Argue for Reform

E A R L Y I N T E R V E N T I O N I N T H E R E A L W O R L D

Australia's innovation in youth mental health care: The headspace centre model

Debra Rickwood1,2 | Marie Paraskakis1 | Diana Quin1 | Nathan Hobbs1 | Vikki Ryall1 |

Jason Trethowan1 | Patrick McGorry3

1headspace National Youth Mental Health

Foundation, Melbourne, Victoria, Australia

2Faculty of Health, University of Canberra,

Canberra, Australian Capital Territory,

Australia

3Orygen: The National Centre of Excellence in

Youth Mental Health, Melbourne, Victoria,

Australia

Correspondence

Prof Debra Rickwood, headspace National

Youth Mental Health Foundation, 485

LaTrobe St, Melbourne, VIC 3000, Australia.

Email: drickwood@headspace.org.au

Aim: headspace is Australia’s innovation in youth mental healthcare and comprises the largest

national network of enhanced primary care, youth mental health centres world-wide. headspace

centres aim to intervene early in the development of mental ill-health for young people aged

12 to 25 years by breaking down the barriers to service access experienced by adolescents and

emerging adults and providing holistic healthcare. Centres have been progressively implemented

over the past 12 years and are expected to apply a consistent model of integrated youth

healthcare. Internationally, several countries are implementing related approaches, but the

specific elements of such models have not been well described in the literature.

Method: This paper addresses this gap by providing a detailed overview of the 16 core compo-

nents of the headspace centre model.

Results: The needs of young people and their families are the main drivers of the headspace

model, which has 10 service components (youth participation, family and friends participation,

community awareness, enhanced access, early intervention, appropriate care, evidence-

informed practice, four core streams, service integration, supported transitions) and six enabling

components (national network, Lead Agency governance, Consortia, multidisciplinary workforce,

blended funding, monitoring and evaluation).

Conclusion: Through implementation of these core components headspace aims to provide easy

access to one-stop, youth-friendly mental health, physical and sexual health, alcohol and other

drug, and vocational services for young people across Australia.

KEYWORDS

early intervention, integrated models, mental health, models of care, youth

1 | INTRODUCTION

headspace is Australia's National Youth Mental Health Founda-

tion. It commenced in 2006 with funding from the Australian

Federal Government via the Department of Health in recogni-

tion of the urgent need for health system reform to respond

more effectively to the high incidence and prevalence of men-

tal health problems among young people in the adolescent and

early adult years, and their low level of mental health service

use (McGorry, Tanti, et al., 2007; McGorry, Purcell, Hickie, &

Jorm, 2007).

At the heart of the headspace initiative is the headspace centre,

which is an easy-access, youth-friendly, integrated primary care ser-

vice, that builds upon the capacity of services in the local community

to provide an early intervention approach to mental health problems

for young people aged 12 to 25 years (McGorry, Purcell, et al., 2007).

headspace centres have been implemented progressively across

Australia, with an initial 10 centres in 2007 and scaling up to a

national network of 110 centres in 2018. Recently, centres have been

strengthened in six regions by vertical integration with specialized ser-

vices for more complex, low prevalence disorders, notably early pre-

sentations of psychosis. Further, the national headspace initiative

Received: 23 March 2018 Revised: 7 August 2018 Accepted: 30 August 2018

DOI: 10.1111/eip.12740

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. © 2018 The Authors Early Intervention in Psychiatry Published by John Wiley & Sons Australia, Ltd

Early Intervention in Psychiatry. 2019;13:159–166. wileyonlinelibrary.com/journal/eip 159

provides other services and programs including an online youth men-

tal health service “eheadspace”, headspace mental health in education

services, the headspace interactive website, and a digital work and

study service, among others.

Internationally, congruent approaches to integrated youth mental

healthcare have been commenced in several countries (Hetrick et al.,

2017), although the headspace centre network comprises the largest

national implementation of a consistent primary care model, world-

wide. A framework for youth-friendly health services was developed

by the World Health Organization some time ago, and emphasizes

three core features: that services are accessible, acceptable and

appropriate (McIntyre, 2002). The headspace centre model is consis-

tent with this framework and has been further developed and refined

through more than 10 years of practice and evaluation (Rickwood,

Anile, et al., 2014). Guiding principles for youth mental health services

have recently been published (Hughes, Hebel, Badcock, & Parker,

2018), and the headspace centre approach both helped to inform and

complies with these principles.

The headspace centre network is supported in model implemen-

tation by a national office (headspace National) that develops

resources and undertakes activities to facilitate model integrity and

evidence-informed innovation and growth. National resources include

collection of a national minimum data set, which is routinely gathered

from headspace centre clients and service providers, and used to

monitor and evaluate service activity and outcomes (Rickwood, Tel-

ford, Parker, Tanti, & McGorry, 2014). There have been two major

external evaluations of the centres (Hilferty et al., 2015; Muir et al.,

2009), regular internal evaluations (Rickwood, Telford, Mazzar, Parker,

et al., 2015; Rickwood, Anile, et al., 2014) and ongoing consultation

for continuous service development (Rickwood, Telford, Mazzer,

Anile, et al., 2015). These quality improvement activities show that,

overall, there is a high level of uptake and access of headspace centres

(Hilferty et al., 2015), young people and their families are very satis-

fied with the headspace centre model (Nicholas, Holloway, Telford, &

Rickwood, 2017; Rickwood, Nicholas, et al., 2015), and positive out-

comes are being achieved (Hilferty et al., 2015; Rickwood, Telford,

Mazzer, Parker, et al., 2015).

