Paper questions funding of mental health service Headspace

There is scant evidence that youth mental health organisation Headspace leads to clinical improvement in young people, raising questions about whether the not-for-profit should continue to attract millions of dollars in government funding, according to a paper published in the Medical Journal of Australia on Monday.

Led by Prof Steve Kisely, a psychiatrist and public health physician at the University of Queensland, the paper examines existing studies into the impact of Headspace, which offers online, face-to-face and telehealth appointments with clinicians. Headspace also offers physical and sexual health services, alcohol and other drug services, and work and study support.

The available evidence on the impact of Headspace includes studies with relatively small sample sizes, the largest of which was a study of 2,222 participants from 2008–09. This represents less than o.5{e577f2e255613ded01a030e42bce2808ed901289218648e026d62c4ad00509a4} of the 700,000 young people seen by Headspace since 2006.

It meant many existing studies were “… either underpowered to detect an effect, or that the findings were unrepresentative and lacked generalisability”, Kisely and his co-author wrote. “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 paper suggests redirecting funds elsewhere, such as to primary care or under-resourced state-provided mental health services.

“Instead, there have been calls for even more funding directed at expanding the scope of Headspace and related services towards the ‘missing middle’ – moderately unwell people who do not require crisis services but still need ongoing treatment, which is often beyond their financial means,” the authors wrote.

The CEO of Headspace, Jason Trethowan, described the paper as “biased” and “misleading”. He said it “misrepresents Headspace and makes irrelevant and inappropriate claims”.

“Over the past 16 years, Headspace has provided more than four million services and supported over 700,000 young people at our centres right across the country,” Trethowan said.

He referred to a preprint study yet to undergo peer review which examined the outcomes of young people accessing supports at Headspace for mental health problems. “The results were based on the experiences of more than 50,000 young people accessing the service between April 2019 and March 2020, making it the largest study of its kind on Headspace to date,” Trethowan said.

The study found more than 70{e577f2e255613ded01a030e42bce2808ed901289218648e026d62c4ad00509a4} of young people who sought help at Headspace centres improved in at least one of the three outcomes, including psychological distress, social and occupational functioning, and self-reported quality of life.

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.

“The impacts of the past two years including Covid-19, natural disasters and the rising cost of living have disproportionately impacted young people and young people are coming to Headspace for help in greater numbers than ever before,” Trethowan said.

“Demand on our services is significant. It is crucial young people have a service like Headspace that they trust, that is designed by them and is for them so they can get through tough times and back on track.”

Of the $2.3bn allocated in the 2020–21 federal budget to new mental health expenditure, almost $766m was directed to Headspace, as well as related services for older age groups. The 2021–22 federal budget allocated an additional $14.3m to Headspace.

The federal health minister Mark Butler told Guardian Australia that 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 said. “We welcome research into publicly funded health and mental health services,” he said.

Mental Health