Is headspace making a difference to young people’s lives?

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Executive Summary young people with mental health concerns; 207 headspace centre managers, professionals affiliated with headspace and/or the mental health care service system; and 29 centre managers • a cost effectiveness analysis including estimates of government investment directed towards treating young people and estimates of the effectiveness of headspace centres • an analysis of centre expansion under the current headspace allocation model, an evaluation of the effectiveness of the current centre allocation model to provide access to headspace services, and a discussion of alternative methods of achieving national coverage for headspace services. The findings presented in this report are subject to the limitations and assumptions of the underpinning modelling as well as the limitations of the data. The evaluators have sought to identify and minimise, to the greatest extent possible, these limitations. While the analysis is firmly based on best practice and has been subjected to rigorous quality assurance procedures, the use of different datasets coupled with ongoing developments and improvements in data may potentially produce different results in different components of the analysis. The outcomes analysis reports the progress of young people over the course of their engagement with headspace. One key issue for the evaluation is the existence of two datasets which were used to examine the outcomes of headspace clients. The evaluation was originally designed to measure outcomes using a single source of data: a survey of headspace clients and a comparison group of young people. However, the implementation of a new administrative dataset (hCSA) at the beginning of the evaluation (January 2013) presented an opportunity to examine client outcomes using a comprehensive administrative data source. In using these two datasets the evaluation employed two complementary approaches to examine the effectiveness of headspace in relation to client outcomes: • a difference-in-difference (DID) approach, and • the clinically significant change (CSC) method. The CSC method utilises the administrative data collection (hCSA) and focuses on changes in psychological distress for different groups of headspace clients over the course of headspace treatment, comparing the progress of headspace clients with benchmarks derived from functional populations. The DID approach analyses survey data collected from a sample of headspace clients and a comparison group of young people. The analysis compares the progress of young people in the ‘headspace treatment’ group with those in two comparison groups – an ‘other treatment’ group comprising those in the general population who have sought mental health treatment outside the headspace program, and a ‘no treatment’ group comprising those in the general population who have sought no mental health treatment. The results of these distinct analyses align; both show headspace has a small program effect. The key findings related to client outcomes and the other evaluation scope areas are presented below. Key Findings A selection of key findings related to the scope areas are presented below. Access and Engagement The evaluation indicates that headspace is an accessible program. During the 2013/14 financial year, 67 headspace centres provided 194,968 occasions of service to 45,195 young people with mental health or other issues (approximately 9,000-12,000 clients per month). Findings show that the centre-based program is being accessed by a diverse group of young people whose need for mental health care is evidenced by high levels of psychological distress. Almost three-quarters of young people who sought help at centres during the 2013/14 financial year had high Social Policy Research Centre 2015 headspace Evaluation Final Report 2
Executive Summary or very high levels of psychological distress 3 at first assessment (74.2%). headspace has been successful in attracting some young people from marginalised and at-risk groups, as well as young people traditionally disadvantaged in their access to mental health care. Most notably, headspace is being accessed by significantly higher proportions of Indigenous young people and those living in regional areas than the proportions of these groups in the general population. The strategic placement of centres in regional areas has been effective in facilitating access to community based mental health for young people living outside of major cities. While this group represents 26.2% of young people nationally, 39% of headspace clients lived in regional areas (inner and outer regional). Indigenous young people are also over-represented as headspace clients. Approximately 7.4% of clients identified as Aboriginal or Torres Strait Islander, which is double their representation in the general population (3.7%). This is another significant finding as research indicates that Indigenous people have higher rates of mental health and substance misuse conditions than the general population, but are more reluctant to seek help (Jorm et al, 2012). The proportion of Indigenous clients varies greatly according to the geographic location of centres and qualitative data indicates that some centres could do more to make their services more culturally appropriate for Indigenous clients. headspace is being accessed by a higher proportion of female young people (62.8%) than males (37.2%). This finding is consistent with results from the National Survey of Mental Health and Wellbeing, which reports higher rates of mental disorders in women (ABS, 2007), as well as the higher overall usage of health services by women in general (ABS, 2010). One in five headspace clients (20.2%) identify as lesbian, gay, bi-sexual, transgender or inter-sex (LGBTI). While no age-specific comparison data is available, the Second Australian Study of Health and Relationships reports that of the adult population, only 3% of men and 4% of women identify as LGBTI (Richters et al., 2014). Other groups of vulnerable young people over-represented at headspace are young people disengaged from work or study (20.2% of clients compared to only 10.7% of the general youth population); and young people who are homeless or living in insecure housing, such as couch surfing or sleeping rough. This group represented one in 10 clients (11.7% of 12-25 year olds; 7% of 12-17 year olds; and 16.7% of 18-25 year olds). The latter group was far less likely to return to headspace after their first visit than all other clients, indicating that sustained engagement with mobile young people is challenging. These findings indicate that headspace has achieved much in initially engaging a significant proportion of vulnerable young people and disadvantaged groups. However, CALD young people are under-represented as headspace clients. Almost all young people attending headspace were born in Australia (92.8%), compared to 82% of all young people across Australia. Of the 7.2% of clients that were born overseas, only 6.6% speak a language other than English at home (compared