Is 'headspace' really improving young people's mental health?

Mental health problems are common in young people and often have their first onset during this period of life. But many affected youth either don’t seek or delay seeking professional help.

To help overcome this low rate of help-seeking, the Australian government set up a National Youth Mental Health Foundation, called headspace, in 2006. Its aim was to increase early intervention for mental health problems among people between 12 and 25 years old, by setting up youth-friendly enhanced primary health services.

The services were designed to provide not only mental health care, but help for alcohol and drug problems, as well as physical health and vocational assistance.

Limited improvement

With government funding, headspace centres have rapidly expanded in number from an initial ten in 2006-2007 to a planned 100 by 2016. But this expansion has occurred before any evaluation of whether headspace services actually improve young people’s mental health.

The government has commissioned an independent evaluation, but that’s yet to be completed. In the meantime, headspace has itself carried out some evaluation of outcomes based on routinely collected data.

The results show that young people attend headspace mainly for mental health problems involving anxiety or depression. It’s clear many headspace clients have major mental health problems and that these can have a negative impact on their functioning.

What’s less clear is whether headspace services produce any improvements in these mental health problems. The data show that 36% of clients had significant improvement in their symptoms, 51% had no significant change and 13% had significant worsening.

The fact that more people improved than worsened may have nothing to do with headspace services. It’s well known that many mental health problems tend to improve even without treatment.

And because there was no untreated control group to compare the results with, it’s not possible to say whether headspace produced any of the improvement. But it is possible to compare the headspace rates of improvement with those from international studies that have looked at changes without treatment in people with depression.

Unfortunately, the comparison is not encouraging; rates of natural improvement are very similar to those reported for headspace. It’s quite plausible the changes seen in headspace clients are simply the spontaneous improvement that can occur even without treatment.

Why not better?

According to headspace data, most clients received types of psychological therapy that should be effective, but most received only a few sessions.

Recently published research on the quality of treatment for depression and anxiety disorders in Australia has defined “minimally adequate treatment”. For psychological therapy, this involves six or more sessions with a therapist.

Using this definition, only 28% of headspace clients received minimally adequate treatment for depression and anxiety. Almost half (45%) received as few as one or two sessions, which is nowhere near the minimum.

Although young people are often difficult to engage for psychological therapy, the outcomes are disappointing given that headspace was specifically set up to be “youth-friendly” and “stigma-free”. So it’s not unreasonable to expect that headspace would promote better engagement than traditional services.

The authors of the recently published headspace evaluation studies were appropriately cautious in their conclusions about the initiative’s effectiveness. But the promotion of the findings to the public by headspace advocates gives cause for concern, with claims such as “New data shows headspace improving outcomes for young people”.

More importantly, there’s a broader lesson here. Like many mental health reforms, headspace centres are based on good ideas with an appealing logic. And the headspace concept has been effectively promoted to politicians who may be very pleased to announce a new centre in their electorate.

But once such an initiative is rolled out nationally, it becomes difficult then to take an alternative approach, even if the data eventually turn out to be unconvincing.

Real reform of Australia’s mental health care system is long overdue and keenly awaited by the sector. But if the community is to benefit, there needs to be piloting of reforms and rigorous evaluation before, rather than after, any national roll-out.

Anthony Jorm has received research grant funding for studies of headspace clients. He has collaborated with headspace staff on research projects. He was formerly associated with Orygen Youth Health Research Centre, which operates a number of headspace services.