Social and occupational outcomes for young people who attend early intervention mental health services

To the Editor: We must clarify that the findings of Iorfino and colleagues1 do not apply to headspace clients. This understandable misperception comes from the article’s title, “early intervention mental health services”, and participants coming from “clinics” that “provide both primary care services (headspace) and more specialised services”. Quotes from an InSight+ article2 and the accompanying editorial3 infer that the findings generalise to headspace, but they do not.

Although some participants in the Iorfino study came from two headspace‐branded centres, they also included young people accessing specialised services. This is evident in the limitations: “our sample was restricted to young people who remained in contact with the service for at least two years … biasing our sample towards people who required ongoing care and were accordingly more likely to have poorer outcomes”.

Generally, headspace does not provide care over a period of two years or more; centres typically provide brief episodes of care, befitting young people with mild to moderate presentations for common mental health problems. The average number of sessions is 4.4 (standard deviation [SD], 6.2); 98% of clients receive 20 sessions or fewer. A negligible 0.4% of clients are still receiving care at two years. Average time between the first and last session is 73.7 days (SD, 120), about 2.5 months (headspace 2015–2021, national unpublished data).

Clarification that the findings are not representative of, nor generalisable to, headspace clients is essential; the headspace initiative is not targeted at young people who need more sustained mental health care. The results are inconsistent with reported outcomes for 24 034 headspace clients from 55 fully established centres.4 Significant improvement in the Social and Occupational Functioning Assessment Scale (SOFAS) scores was evident for 37.1% of headspace clients, 43.4% had no significant change, and 19.5% significantly deteriorated. Updated outcomes are forthcoming. Importantly, multiple outcomes must be considered for headspace clients; these are young people with diverse early intervention needs — the single‐item, clinician‐rated SOFAS is insufficient to ascertain meaningful outcomes.

Despite the inability to generalise from Iorfino’s study to the national headspace centre network, we agree that young people with complex and persisting mental health conditions require more resource‐intensive responses than headspace primary care services were designed for.