The global expansion of youth mental-health service headspace has prompted claims Australia’s $420 million investment in early intervention is an untested ”hopeful experiment” which is corporatising the treatment of mentally ill young people.
Six headspace centres opened in Denmark last month and there are plans to sell the model – which aims to catch mental illness early in 12 to 25-year-olds with mild to moderate problems – to Israel, the United States, Canada, Britain, Hong Kong, Singapore and the Middle East.
Headspace chief executive Chris Tanti said he hoped funds raised from selling the organisation’s branding and business model overseas could eventually be used to launch a ”headspace minus” for children aged up to 12.
He said there was no reason headspace, founded by 2010 Australian of the Year Patrick McGorry, could not be rolled out worldwide for all age groups, from newborns to the elderly.
But prominent psychiatrists have criticised the plans, saying there is little robust data to show the organisation’s approach improves mental health.
They warn that expanding the service, particularly to young children, before its effectiveness is properly evaluated will increase the risk of misdiagnosis and unnecessary medication.
”This is a case of the marketing getting well ahead of the science. What we have here is an attractive business model with something that can be sold around the world – and that’s the way headspace is taking mental health, as a marketable commodity – but the danger is it becomes about what’s best for headspace rather than what’s best for kids,” said Jon Jureidini, professor of child psychiatry at the University of Adelaide. ”There’s nothing wrong with headspace as an idea, but it needs to be implemented conservatively, and the level of evaluation so far is fairly low. It’s certainly not at the stage where it should be dominating the world.”
Mr Tanti mounted a fierce defence of his organisation, saying opponents were ”out of touch” and that headspace was not actively looking to expand overseas but international mental-health practitioners were seeking out its expertise due to the program’s success.
In 2011, the federal government committed nearly a quarter of its $2.2 billion mental health budget over five years to youth early intervention programs headspace and Early Psychosis Prevention and Intervention Centres, with the view that it would save money by treating mental illness in its fledgling stages.
However, American psychiatrist Allen Frances – former chairman of the committee that produced the Diagnostic and Statistical Manual of Mental Disorders IV, the key psychiatric diagnostic source – said the approach is based on a ”false promise” and this made headspace’s global expansion plans concerning.
”There’s no evidence that we can accurately predict later mental illness. No evidence that we can intervene in a way that will be helpful and every possibility that well-meaning efforts may eventually cause more harm than good. This is little more than a hopeful experiment and the fact that the government in Australia has legitimised it gives it an authority in other countries that’s well in advance of the evidence and beyond what prudent people would do for policy,” Professor Frances said.
”If you make this huge investment on an untried program, you run the risk of stigmatising and medicating the kids in it with the expectation that they’re ultra-high risk to become sick when they’re not. And from a fiscal point of view you’re taking money that may be better spent treating the people who really do have the illness.”
Mr Tanti said the claims were in direct conflict with the experiences of the 100,000 young people who had been helped at headspace’s 55 centres since the organisation was founded in 2006.
”I just don’t understand how people who are medically qualified can dispute the concept of early intervention in healthcare. Why do we wait until people are completely acutely unwell and chronically disabled before they get a service?” he said. ”It’s not necessarily about curing mental illness; it’s about support at the appropriate times when these problems emerge.”
Mr Tanti said medication was not a first-line treatment and that the majority of young people seen by headspace centres were treated by staff such as psychologists, social workers, mental-health nurses and youth workers, who could not prescribe drugs.
While conceding that there had been limited assessment of the service, he said he was confident that an ongoing evaluation by the federal Health Department would soon show strong results.
This article first appeared on The Age on 20 October, 2013.