Nevertheless, a recent systematic review concluded that many

different integrated youth mental health models have evolved interna-

tionally and that no single example could currently claim to constitute

best practice (Hetrick et al., 2017). The review noted that the core

features of the services have not been sufficiently well defined or

described, although the general concepts underpinning these models

have been established (McGorry, Goldstone, Parker, Rickwood, &

Hickie, 2014). Consequently, to redress this knowledge gap, the aim

of this paper is to describe the essential components of the headspace

centre model as a key example of innovation in youth mental

healthcare.

2 | THE HEADSPACE CENTRE MODEL

At the epicentre of the headspace model are young people them-

selves. Everything that headspace centres do revolves around being

responsive to the needs of young people aged 12 to 25 years. It is

now well-documented that this is a life-stage of very high vulnerability

to the emergence of mental health problems, yet marked reluctance

to seek help, particularly professional help (Slade et al., 2009). Three-

quarters of all mental disorders commence by the age of 24 (Merikan-

gas et al., 2010). Within a population health approach, effective early

intervention is essential for young people at high risk and experiencing

the early signs of mental health problems to attempt to prevent dete-

rioration of mental health and to support vulnerable young people to

transition more effectively into productive adulthood (Australian Gov-

ernment, 2000). The headspace model is based on removing the bar-

riers to service access and increasing the propensity for young people

to seek help at this stage of life. The aim is to ensure that young peo-

ple receive accessible, appropriate and effective services within a sus-

tainable service system (Rickwood, Anile, et al., 2014).

The headspace centre model comprises 16 components, 10 of

which are core service provision components and 6 of which are

enabling system components. These are shown in Figure 1 and

described briefly below.

3 | SERVICE COMPONENTS

3.1 | Youth participation

The participation of young people is a key driver of the headspace

model to ensure that it is genuinely youth-centric and responsive to

young people's needs and preferences. This is evident through youth

participation being the first core model component. Youth participa-

tion occurs at three levels. The first level is the young person's treat-

ment plan, whereby young people are enabled to participate in their

own care. This is supported by a comprehensive orientation process,

resources for young people, and policies and procedures to involve

them in decisions about their care at all points in their care pathway,

including a collaborative treatment plan. The second level is that

young people are engaged in ongoing service development, particu-

larly through the operation of a centre-specific Youth Reference

Group. This group is able to provide input into service design, delivery

and evaluation. The third level is at the highest level of governance.

Young people need to be included in centre governance processes,

through attendance at governance meetings and input to strategic

and operational planning.

Youth participation in service evaluation is facilitated by routine

collection from young people of a standardized measure of service

satisfaction via the national electronic data collection system

(Rickwood, Nicholas, Mazzer, Telford, et al., 2015). This information is

continually fed back to the centre through a dashboard report of the

centre's satisfaction scores and regularly analysed by the headspace

National evaluation staff. This helps to identify service gaps and areas

of strength according to the voices of young people accessing centre

services.

3.2 | Family and friends' participation

The second key driver is young people's family and friends. Young

people live their lives supported by family and friends, and these

160 RICKWOOD ET AL.

people are critical to their service access and engagement (Rickwood,

Mazzer, & Telford, 2015) as well as their ongoing well-being. head-

space centres need to be accessible and accommodating to the needs

of family and friends.

Family and friends' participation is also at the three levels. At the

first level of a young person's individual care, the critical role of the

family is recognized and prioritized. Centre staff emphasize engaging

family and friends in supporting the young person in their mental

healthcare and encourage family inclusive practice. The inclusion of

family and friends is negotiated with the young person with due

regard to choice, confidentiality and privacy. At the second level, fam-

ily and friends have a role in service development and evaluation. This

ensures that the operations of the centre are suited to the needs of

families and friends, enabling their engagement and ability to support

their young person. This can be achieved through a Family and

Friends' Reference Group, or other mechanisms that include the views

of young people's significant others in service development. At the

third level, family and friends' input is required in governance of the

centre. This ensures that the strategic directions of the centre are

responsive to the needs and well-being of families and friends. This is

achieved through involving family and friends in centre governance

processes and strategic planning.

The participation of family and friends in service evaluation is

facilitated by an annual survey whereby centres are supported by

headspace National to obtain feedback on a standardized measure of

service satisfaction developed specifically for family and friends

(Nicholas et al., 2017). This satisfaction survey is available all year

round, but during a 1-month period each year a major focus is placed

on obtaining this feedback. Information is analysed by evaluation staff

at headspace National and provided back to the centre network

through a centre-specific report.

