Volume 218 - Issue 11
Latest evidence casts further doubt on the effectiveness of headspace
Authors: Steve Kisely and Jeffrey CL Looi
Med J Aust 2023; 218 (11): 543-543. || doi: 10.5694/mja2.51944
Published online: 19 June 2023
Published online: 19 June 2023
In reply
In reply: We thank Rickwood and colleagues1 for their interest in our article.2 Given limited resources to meet the increasing need for psychiatric care, services should focus on people with clinically significant symptoms and deliver sustained improvements that are clinically, as well as statistically, significant. There should also be adequate follow‐up so that results are generalisable. We therefore used headspace's own definitions of follow‐up (90 days post‐treatment) and clinically significant improvement (only possible if presenting symptoms are of clinical severity).3,4,5 In all the cited studies,3,4,5,6 follow‐up was very low and so it is legitimate to highlight that they represent a small, unrepresentative proportion of overall headspace attendees.6
Rickwood and colleagues mention three seemingly large studies of outcome data. One appeared as a non‐peer‐reviewed preprint after final acceptance of our article.3 In the other two studies, the quoted participant numbers are misleading, as these represent the baseline numbers. Follow‐up data were only available in 1326 out of 17337 (7.6%) in one,5 and 651 out of 15496 (reported as 3.1%) in the other.6 Although numbers in the preprint were larger, there were data on only 4.08% at 90‐day follow‐up.3
Notably, Rickwood and colleagues do not provide any detailed rebuttal of our conclusion that outcomes, when available, are disappointing. For instance, in the most recent nationwide evaluation, most attendees did not report clinically significant changes on standardised measures including the Kessler‐10.4 Again, only 4.6% of participants had 90‐day follow‐up data.6 Although headspace is described as primary care, the average cost of a consultation (AU$230) was more than double that of a comparable mental health consultation fee with a general practitioner.4 Given identified deficits in clinical governance, the report also recommended improved data on funding, costs and long term outcomes.6
In further response to the concerns of Rickwood and colleagues, we direct readers to a recently published detailed update of our original article.7
Finally, while standard care in either primary or secondary settings has been underfunded, headspace has enjoyed the largesse of both state and federal governments, supplemented by uncapped Medicare billings.
Competing interests
No relevant disclosures.
References
- Rickwood DJ, Trethowan J, McGorry PD. Latest evidence casts further doubt on the effectiveness of headspace [letter]. Med J Aust 2023; 218: 542.
- 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
- 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).
- 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 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
- 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).
- Kisely SR, Bastiampillai T, Allison S, Looi JC. More smoke and mirrors: fifteen further reasons to doubt the effectiveness of headspace. Australas Psychiatry 2023. doi: https://doi.org/10.1177/10398562231167683 [Epub ahead of print].