Letters
We contend that no other government-­
Latest evidence casts further
doubt on the effectiveness of
headspace
To the Editor: An MJA perspective by
Kisely and Looi claims to cast doubt on
the effectiveness of headspace,1 but we
contend this is an incomplete, and at
times inaccurate, critique of Australia’s
reform in youth mental health through
the National Youth Mental Health
Foundation, headspace.
First, the authors omit relevant evidence.
For example, they claim “limited
evidence of effectiveness”, while not
citing the three comprehensive external
evaluations commissioned by the
Australian Government. These showed
positive outcomes for young people,
families and communities including,
recently, evidence of cost-­effectiveness.2-­4
Each evaluation concluded that
headspace is achieving its objectives
overall, although more is needed to
address unmet demand and attain better
outcomes for all young people, including
those from First Nations and culturally
diverse backgrounds.
Second, the authors make some incorrect
claims. For example, they state that
“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
700 000 young people seen by headspace
since 2006”. This statement uses a
numerator from a one-­year period at the
commencement of headspace when only
ten headspace centres were open (2008–­
2009), but a denominator from a 16-­year
period (2006–­2021), thus erroneously
calculating a very small percentage.
The statement is also incorrect as there
are published outcome data for 15 496, 5
17 337,6 and 58 2337 young people who
have accessed headspace services.
Importantly, no alternative solutions
are offered other than increased use of
traditional mental health care, which is
not fit for purpose as determined by the
Productivity Commission8 and Victorian
MJA 218 (11) ▪ 19 June 2023
Royal Commission.9 The authors defend
standard care, which headspace was
deliberately designed to redress the
failings of for young people.10 The
inability of standard approaches to meet
young people’s mental health needs is
widely acknowledged internationally,
and major reform initiatives are taking
place in many western countries,
542 following the pioneering work of
headspace.11,12
funded mental health initiative has the
same level of transparency, examination
and evidence as headspace, evident
by the three major external evaluations.
Headspace itself is proactive in
routinely collecting and openly
reporting its client characteristics and
outcomes. The most recent report reveals
that 71% of young people improved on
either psychological distress, social and
occupational functioning, or quality
of life.7 Notably, headspace has taken
the initiative to develop new routine
outcome measures for youth mental
health.13
Nonetheless, headspace faces
considerable and growing challenges,
including overwhelming demand,
increasing client complexity, lack of
workforce availability and capacity, and
funding constraints and inefficiencies.
Concerted, collaborative effort is needed
across levels of government and health
care to build upon the Australian
Government’s investment in headspace.
Robust, well informed and constructive
debate is critical to advancing health
science, policy and practice. We strongly
support this to determine the best
ways forward; assist the services and
service providers, including headspace
staff, who are currently working hard
to address youth mental health issues;
and provide the much-­needed trusted,
accessible and effective service pathways
for young people, their families, referrers
and communities.
Debra J Rickwood1,2
Jason Trethowan2
Patrick D McGorry3
1 University of Canberra, Canberra, ACT.
2 headspace National Youth Mental Health Foundation,
Melbourne, VIC.
3 Orygen, The National Centre of Excellence in Youth Mental
Health, Melbourne, VIC.
debra.rickwood@canberra.edu.au
Acknowledgements: Headspace is funded by the
Australian Government.
Competing interests: Debra Rickwood is seconded
from her university as Chief Scientific Advisor to
headspace. Jason Trethowan is CEO of headspace.
Patrick McGorry is founder of headspace and Director
on the headspace board. ■
doi: 10.5694/mja2.51945
© 2023 AMPCo Pty Ltd.
1 Kisely S, Looi JCL. Latest evidence casts further
doubt on the effectiveness of headspace. Med J
Aust 2022; 217: 388-­390. https://www.mja.com.
au/journ​al/2022/217/8/latest-evide​nce-casts-
furth​er-doubt-effec ​tiven​ess-heads​pace
2 Hilferty F, Cassells R, Muir K, et al. Is headspace
making a difference to young people’s lives?
