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EXPERTS have welcomed two new studies on the headspace initiative, but believe the research does not provide the critical, comparative data needed to make the best policy decisions and meet mental health objectives.
Professor Ian Hickie, executive director of the Brain and Mind Research Institute in Sydney, which runs one of Australia's busiest headspace centres, told MJA InSight that the medical community was no closer to addressing the key issues raised in the National Mental Health Commission’s review of mental health services because there was a lack of informative research to provide direction. (1)
“I’m totally in favour of headspace, but I do look forward to a more empirically driven approach to help us with strategic decisions and improve the implementation of services.”
Professor Hickie was responding to two research papers published this week in the MJA that assessed the headspace initiative and the uptake of its services.
The first study was based on a census of 33 038 young people who started an episode of care at one of the 55 fully established headspace centres between 2013 and 2014. The authors assessed the main reason for presentation, wait time, service type, service provider type and funding stream. (2)
The majority of young people attended headspace centres for mental health problems. The next most common reason for attendance involved situational problems, such as bullying at school, difficulty with personal relationships or grief, the authors wrote.
They said the wait time for the first appointment was 2 weeks or less for 80.1% of clients, and only 5.3% waited for more than 4 weeks.
The main services provided were a mixture of intake and assessment, and mental health care, provided mainly by psychologists, intake workers and allied mental health workers.
“Our results confirm patterns that diverge from traditional mental health service delivery, and we argue that these patterns are more appropriate for meeting the social and mental health needs of young people”, the authors wrote.
Professor Hickie said that while it was a positive thing that young people were walking through the doors of headspace, the long waiting times reported by 27% of participants in this study raised concerns about how headspace would keep up with growing demand under current funding arrangements. He said that funding levels for the initiative were frozen, and had not kept pace with inflation, let alone increased.
“Because headspace is an enormous national investment, we need to be sure the real needs of young people are actually being met”, he said.
“But this research is purely descriptive, so we can’t conclude if headspace is better or worse than any other mental health pathway.”
The second MJA paper aimed to examine the changes in psychological distress and functioning in young people presenting to headspace centres. The authors analysed routine data collected from 24 034 people aged 12‒25 years who had started an episode of care between 2013 and 2014; 90-day follow up surveys were also completed by 651 clients. (3)
Outcomes measured included the main reason for presentation, types of therapeutic services provided to the young people, and distress and social and occupational functioning scores.
The authors found that most clients presented with symptoms of depression and anxiety, although younger males were more likely to present for anger and behavioural problems, while younger females were more likely to present for deliberate self-harm. In most cases, the most common assistance provided was cognitive behaviour therapy.
Between presentation to last psychological assessment, more than a third of clients experienced significant reductions in psychological distress, and a similar proportion showed improvements in psychosocial functioning, with 60% of clients having significant improvement on one or both measures.
The authors wrote that their results indicated that the headspace centre initiative “is associated with improved mental health outcomes for a large number of young people assisted by this network across Australia”.
Professor George Patton, director of adolescent health research at the Royal Children’s Hospital in Melbourne, told MJA InSight that while this study highlighted improved mental health outcomes across time, “spontaneous remission of an episode is very common, and the real test is whether or not one prevents a future episode from occurring”.
He said with a response rate to the follow-up survey of only 3%, there was “no way that this kind of study is going to tell us much about prevention of relapse”.
Professor Patton said that without a comparison group, it was also not possible to determine whether the trends reported in the study were simply a pattern of regression.
“Young people are likely to present at times of particular distress, and, in any group of this kind, the mean score will improve by simply waiting and coming back a few weeks later.”
While Professor Patton agreed that the aspirations of the headspace initiative were admirable, he said there was a need for a controlled comparison between headspace and an alternative model of care, such as existing primary health care networks.
Without this type of comparison, “it is not really possible to do an adequate economic analysis, which I think is necessary for making the best policy decisions”, Professor Patton said.
1. Mental Health Commission; Review of mental health programmes and services
2. MJA 2015; 202: 533–536
3. MJA 2015; 202: 537–542
(Photo: GhostOfTragedy / iStock)
I agree with Prof Patton that you cannot draw valid conclusions from this research. Despite Headspace being lauded as a good resource, in much the same way we laud mother’s milk, I believe there should not have been a duplication of resources to create Headspace, but rather enhancement of existing Child and Adolescent Community Mental Health Services. The Headspace model was funded by billing Medicare (and thus the Federal Government) directly for GP and Psychology services, and there was no real integration attempted with existing Child and Adolescent Mental Health Services (funded by the states). As a Child and Adolescent Psychiarist working in an exising Communty Mental Health Team, it felt like the Headspace initiators wanted to throw the baby out with the bathwater, so to speak, and build another stand-alone silo. There was no attempt at integration with the existing CMHT I worked in when Headspace opened in the same regional city, but instead an assumed reliance on the existing CMHT whenever serious psychopathology was uncovered.
I am tired of hearing the argument that Child and Adolescent Psychiatrists don’t see anyone after 18 years of age.There needs to be more continuity of care into the young adult years. This surely is a matter of definition of roles. There should be capacity for Child and Adolescent Psychiatrists to keep following their patients beyond the traditional 18 year cut-off.This is probably a historical relic reflecting what what we define as the age of maturity, and lines up with the age limits for Paediatics. Now that we know that the brain continues to change and develop well into young adulthood, the goalposts for Child and Adolscent Psychiatry should be moved accordingly.
My great concern wth the headspace model is that another ‘silo’ of service delivery has been created to provide care for a largely generic group of anxiety and depression conditions in adolescents (as outlined in the two MJA articles). This separate care model creates divisions between services and professionals and may not be as effective as improving the skills of doctors and allied mental health professionals (psychologists etc) in dealing with distressed young people presenting in varied situations including more conventional general practice. Until a controlled comparison of these approaches is done and replicated we will not know which is the most effective method or in what way the two approaches woould best compliment each other.
As a psychiatrist in rural NSW, my only experience of Headspace was of a young man who had “dobbed in” other boys at his High School who were using and selling drugs. His Headmaster let it be known who had done the dobbing in and so the boy and his family were subjected to severe threats and persecution. He developed a severe PTSD and was referred by his GP to Headspace, where the diagnosis was not recognised, he was advised on relaxation training as a means to deal with anxiety, and was not followed up at all after the initial interview. I saw him 2 years after this, when his PTSD had become chronic.