3.3 | Community awareness

Community awareness and engagement are essential to the headspace

model to enable young people to seek help early. Young people, their

families and the general community need a good level of mental health

literacy to: be able to recognize when issues might need professional

support, reduce the stigma of mental health problems, encourage a pos-

itive attitude to seeking help and know where to go for appropriate

support (Jorm et al., 1997). Awareness about the local headspace centre

is a primary focus. headspace centres dedicate a proportion of their

staffing resources to a community awareness and engagement position

and have an annual plan of activities to build community knowledge

and support. It is essential that young people and relevant agencies in

the community (especially schools and general practices) are aware of

the work of the headspace centre and know how to access it.

While awareness is critical for the local community, this is further

supported by national campaigns run by headspace National. To date,

these have focused on improving mental health literacy and reducing

stigma for population groups that are less likely to access mental

health services, such as young men and young people from Aboriginal

and Torres Strait Islander backgrounds (Brown, Rice, Rickwood, & Par-

ker, 2015).

3.4 | Enhanced access

This service component recognizes that the design of the centre must

reduce the many barriers that have been identified to young people

FIGURE 1 The headspace centre model

RICKWOOD ET AL. 161

accessing mental health services (Gulliver, Griffiths, & Christensen,

2010; Rickwood, Deane, & Wilson, 2007). Fundamentally, headspace

centres accept all types of referrals, including self-referral, and ser-

vices are no or low cost. Centres are expected to have a “no wrong

door” policy so that young people can present with any issue, meaning

they and their families do not have to navigate a complex care system

on their own. This is in marked contrast to traditional mental health

services in Australia, and elsewhere, which have many exclusion cri-

teria (Purcell et al., 2011). Centres are expected to provide a timely

response to young people and wait times are routinely monitored

through the headspace minimum data set. Centres are also expected

to operate out of normal business hours, as a 9 AM to 5 PM approach

does not meet the needs of many young people and their families.

Young people need to be able to attend at times that don't interfere

with their study or work commitments, or that are suitable to a family

member transporting them. Young people from more marginalized

population groups, such as those who are homeless, particularly value

the availability of drop-in sessions (Rickwood, Telford, Mazzer, Anile,

et al., 2015).

Service access is facilitated by ensuring that the centre has a wel-

coming environment, in both its physical setting, and a non-

judgemental and personalized staff response and orientation process.

Importantly, the service must be youth-friendly, and socially and cul-

turally inclusive. This is achieved through staff training and a priori-

tized focus on being inclusive of young people from more vulnerable

population groups within the local community, including young people

who are same-sex attracted, gender diverse, and from diverse cultural

backgrounds.

The design and décor of the centre are understood to be critical

factors in access and engagement. Centres are expected to be located

in easily accessible locations with public transport access, but also

some privacy to entry. There are clear design and branding require-

ments to ensure that the centre is identifiable as a headspace centre

and appears welcoming and inclusive. For example, evaluation

research has shown that displaying posters showing that the centre

acknowledges diverse sexual orientations and having Aboriginal and

Torres Strait Islander artwork is helpful for young people from these

population groups to feel more comfortable (Rickwood, Telford,

Mazzer, Anile, et al., 2015). Through youth and family participation,

and community engagement, the centre is able to identify local youth

needs and customize the centre's atmosphere and orientation

accordingly.

3.5 | Early intervention

Early intervention is about reorienting services to enable young peo-

ple access as early as possible in the development of a mental health

problem. In contrast to traditional service approaches, young people

are able to access headspace centres long before an acute or crisis sit-

uation arises, or before a problem or disorder becomes chronic. Young

people at risk of developing a mental health problem through expo-

sure to risk factors and those showing early symptoms and sub-

syndromal mental disorder are expected to be prioritized.

The headspace initiative is based on the population health pre-

mise that only by intervening early will the burden of mental illness be

reduced, over time (Mrazek & Haggerty, 1994). It is also a fundamen-

tal tenet that intervening early is in the best interests of young people,

their families and communities, to provide appropriate treatment and

psychosocial supports to help young people get their life back on track

quickly and make an effective transition to productive adulthood. Key

aims are to eliminate the damage to physical health, social relation-

ships and vocational engagement that ineffectively treated mental ill-

ness can cause.

Maintaining a focus on early intervention is acknowledged as an

ongoing challenge because there is so much unmet need for all stages

of mental health intervention, due to the lack of sufficient resources

allocated to mental healthcare (Purcell et al., 2011). Consequently,

headspace centres do not turn away young people who are accessing

with later presentations. Rather, a constant focus on ensuring early

access for early presentations is expected. This is monitored through

the minimum data set which shows the proportion of young people

accessing at different stages of risk and ill-health.

3.6 | Appropriate care

Appropriate care is developmentally and culturally tailored, and pro-

portional to the stage of illness, stage of life and complexity of pre-

senting issues. First, care provided through the headspace model must

be developmentally appropriate; the age range from 12 to 25 years

spans a period of dramatic change in all the domains of physical, cog-

nitive, social and emotional development (Arnett, 2013). The charac-

teristics and needs of young people in early adolescence are distinct

from those in later adolescence, which are different from those in

early adulthood. headspace centre staff must be skilled in develop-

mentally appropriate assessment and treatment approaches.

