headspace and the Creation of Mental Wealth

Mental illness not only causes enormous suffering and disability but among all the non-communicable diseases, it is responsible for 35 per cent of health-related reductions in GDP, twice the impact of cancer. This is because mental illness strikes in the prime productive years of life. 75 per cent of mental disorders emerge before 25 years.  

Early intervention for young people with emerging mental disorders is therefore one of the best buys in health care in terms of return on investment.  

The Commonwealth government recognised this over a decade ago. It began a reform which aimed to improve access and quality of care for young Australians who had – until then been largely locked out of mental health care.

A new model of enhanced primary care was designed and trialled in 10 sites from 2006.  Co-designed with young people and families and locally led, headspace’s stigma-free “one stop shops” proved to be highly successful. The network of locally-auspiced centres has progressively expanded, with strong bipartisan political support, to a total of 95 centres currently, and to 110 by 2018. 

Local communities, particularly in rural and regional Australia, where access to services can prove challenging, value headspace very highly. 

In 10 years, more than 270,000 young Australians have received help and treatment through headspace services.  

headspace has been independently evaluated twice by the Commonwealth government.  Both reports have been extremely positive, especially considering the system is still evolving with many centres still emerging from the start-up phase.

The most recent evaluation was conducted in 2013-2014 by researchers from the University of NSW. 

The ABC seems to have missed publication of this report back in May and last week breathlessly "revealed" that the report found headspace to be only barely positive as a program. Perhaps the reporter had not fully read the report because on any objective assessment, the seven-month old report was overwhelmingly favourable to headspace. In fact, its findings were welcomed by the Federal Government and paved the way for the decision to expand headspace by ten more centres by 2018.

The report was overwhelmingly positive and highlighted significant achievements. Top of the list was the improved access, engagement and satisfaction.  The evaluation also stated that if headspace did not exist, “large numbers of young people would not access services or would access them at a much later stage in the development of their disorders, potentially incurring significant costs to the government as well as difficulties for the young people and their families”.   The report noted that some particularly at risk and marginalised groups - those in rural and regional Australia, indigenous young people and LGBTIQ young people - were able to obtain access at unprecedented levels. 

Given the low levels of access prior to headspace, the fact that young people can now access evidence-based care in larger numbers must be regarded as the principal indicator of success.  It was not to be expected that the existing interventions would necessarily work any better than in traditional settings, so the benefits are most appropriately measured in terms of more people receiving the best available care at one convenient venue. 

Nevertheless the evaluation showed some unexpected and important benefits.  headspace services reduced suicidal ideation and self-harm, the major risk factors for youth suicide.  Young people accessing headspace services had fewer days out of school or employment than young people receiving traditional care or no treatment.   And young people and families were overwhelmingly positive about headspace, and generally satisfied with the services they received.   

These findings underscore why communities around Australia value their headspace centres so highly.

However as with all health services, particularly new and evolving ones, some weaknesses and areas for improvement were identified.  The report emphasised the need to work more collaboratively with local general practitioners and for general practice to be strengthened within the headspace model.  Poor access for many from culturally and linguistically diverse communities remains a significant issue. A greater emphasis on family involvement and extended office hours was recommended, as was greater public awareness of the nature and availability of the services. The overall cost of occasions of service and high variations in cost-effectiveness across centres were also identified as areas for improvement.

headspace was also criticised as operating in an excessively centralised fashion, an issue since resolved as a result of greater devolution now available through primary health networks and other changes in government policy flowing from the National Mental Health Commission’s report.

Also in response to those policy changes there is now a revised headspace framework, a new, skills-based headspace board, and a new CEO due to start in January.  There is a sense of renewal and refreshed commitment to collaborate with others.

The Prime Minister speaks increasingly of improving Australia’s “mental wealth”.   Early intervention, stepped care, cost-effectiveness and evidence-based care are the key principles at the heart of the Turnbull government’s mental health reforms. headspace is the real-world example of these principles in action. It is the first step towards improving the lives and wellbeing of young Australians - and securing a substantial increase in Australia’s mental wealth.

Ian Marshman
Chair, headspace Board                                                      
18 December 2016