A major rift within national youth mental health service headspace has erupted, with one of its founding board members publicly raising questions about how the organisation is run and whether it is reaching the vulnerable young people it was set up to help.
Ian Hickie, who was a key player in securing $420 million in early- intervention funding from the Gillard government, including the roll-out of 90 headspace drop-in centres across Australia, is now calling for an ”urgent, systematic national evaluation” of the organisation he helped build, claiming only half its centres are functional.
In a bitter feud which has seen lawyers engaged, headspace chief executive Chris Tanti described the claims as ”nonsense”, saying they may be part of a backlash over the investigation of an incident at a Sydney headspace centre Professor Hickie runs through his Brain and Mind Research Institute, which remains in dispute.
However, this was rejected by Professor Hickie, one of Australia’s most prominent psychiatrists. He acknowledged the ”confidential” review of clinical services was under way, but said his concerns were long-standing and shared by other major agencies in the mental health sector.
”It is worrying that Mr Tanti’s assertions are an attempt once again to deflect public attention away from the open and appropriate reporting of the operations of headspace centres,” he said.
While Mr Tanti denied that half the centres were not functioning, he conceded after questioning from The Sunday Age that one in five were experiencing performance management issues related to workforce shortages, difficulties with external agencies, or low client numbers.
On average, each site saw 1000 young people a year, he said. ”Eighty per cent of our centres are functioning well and have good traction in their communities. A handful are not meeting performance requirements but are being actively managed. Most centres are seeing reasonable numbers of patients and have good uptake,” Mr Tanti said.
Professor Hickie first raised concerns in a keynote address at a youth mental health conference in February in Melbourne. He claimed the national rollout of headspace – the largest federal investment in the sector, intended to save money and lives by treating psychological distress early – had turned out to be ”high-cost, low-impact and low-population coverage.”
Last week Professor Hickie, who resigned from the headspace board in 2012 to take up a position on the National Mental Health Commission – an expert group advising the Prime Minister on reform and funding – went further in an interview with The Sunday Age, saying a lack of evaluation and transparency had thrown the service’s effectiveness into doubt.
He also argued it had deviated from its original goal to help 12 to 25-year-olds with mental health problems such as anxiety or depression, and instead had become a ”coffee shop” model, seeing people with minor issues such as exam stress and relationship difficulties.
”There’s concern [about headspace] in the community and this has been expressed right up to the commission and the responsibility to respond to that lies with management,” Professor Hickie said.
”There’s a great deal of international interest in what Australia is doing, but the next question is what is the evidence? Not what is the brand, but what is the evidence? It will not cut the mustard unless it has a very substantive evidence base to justify this style of national investment.”
Mr Tanti said headspace was required to provide quarterly financial and operational data to the Department of Health, and all key decisions were made with the oversight of probity advisers.
”Ian’s comments possibly reflect a frustration he might have in respect to other issues we are currently working with the Brain and Mind Research Institute to resolve.”
He said the ”coffee shop” criticism was unfounded, pointing to a study of 21,000 headspace client, published in February in the Medical Journal of Australia, which showed 62 per cent of those who used the service last year presented with high levels of psychological distress, compared to just 9 per cent in the general community.
One of Professor Hickie’s chief concerns – that seven years since the first centre opened there was little evidence the model was improving mental health and reaching the young people who needed help the most – has been echoed by other mental health experts in Australia and overseas.
Leading psychiatrists last year told The Sunday Age they feared the organisation’s ”marketing is getting ahead of the science” and that better evaluation was needed before it expanded any further.
Last year six headspace centres opened in Denmark and there are plans to sell the model to Israel, the United States, Canada, Britain, Hong Kong, Singapore and the Middle East.
Mr Tanti acknowledged headspace did not have long-term data yet to show what happened to young people after they have been treated at a centre. He said the service was not funded to do this type of research and that there were ethical limits to institutions evaluating their own services. He also stressed how difficult it was to track transient youth populations , and to definitively gauge whether specific interventions had altered the trajectory of mental illness.
He said headspace was relying on a Department of Health evaluation – originally due this year, but now delayed until 2015 – to provide outcome data for young people nine months after leaving the service. The organisation this year also has started collecting information to provide a three-month follow-up on clients’ short-term outcomes.
This article first appeared on ‘The Sydney Morning Herald’ on 12 April 2014.