Similarly, cultural safety and appropriateness is essential. Australia

has a very diverse population mix culturally, including first nation

Aboriginal and Torres Strait Islander peoples, who through their his-

tory of invasion and colonization experience unique and potent risk

factors for their mental health and well-being (Parker & Milroy, 2014).

headspace prioritizes Aboriginal and Torres Strait Islander young peo-

ple through regular cultural awareness training for staff, targeted con-

sultation for youth participation and national media campaigns, and

development of Reconciliation Action Plans.

Other population and cultural groups also need to be recognized,

and the priority groups vary centre-by-centre depending on the popu-

lation mix in the local community. Young people who are lesbian, gay,

trans, intersex, queer or questioning are expected to always be a pri-

ority group. Other priority groups for young people from diverse cul-

tural and linguistic backgrounds will vary by community. Centres are

expected to know and respond to the needs of the priority cultural

groups in their community. This is achieved through appropriate local

planning and can be facilitated through relevant partnerships and rep-

resentation on the headspace centre governance group.

Providing services across a range of risk and illness presentations

and complexity is also paramount. With a focus on early presenta-

tions, but also a “no wrong door” approach, centres must be able to

respond appropriately to diverse presentations. This requires a highly

skilled and multidisciplinary workforce, along with strong partnerships

and referral pathways with other local services. If the headspace

162 RICKWOOD ET AL.

centre itself is not able to address any presenting issue, then a “warm

referral” that ensures that a young person gets to an appropriate ser-

vice is required.

3.7 | Evidence-informed practice

headspace centres deliver services based on the best current evidence

(Rickwood, Anile, et al., 2014). This is achieved by employing staff

who are appropriately trained and credentialed, and additionally

trained through headspace orientation. A knowledge transfer cycle is

supported throughout the headspace network by headspace National,

which includes a continually updated headspace learning platform

available through online and other resources. This education and

training is informed by research, evaluation and comprehensive evi-

dence reviews, strongly supported by a key partnership with Orygen:

The National Centre for Excellence in Youth Mental Health (www.

orygen.org.au), which is a centre of long-standing excellence in youth

mental health research and clinical practice in Australia and interna-

tionally. The centre network also convenes regularly in a headspace

Forum which is used to share research and practice and keep staff up-

to-date with the most recent advances in youth mental health.

Centres are committed to developing the evidence base for youth

mental health through involvement in research and evaluation. They

contribute to the evidence base by sharing innovations in practice

with other centres through the headspace network and its resources.

Centres are required to input to the routine minimum data set collec-

tion, as well as be engaged in research and evaluation projects that

are identified as priorities through the headspace National research

and evaluation strategy.

3.8 | Four core streams

headspace centres are an enhanced primary care platform providing

four core service streams—mental health, physical and sexual health,

alcohol and other drug, and vocational—that match the needs of

young people in adolescence and young adulthood (McGorry, Bates, &

Birchwood, 2013). The main health need for this age range is mental

health, however, so this comprises the largest service focus. Other

issues that are important are physical health, particularly sexual health,

which is critical due to rapid sexual development and exploration at

this life-stage. While physical health issues, in general, are relatively

uncommon, general health services can provide a non-stigmatizing,

soft-entry point to mental health care. It is also critical to treat the

whole person and ensure both mental and physical health needs are

met. Recognizing that young people with the more common physical

health concerns, such as asthma, are at increased risk of mental health

concerns (Rickwood, White, & Eckersley, 2007), is also imperative to

ensure their mental health needs are identified and met.

Alcohol and other drug use emerges during these years and co-

morbid syndromes of mental health and substance use problems are

common presentations (Baker & Kay-Lambkin, 2016). Young people

may develop dependency, but are also at risk through initial experi-

mental use and need effective harm minimization approaches to be

available.

The foundations of vocational well-being are laid down in adoles-

cence and early adulthood, so the engagement of young people in

study and work must be a primary focus. Young people accessing

headspace services are at significantly increased risk of disengage-

ment from work and study (Holloway et al., 2017). Ensuring that voca-

tional needs are assessed and appropriate supports put in place are

essential to enabling young people an independent adulthood. Young

people with more complex mental health problems may require inten-

sive vocational support, but even transitory mental health issues can

cause disruptions to study and work that have long-term conse-

quences, so all young people need to be supported to be engaged on

an appropriate vocational track.

Implementation of the four core streams is facilitated through

holistic assessment that focuses on all the domains of a young per-

son's life through routine implementation of the headspace holistic

assessment tool (Parker, Hetrick, & Purcell, 2010). The headspace

minimum data set is also used to monitor the level of service activity

across streams.

3.9 | Service integration

On-site and off-site service integration are necessary to coordinate

and provide appropriate clinical governance for the four core streams

and any other services provided through the headspace centre. After

the holistic needs of each young person are identified, they are met

through an integrated care pathway with a coordinated approach to

the mix of services required.

