination and evidence as headspace, evident by the three major external evaluations. Headspace itself is proactive in routinely collecting and openly reporting its client characteristics and outcomes. The most recent report reveals that 71% of young people improved on either psychological distress, social and occupational functioning, or quality of life.7 Notably, headspace has taken the initiative to develop new routine outcome measures for youth mental health.13
Nonetheless, headspace faces considerable and growing challenges, including overwhelming demand, increasing client complexity, lack of workforce availability and capacity, and funding constraints and inefficiencies. Concerted, collaborative effort is needed across levels of government and health care to build upon the Australian Government's investment in headspace. Robust, well informed and constructive debate is critical to advancing health science, policy and practice. We strongly support this to determine the best ways forward; assist the services and service providers, including headspace staff, who are currently working hard to address youth mental health issues; and provide the much‐needed trusted, accessible and effective service pathways for young people, their families, referrers and communities.
Competing interests
Debra Rickwood is seconded from her university as Chief Scientific Advisor to headspace. Jason Trethowan is CEO of headspace. Patrick McGorry is founder of headspace and Director on the headspace board.
Acknowledgements
Headspace is funded by the Australian Government.
References
- Kisely S, Looi JCL. Latest evidence casts further doubt on the effectiveness of headspace. Med J Aust 2022; 217: 388‐390. https://www.mja.com.au/journal/2022/217/8/latest‐evidence‐casts‐further‐doubt‐effectiveness‐headspace
- Hilferty F, Cassells R, Muir K, et al. Is headspace making a difference to young people's lives? Final Report of the independent evaluation of the headspace program (SPRC Report 08/2015). Sydney: Social Policy Research Centre, UNSW Australia, 2015. https://headspace.org.au/assets/Uploads/Evaluation‐of‐headspace‐program.pdf (viewed Mar 2023).
- Muir K, Powell A, Patulny R, et al. Independent evaluation of headspace: the National Youth Mental health Foundation. Sydney: Social Policy Research Centre, University of New South Wales, 2009. https://headspace.org.au/assets/Uploads/Corporate/Publications‐and‐research/final‐independent‐evaluation‐of‐headspace‐report.pdf (viewed Mar 2023).
- KPMG. Evaluation of the national headspace program. Final Report to Department of Health. Sydney: KPMG, 2022. https://www.health.gov.au/sites/default/files/documents/2022/10/evaluation‐of‐the‐national‐headspace‐program.pdf (viewed Mar 2023).
- Rickwood DJ, Telford NR, Mazzer K, et al. Changes in psychological distress and psychosocial functioning for young people accessing headspace centres for mental health problems. Med J Aust 2015; 202: 573‐542. https://www.mja.com.au/journal/2015/202/10/changes‐psychological‐distress‐and‐psychosocial‐functioning‐young‐people
- Bassilios B, Telford N, Rickwood D, et al. Complementary primary mental health programs for young people in Australia: Access to Allied Psychological Services (ATAPS) and headspace. Int J Mental Health Syst 2017; 11: 19.
- Rickwood D, McEachran J, Saw A, et al. Sixteen years of innovation in youth mental healthcare in Australia: outcomes for young people attending headspace centre services [preprint]. MedRXiv 25 Aug 2022; https://doi.org/10.1101/2022.08.24.22279102 (viewed Apr 2023).
- Productivity Commission. Mental health: inquiry report, volume 2 (Report No. 95). Canberra: Commonwealth of Australia, 2020. https://www.pc.gov.au/inquiries/completed/mental‐health/report/mental‐health‐volume2.pdf (viewed Apr 2023).
- Royal Commission into Victoria's Mental Health System. Final report, volume 1: A new approach to mental health and wellbeing in Victoria (PP No. 202, Session 2018–21 (document 2 of 6). Melbourne: State of Victoria, 2021. https://finalreport.rcvmhs.vic.gov.au/wp‐content/uploads/2021/02/RCVMHS_FinalReport_Vol1_Accessible.pdf (viewed Apr 2023).
- McGorry PD, Tanti C, Stokes R, et al. headspace: Australia's National Youth Mental Health Foundation — where young minds come first. Med J Aust 2007; 187: S68‐S70. https://www.mja.com.au/journal/2007/187/7/headspace‐australias‐national‐youth‐mental‐health‐foundation‐where‐young‐minds
- Hetrick SE, Bailey AP, Smith KE, et al. Integrated (one‐stop shop) youth health care: best available evidence and future directions. Med J Aust 2017; 207(10 Suppl): S5‐S18. https://www.mja.com.au/journal/2017/207/10/integrated‐one‐stop‐shop‐youth‐health‐care‐best‐available‐evidence‐and‐future
- McGorry PD, Mei C, Chanen A, et al. Designing and scaling up integrated youth mental health care. World Psychiatry 2022; 21: 61‐76.
- Kwan B, Rickwood DJ, Telford NR. Development and validation of MyLifeTracker: a routine outcome measure for youth mental health. Psychol Res Behav Manag 2018; 11: 67‐77.