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Study questions whether headspace represents value for money
Hundreds of millions of dollars have been spent on the youth mental health service, but a new paper argues the funding may be better directed elsewhere.
Headspace has provided 4.4 million services to more than 700,000 young Australians since its inception.
Of the $2.3 billion in new mental health expenditure allocated in the 2020–21 Federal Budget, $278.6 million was directed exclusively to headspace.
According to a paper in MJA Insight, which has questioned the success of the youth mental health service, the funding was in addition to previous allocations totalling nearly $298 million from 2017–18 onwards, as well as another $14.3 million awarded this year.
However, while headspace has reportedly received more than half a billion dollars in funding in recent years – and provided 4.4 million services to more than 700,000 young Australians since its inception – the paper suggests there is limited evidence supporting its effectiveness.
‘Where there are data on outcomes using standardised instruments, findings have been disappointing,’ the paper’s authors, psychiatrists Professor Steve Kisely and Associate Professor Jeffrey Looi wrote.
‘The 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 … people seen by headspace since 2006.
‘As a result, the ongoing level of uncertainty in the strength of the available evidence seems inconsistent with the current generous funding of headspace.’
The mental health organisation’s CEO, Jason Trethowan, has since responded to the paper, saying it shows evidence of ‘considerable bias’, while also labelling it deliberately misleading.
‘[The study] misrepresents headspace and makes irrelevant and inappropriate claims,’ he said.
‘We are proud of what we offer, not just to young people but also their families and the communities in which we operate.’
As part of his response, Mr Trethowan pointed to a recently published pre-print study involving more than 50,000 young people who accessed the service between April 2019 and March 2020.
‘The study found just under 71% young people who sought help at headspace centres improved in at least one of the three outcomes,’ he said.
‘These included psychological distress [K10], social and occupational functioning [SOFAS] and self-reported quality of life [MyLifeTracker] – all key measures in assessing a young person’s wellbeing.
‘Just under half of young people improved in self-reported quality of life, over one-third had significant improvements in psychological distress, and a similar proportion improved in psychosocial functioning.’
Despite these findings, the MJA paper suggests funding could be redirected elsewhere, including primary care.
Dr Andrew Leech, a GP who has warned of growing mental distress among young people, told newsGP headspace works as a service that GPs can utilise when needing added support such as psychology input or social work.
But while its initial implementation was ‘critical’ at a time when youth mental health was ‘skyrocketing’ and other services were not keeping up with demand or were unaffordable, he believes it now has its own set of problems.
Current issues identified by Dr Leech include the fact that headspace:
- takes at least eight weeks to access
- generally only accepts referrals for low-risk patients (those who are not suicidal)
- does not accept referrals regarding ADHD or autism spectrum disorder.
‘[It] was [also] intended to be a multi-disciplinary service, that is, having GPs in-house,’ he said.
‘However, from my experience there have been many challenges in attracting GPs to work in a headspace centre and this model of care is not currently operating effectively.
‘If they are going to receive more funding, it is essential they open their availability to higher risk patients and neurodiverse patients … [and even] become a centre for patients with other difficulties such as eating disorders, gender diversity, gaming addiction, drug and alcohol abuse, and trauma related problems.’
Dr Leech believes headspace needs to recruit psychiatrists to work within its centres to offer patients a ‘one-stop option’ that provides timely, affordable care to young people, and make it more attractive for GPs to work there.
This lack of integration is also cited by the
MJA authors, who pointed out that in 2014
the National Mental Health Commission said the creation of headspace mental health centres was conducted without sufficient consultation, leading to ‘duplication of, and competition with, other community, private and state government services’.
‘Australia’s mental health system is already complex and fragmented, with roles and responsibilities split between federal and state, public and private, and community and acute services,’ Professor Kisely and Associate Professor Looi wrote.
‘Large non‐governmental organisations such as headspace further complicate this picture, increasing fragmentation in an already poorly integrated national mental health system.
‘This level of complexity is not seen in any other branch of medicine.’
While much of the support for headspace was provided under the Coalition Government, new Federal Health Minister Mark Butler has said the Federal Government remains committed to the organisation.
‘The Government has funded an independent evaluation of the headspace program which is due for finalisation in 2022,’ he
told The Guardian.
‘We welcome research into publicly funded health and mental health services.’
Regardless of whether headspace continues to attract funding in future, Dr Leech would welcome additional investment in primary care, saying it is ‘disappointing’ that general practice has been overlooked.
‘GPs are good at talking to young people and their families, as well as navigating the system to manage their mental health needs,’ he said.
‘Funding for general practice would help us to provide longer consultations, better skills through funded training in this area, promote the work we do and even fund our own in-house psychologists to work alongside us.
‘It is my experience that we save young lives through assessing risk and safety netting, as well as following up over time.
‘This does not have a dollar value. This is priceless. But we need support.’
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