On-site integration is achieved within the headspace centre and

co-located services through collaborative care planning and delivery,

shared-care arrangements and multidisciplinary case review. Adminis-

trative procedures are expected to provide a seamless experience for

the young person and their family. For example, medical records and

other paperwork should be harmonized. Any headspace services that

are not co-located physically are expected to be similarly integrated.

headspace centres need to maintain an up-to-date register of

other services in the community that young people might need.

Strong partnerships, established referral pathways and warm referrals

are used to integrate care with external service providers. For exam-

ple, psychosocial needs, like housing, may need to be addressed and

the headspace centre requires strong collaborative relationships with

such community service providers to ensure a timely and integrated

response. Maintaining strong links and relationships with other local

service providers critical to young people's care pathways is an impor-

tant focus of centre staff.

3.10 | Supported transitions

Supported transitions proactively and personally link young people

with external services when a headspace centre is not able to meet

their needs. This ensures those who are at risk of disengagement do

not fall through the gaps during transitions. Again, strong collaborative

partnerships, established referral pathways and warm referrals are the

techniques used to support effective service transitions.

Transitions within stepped or staged care processes may be

required so that young people receive the level of care that best

RICKWOOD ET AL. 163

meets their needs (Hamilton et al., 2017). For example, headspace

centres are expected to be strongly connected with local schools so

that young people can be identified as in-need at school and receive a

well-coordinated approach to care at the local headspace centre. For

young people who need more intensive, longer-term or complex-care

management than the headspace primary care approach can provide,

supported transitions are required with secondary and tertiary ser-

vices. Such transitions are able to be strongly supported for young

people experiencing the early signs of psychosis by vertical integration

with headspace Youth Early Psychosis Program services, which have

been built onto some of headspace primary care services since 2014.

Further, young people ageing out of headspace at 26 years may need

to be sensitively and effectively engaged with appropriate adult men-

tal healthcare.

4 | ENABLING COMPONENTS

4.1 | National network

The national network, currently comprising 110 centres along with

the coordinating support of headspace National, provides a strong

platform to leverage its collective strength. The network enables inno-

vation and shared learning to develop best practice and continually

improve service quality. The network supports and strengthens indi-

vidual centres, helps achieve national consistency with appropriate

local customization, and provides opportunities for inter-centre

knowledge transfer.

Having a strong and consistent national brand that clearly iden-

tifies and promotes headspace centres is crucial, and something that

is quite unique for a mental health service. The national brand and

communication strategies, including national media, position head-

space as the peak organization for youth mental healthcare across

Australia. The brand has become a trusted and credible source of

information and support that is highly visible and valued by young

people, families and communities throughout Australia (Hilferty

et al., 2015).

The network operates through multiple channels to bring the cen-

tres together to learn from evidence-based practice and practice-

based evidence. Centres have access to headspace National orienta-

tion material, national resources and a comprehensive online

education and learning platform, communities of practice, and the

Forum where centre staff convene to share their experiences. Centre

staff particularly value learning from each other, with more estab-

lished centres being models for newer centres, and centres that are

innovating in particular aspects of the model able to share their exper-

tise. A strong sense of community and identification with the head-

space way has been forged, and headspace staff are passionate about

youth mental health and their role in system and practice reform.

A national data system that collects a consistent minimum data

set from young people and their headspace service providers was

implemented in 2013. The data items cover who, how and why young

people access headspace centres, what services they receive, out-

comes achieved, and their satisfaction with services (Rickwood, Tel-

ford, et al., 2014). This information is used to monitor and evaluate

activity across the centre network. It enables centres to compare

themselves with national and peer groupings. The data are used in

multiple ways to identify progress and areas of strength as well as

gaps and service development needs.

The network is further enhanced by the partnership with Orygen,

which inspires a strong commitment to research to better understand

the mental health needs of young people and the most effective inter-

ventions and systems of care. Centres are expected to be regularly

involved in research as well as service evaluation projects.

4.2 | Lead agency governance

Another enabling component of the headspace centre model is gover-

nance by a Lead Agency. Independent organizations are commis-

sioned to operate each headspace centre, although some agencies

operate multiple centres. There are currently 68 different Lead Agen-

cies operating the centres. The Lead Agency provides the infrastruc-

ture and is responsible for corporate and clinical governance. Lead

Agencies have the premises, employ staff, engage with the community

and develop partnerships with other agencies to fulfil their role of

delivering safe, high quality services that implement the headspace

model and meet the needs of young people and their families. Impor-

tantly, although centres are operated by different Lead Agencies, they

are branded and delivered as headspace.

4.3 | Consortia

Governance is provided by a Consortium of local service providers

that collaborate with the Lead Agency to give strategic direction, addi-

tional capacity through in-kind contributions and local planning over-

sight. The Consortia approach enables local community investment in

and support for the centre and ensures that the centre meets commu-

nity needs through planning and appropriate collaboration. It provides

a formal structure for the creation and maintenance of partnerships

that increase the reach and continuity of care of headspace services.