Final Report of the independent evaluation of
the headspace program (SPRC Report 08/2015).
Sydney: Social Policy Research Centre, UNSW
Australia, 2015. https://heads​pace.org.au/asset​s/
Uploa​ds/Evalu​ation-of-heads​pace-progr​am.pdf
(viewed Mar 2023).
3 Muir K, Powell A, Patulny R, et al. Independent
evaluation of headspace: the National Youth
Mental health Foundation. Sydney: Social Policy
Research Centre, University of New South
Wales, 2009. https://heads​pace.org.au/asset​s/
Uploa​ds/Corpo​rate/Publi​c atio​ns-and-resea​rch/
final-indep​endent-evalu​ation-of-heads​pace-
report.pdf (viewed Mar 2023).
4 KPMG. Evaluation of the national headspace
program. Final Report to Department of Health.
Sydney: KPMG, 2022. https://www.health.gov.
au/sites/​defau​lt/files/​docum​ents/2022/10/evalu​
ation-of-the-natio​nal-heads​pace-progr​am.pdf
(viewed Mar 2023).
5 Rickwood DJ, Telford NR, Mazzer K,
et al. Changes in psychological distress and
psychosocial functioning for young people
accessing headspace centres for mental health
problems. Med J Aust 2015; 202: 573-­5 42. https://
www.mja.com.au/journ​al/2015/202/10/chang​es-
psych​ologi​c al-distr​ess-and-psych​osoci​al-funct​
ioning-young-people
6 Bassilios B, Telford N, Rickwood D,
et al. Complementary primary mental health
programs for young people in Australia:
Access to Allied Psychological Services (ATAPS)
and headspace. Int J Mental Health Syst 2017;
11: 19.
7 Rickwood D, McEachran J, Saw A, et al.
Sixteen years of innovation in youth mental
healthcare in Australia: outcomes for young
people attending headspace centre services
[preprint]. MedRXiv 25 Aug 2022; https://doi.
org/10.1101/2022.08.24.22279102 (viewed Apr
2023).
8 Productivity Commission. Mental health: inquiry
report, volume 2 (Report No. 95). Canberra:
Commonwealth of Australia, 2020. https://www.
pc.gov.au/inqui​ries/compl​eted/mental-healt​h/
repor ​t /mental-health-volum​e2.pdf (viewed Apr
2023).
9 Royal Commission into Victoria’s Mental Health
System. Final report, volume 1: A new approach
to mental health and wellbeing in Victoria (PP
No. 202, Session 2018–­2 1 (document 2 of 6).
Melbourne: State of Victoria, 2021. https://final​
report.rcvmhs.vic.gov.au/wp-conte​nt/uploa​
ds/2021/02/RCVMHS_Final​Report_Vol1_Acces​
sible.pdf (viewed Apr 2023).
10 McGorry PD, Tanti C, Stokes R, et al. headspace:
Australia’s National Youth Mental Health
Foundation —­where young minds come first.
Med J Aust 2007; 187: S68-­S 70. https://www.
mja.com.au/journ​al/2007/187/7/heads​pace-austr​
alias-natio​nal-youth-mental-health-found​
ation-where-young-minds
11 Hetrick SE, Bailey AP, Smith KE, et al. Integrated
(one-­s top shop) youth health care: best available
evidence and future directions. Med J Aust 2017;
207(10 Suppl): S5-­S18. https://www.mja.com.
au/journ​al/2017/207/10/integ​rated-one-stop-
shop-youth-health-care-best-avail​able-evide​
nce-and-future
12 McGorry PD, Mei C, Chanen A, et al. Designing
and scaling up integrated youth mental health
care. World Psychiatry 2022; 21: 61-­76.
13 Kwan B, Rickwood DJ, Telford NR. Development
and validation of MyLifeTracker: a routine
outcome measure for youth mental health.
Psychol Res Behav Manag 2018; 11: 67-­7 7. ■