Social and occupational outcomes for young people who attend early intervention mental health services: a longitudinal study

To the Editor: The article by Iorfino and colleagues1 presents interesting follow‐up data on young people attending two mental health clinics. For 1510 of 2901 young people who presented in 2008–2018 with anxiety, mood or psychotic disorders, the authors identified trajectories in social and occupational functioning over 2years. Iorfino and colleagues describe the model as “primary care‐based” and “low intensity”, but it is neither generalist primary care nor low intensity as it comprises headspace plus specialised services and hospitalisation if needed.

Several limitations, including 48% of patients excluded and the lack of a comparison group, make any conclusions problematic. Box 3 suggests little average change, but a latent class analysis suggests that one‐third participants who were well functioning at baseline had good functional outcomes, while the remaining two‐thirds “had generally poor functional outcome patterns”. The data are compatible with a range of conclusions, including “findings suggest that employment and engagement in education and training are protective” or “the treatment model makes no discernible difference to young people’s social and occupational functioning”. Yet Iorfino and colleagues claim that “findings suggest that the current primary care‐based model meets the needs of only a minority of young people seeking care” and call for “more comprehensive and multidisciplinary approaches because of substantial comorbidity, ambiguous or attenuated symptomatology”. This sounds like general practice, where undifferentiated illness and multimorbidity are the norm.

Contrary to Iorfino et al, who state that “conclusions about the effects of specific treatments cannot be drawn”, McGorry in the accompanying editorial2 claims that findings “clearly illustrate what else is needed” — “more sustained, expert, and multidisciplinary care”. He uses the editorial to champion headspace and request yet more financial support. McGorry characterises the two‐thirds with persisting poor functioning as the “missing middle” for whom he advocates scaling up his model of care, developed for people with psychosis, to “be rapidly installed across the nation”, claiming “Countless lives and futures will be saved”.

Given the uncertainty of the evidence, it is difficult to understand how such sweeping claims have survived the peer review process. Decisions on investment in mental health care should be based not on rhetoric, but on a rigorous and impartial review of the evidence and research to develop the evidence base.