Membership needs to have representation from each of the four

core streams of mental health, physical health, alcohol and other drug,

and vocational services. The Consortium should also have representa-

tion from other relevant organizations within the community. For

example, in a community with a significant Aboriginal and/or Torres

Strait Islander population, an appropriate organization representing

these interests should be on the Consortium. Through such strategic

collaborations, the centre can make sure that it is responsive to the

needs of the local community and is able to draw on local expertise

to do so.

The Consortium operates under formal governance processes and

terms of reference. Consortium members have a partnership agree-

ment or memorandum of understanding with the Lead Agency. Meet-

ings are held regularly and appropriately recorded. As described in the

youth participation and family and friends' participation core compo-

nents, established mechanisms for such participation at the Consor-

tium level must be evident. Importantly, the Consortium is led by an

independent chair, so that it can provide strategic oversight and direc-

tion specifically for headspace and independent of the interests of the

Lead Agency.

164 RICKWOOD ET AL.

4.4 | Multidisciplinary workforce

Centres are staffed by multidisciplinary teams that can address the

holistic needs of young people. This comprises both clinical and non-

clinical staff with a minimum staffing mix that includes a centre man-

ager, clinical coordinator, community engagement and intake workers,

and reception staff. Services are delivered by appropriately qualified

and experienced allied health professionals (eg, psychologists, social

workers), youth workers, nurses, general practitioners, alcohol and

other drug workers, and vocational workers. Access to sessional psy-

chiatry is ideal. Core staff are directly employed through the head-

space centre grant, while others are employed through contracted

private practitioner arrangements or via in-kind contributions. The

centre has processes to promote and support multidisciplinary team-

based care through, for example, a shared electronic medical record

and team-based orientation, training, care planning and case review,

and regular meetings and communication channels.

Workforce capacity is, however, a challenge for some centres,

particularly those in rural and remote locations where a full comple-

ment of the necessary workforce may not be available (Carbone, Rick-

wood, & Tanti, 2011). Innovative ways to increase workforce capacity

are a constant focus to build the ability of centres across Australia to

deliver to this component, as well as advocacy for improved funding

models that can incentivize the required workforce.

4.5 | Blended funding

Multiple funding streams are combined to support a headspace cen-

tre. This ensures that services can be provided to young people at no

or low cost. Blended funding also facilitates growth, flexibility and sus-

tainability of the centre. The headspace centre grant, which comes

from the Australian Government Department of Health, provides core

funding which covers infrastructure and salaries for essential staff

positions. Health and mental health service provision is supported by

access to the Australian Government's Medical Benefits Scheme,

which rebates medical and allied health staff for designated health

services. In-kind contributions are expected from Consortium member

organizations and from other local partner organizations to provide

the full range of services. Fundraising and donations are encouraged.

Some centres are enhanced by funding from additional state/territory

government funding. headspace National helps to address some work-

force capacity issues; for example, by providing tele-psychiatry to eli-

gible rural centres. Centres, and their Lead Agencies, are expected to

be proactive in investigating and taking advantage of all appropriate

funding opportunities, and ongoing advocacy from headspace

National and the entire network promotes greater resourcing of youth

mental health.

4.6 | Monitoring and valuation

The final component reflects the priority accorded to continuous qual-

ity improvement. All centres must contribute to the national minimum

data set through the headspace data collection system. Analytics are

routinely provided through dashboard reports to service providers,

centre managers, Lead Agencies and their commissioning agents

(regional Primary Health Networks) about the characteristics and

outcomes of young people accessing the centres and the level and

types of service activity. Centres are expected to use this information

and undertake their own evaluations to improve performance and

engage in a cycle of continuous quality improvement. They are also

required to be involved in evaluations undertaken by headspace

National and external evaluators, as required. There is a high priority

placed on demonstrating outcomes to the Australian public and identi-

fying areas for service improvement.

5 | CONCLUSION

The 16 core components of the headspace model articulate the 10 ser-

vice components and 6 enabling components that underpin a head-

space centre. Altogether, these describe what makes a headspace

centre unique in youth mental healthcare. While headspace centres

have flexibility in how they deliver these components to ensure they

are responsive to their local community context, all components need

to be under implementation for the centre to be licenced to operate,

and this is ascertained through the headspace Model Integrity Frame-

work process. It is acknowledged that some components of the model

have many implementation challenges, mostly due to insufficient

workforce and funding capacity, and need to be strengthened, but a

clear description of the core components facilitates the ability of each

headspace centre to work progressively towards stronger model

integrity.

The components reflect what is currently understood as best

practice to reorientate youth mental healthcare to meet the needs of

young people at this critical and vulnerable stage of life through an

enhanced primary care platform. The model will evolve as the head-

space initiative matures, expands and continues to innovate to better

meet the needs of young people in Australia. For example, future

model extensions will include provisions for supporting young people

with more severe and complex presentations and to increase the

reach of services through innovations in service delivery modes, such

as outreach.

