A comparative case control study between Innovations Team Malta and Innovations Project UK working with hard to reach young people with complex mental disorders

Abstract

Background: Hard-to-reach young people (HTRYP) can be defined as YP who are suffering from complex mental disorders who are also at risk, disadvantaged, marginalized and who slip through the healthcare system or are unwilling to engage with mental health services.

Method: This case control study compared the outcomes from two HTRYP services, (Innovation Team (IT) Malta and Innovation Team UK) and a matched control sample from a UK based Community Mental Health Team (CMHT) over a 12 month period. IT Malta included HTRYP 13-25 years and IT UK 15-25 years. An in-depth multidisciplinary team (MDT) assessment was carried out together with the Health of the Nation Outcome Scales for Child and Adolescent Mental Health (HoNOSCA) and Children’s Global Assessment Scale (CGAS) at assessment and discharge. Those meeting criteria were offered intensive individualised tailored therapy.

Results: 38 YP were referred to IT Malta, 34 (89.5%) assessed and 22 (57.9%) treated in 2018. 40 referrals to IT UK, 36 (90%) assessed, 31 (86%) met criteria and 15 (48%) were treated. The HoNOSCA for IT Malta and IT UK were similar, at baseline (20.65, 19.32) and discharge (16.65, 16.53) respectively, but higher when compared to CMHT (11.19, 8.03) (p <0.001). The mean baseline CGAS for IT Malta (46.0) elucidates more impairment compared to IT UK (51.1) and CMHT (58.9). The total mean contact times (hours) per YP were; IT Malta (24.5), IT UK (18.2) and CMHT (8.6).

This study identified that in both the Maltese and UK population there exist a cohort of HTRYP who are not accessing services and are not addressing their mental health needs. Both IT Malta and IT UK identified HTRYP and through intensive outreach work, were able to engaged and treat these. HTRYP may benefit from a flexible YP oriented service, including outreach capacity and a focus on engagement. Despite improvement, HTRYP’s mental and social functioning remained clinically worse than CMHT. However, a key message to clinicians is that the term HTR seems to imply a state of being at one point in one’s life, because following successful engagement with services, most of these same HTRYP seem to have a comparative attendance rate with their matched counterparts at CMHT.