to 19.3% of Australian young people). This finding suggests that centres may need to target CALD young people in promotion activities and connect more with local CALD services to facilitate integrated service provision for this group of young people. Stakeholders (clients, staff and parents) generally identified headspace to be an accessible and engaging service. The youth-friendly environment and innovative engagement approaches; the friendly, non-judgemental and relatable staff; the free or low cost service; wide-range of services provided; and practical assistance (such as transportation) were all commonly mentioned as important factors that helped young people access and stay engaged with headspace. Despite the high value that many young people and their parents placed on these program features, a number of barriers to service access were raised by stakeholders. These included the stigma of mental illness, practical barriers (such as standard opening hours and lack of transportation), centre waiting lists, and concerns around the cultural appropriateness of services provided in some centres. 3 As measured by the Kessler Psychological Distress Scale (K10) which categorises distress levels into four groups: low, moderate, high and very high. Social Policy Research Centre 2015 headspace Evaluation Final Report 3
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Page 3 and 4: Authors This report was written by
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y three percentage points, and 2.1
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6. The Costs of headspace One of th
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6. The Costs of headspace Table 6.1
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6. The Costs of headspace In-scope
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6. The Costs of headspace Revenue/
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6. The Costs of headspace Other gov
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7. Conclusion The evaluation of hea
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7. Conclusion treatment); however,
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7. Conclusion Overall the evaluatio
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Appendix A Evaluation scope areas h
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Appendix B The current model of hea
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Appendix B and each SA3 in non-capi
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Appendix B chapter 39 . To determin
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Appendix B While there is an overal
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Appendix B Figure B3 describes the
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Appendix B Figure B5 Cost per young
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Appendix B The concept of access as
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Appendix B Figure B7 Heard of heads
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Figure B10 Proportion of headspace
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Appendix B Table B5 Females 18-25 y
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Appendix B following section. Figur
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Appendix B and less access to mains
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Appendix B Figure B17 Estimated pre
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Appendix B Figure B18 SA1s within 1
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Figure B20 Hypothetical allocation
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Appendix B The current model of cen
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Appendix B Current centre funding m
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Appendix B Evaluation of the curren
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Appendix B Level of funding availab
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Appendix B provide a method for ide
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Appendix B centres and Localities i
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Appendix B for greater flexibility
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Appendix B Additional consideration
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Appendix B of achieving more effici
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Appendix B • Used the simulation
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Appendix C information relating to
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Appendix C Regarding gender, in bot
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Appendix C Figure C5 Total number o
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Appendix C Table C1 Information Sum
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Appendix C Data Cleaning and Analys
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Appendix C groups. The age and sex
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Appendix C Figure C8 Demographic ch
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Appendix C The KeySurvey software s
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Appendix C different client groups.
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Appendix D Round State Centre Name
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Appendix E Characteristics HS clien
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Table E4 Cell Sizes for Figure 3.4
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Appendix F Figure F1 Changes in K10
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Appendix F three SEIFA quintiles. A
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Appendix F Occasion of service inte
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Appendix F Table F1 Cell sizes for
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Appendix G Supplementary material f
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Appendix G Table G3 Round 3 (10 cen
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Appendix G Table G7 Round 7 (10 cen
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State (youth population) a headspac
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Appendix G Table G12 Round 11(16 ce
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Table G16 Additional youth populati
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Round Region State Additional youth
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Appendix G Table G22 Australians 18
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Appendix G Figure G22 SA1s within 1
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Appendix G Table G25 Centres alloca
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References Atkins, D.C., Bedics, J.
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References Smith, E., Jones, T., Wa
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Is headspace making a difference to young people’s lives?

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