Finally, while the headspace centre model represents a key exam-

ple of innovation and best practice in youth mental healthcare, youth

mental health service reform has been gaining ground

internationally—in Ireland, Canada, United Kingdom, Denmark, Asia

and United States (McGorry et al., 2014). In terms of generalizability,

the underlying framework and principles being applied internationally

are remarkably similar (Henderson, Iyer, & Rickwood, 2018), however,

the ways that the principles are operationalized inevitably varies

between countries. In particular, replicability must take into account

different funding streams, health service systems and capacity, youth

population needs and cultural mores. As youth mental health reform

continues to advance internationally, all countries will benefit from

sharing information on the principles, core components and imple-

mentation practices that work.

ORCID

Debra Rickwood https://orcid.org/0000-0002-4227-0231

RICKWOOD ET AL. 165

REFERENCES

Arnett, J. J. (2013). Adolescence and emerging adulthood (5th ed.). Great Britain: Pearson Education Limited.

Australian Government. (2000). National Action Plan for Promotion, Preven- tion and Early Intervention for Mental Health. Canberra, Australia: Com- monwealth Department of Health and Ageing, Australian Government.

Baker, D., & Kay-Lambkin, F. (2016). Two at a time: Alcohol and other drug use by young people with a mental illness. Retrieved from https://www.orygen. org.au/Policy-Advocacy/Policy-Reports/Alcohol-and-other-drug-use

Brown, A., Rice, S., Rickwood, D., & Parker, A. (2015). Systematic review of barriers and facilitators to accessing and engaging with mental health care among at-risk young people. Asia-Pacific Psychiatry, 8(1), 3–22. https://doi.org/10.1111/appy.12199

Carbone, S., Rickwood, D. J., & Tanti, C. (2011). Workforce shortages and their impact on Australian youth mental health reform. Advances in Men- tal Health, 10(1), 89–94. https://doi.org/10.5172/jamh.2011.10.1.92

Gulliver, A., Griffiths, K. M., & Christensen, H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: A sys- tematic review. BMC Psychiatry, 10, 113. https://doi.org/10. 1186/1471-244X-10-113

Hamilton, M. P., Hetrick, S. E., Mihalopoulos, C., Baker, D., Browne, V., Chanen, A. M., … McGorry, P. D. (2017). Targeting mental health care attributes by diagnosis and clinical stage: The views of youth mental health clinicians. Medical Journal of Australia, 207(Suppl. 10), S19–S26. https://doi.org/10.5694/mja17.00692

Henderson, J., Iyer, S., & Rickwood, D. (2018). Systems transformation in youth mental health services: Learnings from the implementation experiences of Canada and Australia. Presentation to the 23rd World Congress of the International Association for Child and Adolescent Psychi- atry and Allied Professions, 26 July, Prague, Czech Republic.

Hetrick, S. E., Bailey, A. P., Smith, K. E., Malla, A., Mathias, S., Singh, S. P., … McGorry, P. D. (2017). Integrated (one-stop shop) youth health care: Best available evidence and future directions. Medical Journal of Australia, 207(10), S5–S18. https://doi.org/10.5694/mja17.00694

Hilferty, F., Cassells, R., Muir, K., Duncan, A., Christensen, D., Mitrou, F., … Katz, I. (2015). Is headspace making a difference to young people's lives? Final report of the independent evaluation of the headspace program. (. (SPRC Report 08/2015 ed.). Sydney, Australia: Social Policy Research Centre.

Holloway, E., Rickwood, D., Rehm, I., Meyer, D., Griffiths, S., & Telford, N. (2017). Non-participation in education, employment and training among young people accessing youth mental health services: Demo- graphic and clinical correlates. Advances in Mental Health, 16, 19–32. https://doi.org/10.1080/18387357.2017.1342553

Hughes, F., Hebel, L., Badcock, P., & Parker, A. P. (2018). Ten guiding prin- ciples for youth mental health services. Early Intervention in Psychiatry, 12(3), 513–519. https://doi.org/10.1111/eip.12429

Jorm, A. F., Korton, A. E., Jacomb, P. A., Christensen, H., Rodgers, B., & Pollitt, P. (1997). “Mental health literacy”: A survey of the public's abil- ity to recognise mental disorders and their beliefs about the effective- ness of treatment. Medical Journal of Australia, 166, 182–186.

McGorry, P. D., Bates, T., & Birchwood, M. (2013). Designing youth mental health services for the 21st century: Examples from Australia, Ireland and the UK. British Journal of Psychiatry, 202, s30–s35. https://doi. org/10.1192/bjp.bp.112.119214

McGorry, P. D., Goldstone, S. D., Parker, A. G., Rickwood, D. J., & Hickie, I. B. (2014). Cultures for mental health care of young people: An Australian blueprint for reform. Lancet Psychiatry, 1(7), 559–568. https://doi.org/10.1016/S2215-0366(14)00082-0

McGorry, P. D., Purcell, R., Hickie, I. B., & Jorm, A. F. (2007). Investing in youth mental health is a best buy. Medical Journal of Australia, 187(7), S5–S7.

McGorry, P. D., Tanti, C., Stokes, R., Hickie, I. B., Carnell, K., Littlefield, L. K., & Moran, J. (2007). headspace: Australia's National Youth Mental Health Foundation – Where young minds come first. Medical Journal of Australia, 187, S68–S70.

McIntyre, P. (2002). Adolescent friendly health services: An agenda for change. Oxford, England: World Health Organization.

Merikangas, K., He, J., Burstein, M., Swanson, S., Avenevoli, S., Cui, L., … Swendsen, J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American

Academy of Child and Adolescent Psychiatry, 49(10), 980–989. https:// doi.org/10.1016/j.jaac.2010.05.017

Mrazek, P. J., & Haggerty, R. J. (1994). Reducing the risks for mental disor- ders: Frontiers for preventive intervention research. Washington DC: National Adacemy Press.

Muir, K., Powell, A., Patulny, R., Flaxman, S., McDermott, S., Oprea, I., … Katz, I. (2009). Independent evaluation of headspace: The National Youth Mental health Foundation. Retrieved from https://www.sprc.unsw.edu.au/ media/SPRCFile/2009_Report5_09_headspace_interim_evalreport.pdf

Nicholas, A., Holloway, E., Telford, N., & Rickwood, D. J. (2017). Develop- ment of the headspace family and friends satisfaction scale: Findings from a pilot study. Early Intervention in Psychiatry, 12, 478–482. https://doi.org/10.1111/eip.12427

Parker, A., Hetrick, S., & Purcell, R. (2010). Psychosocial assessment of young people: Refining and evaluating a youth friendly assessment interview. Australian Family Physician, 39(8), 585–588.

Parker, R., & Milroy, H. (2014). Aboriginal and Torres Strait islander mental health: An overview. In P. Dudgeon, H. Milroy, & R. Walker (Eds.), Work- ing together aboriginal and torres strait islander mental health and well- being principles and practice (pp. 25–38). Commonwealth of Australia, Canberra Australia.

Purcell, R., Goldstone, S., Moran, J., Albiston, D., Edwards, J., Pennell, K., & McGorry, P. (2011). Toward a twenty-first century approach to youth mental health care. International Journal of Mental Health, 40(2), 72–87. https://doi.org/10.2753/IMH0020-7411400204

Rickwood, D. J., Anile, G., Telford, N., Thomas, K., Brown, A., & Parker, A. (2014). Service innovation project component 1: Best practice framework. headspace National, Melbourne, Australia. Retrieved from: http:// headspace.org.au/assets/Uploads/Corporate/Publications-and-research/ headspace-best-practice-framework-april-2014.pdf

Rickwood, D. J., Deane, F. P., & Wilson, C. J. (2007). When and how do young people seek professional help for mental health problems? Medi- cal Journal of Australia, 187(7 Suppl), S35–S39.

Rickwood, D. J., Mazzer, K. R., & Telford, N. R. (2015). Social influences on seeking help from mental health services, in-person and online, during adolescence and young adulthood. BMC Psychiatry, 15, 40. https://doi. org/10.1186/s12888-015-0429-6

Rickwood, D. J., Nicholas, A., Mazzer, K., Telford, N., Parker, A., Tanti, C., & Simmons, M. (2015). Satisfaction with youth mental health services: Further scale development and findings from headspace – Australia's National Youth Mental Health Foundation. Early Intervention in Psychi- atry, 11, 296–305. https://doi.org/10.1111/eip.12248

Rickwood, D. J., Telford, N., Mazzer, K., Anile, G., Thomas, K., Parker, A., … Soong, P. (2015). Service innovation project component 2: Social inclusion model project. headspace National, Melbourne, Australia. Retrieved from: http://headspace.org.au/assets/Uploads/Corporate/Publications-and- research/HSP201-Service-Innovation-Part-2-FA-LR.pdf

Rickwood, D. J., Telford, N., Mazzer, K., Parker, A., Tanti, C. P., & McGorry, P. D. (2015). Changes in psychological distress and psycho- social functioning for young people accessing headspace centres for mental health problems. Medical Journal of Australia, 202(10), S37–S42. https://doi.org/10.5694/mja14.01696

Rickwood, D. J., Telford, N., Parker, A., Tanti, C., & McGorry, P. D. (2014). headspace―Australia's innovation in youth mental health: Who's com- ing and why do they present? Medical Journal of Australia, 200(2), 108–111. https://doi.org/10.5694/mja13.11235

Rickwood, D. J., White, A., & Eckersley, R. (2007). Overview of current trends in mental health problems for Australia's youth and adolescents. Clinical Psychologist, 11(3), 72–78. https://doi.org/10.1080/13284200701870970

Slade, T., Johnston, A., Teesson, M., Whiteford, H., Burgess, P., Pirkis, J., & Saw, S. (2009). The mental health of Australians 2: Report on the 2007 National Survey of Mental Health and Wellbeing. Canberra, Australia: Department of Health and Ageing.

How to cite this article: Rickwood D, Paraskakis M, Quin D,

et al. Australia's innovation in youth mental health care: The

headspace centre model. Early Intervention in Psychiatry. 2019;

13:159–166. https://doi.org/10.1111/eip.12740

166 RICKWOOD ET AL.