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

In reply: In response to Wallis and colleagues,1 their interpretation of the Iorfino et al2 article is incorrect. Being fully acquainted with the youth mental health service described, I am clear that what was provided to most patients in the sample reported is in fact low intensity and primary care. Multiple publications on headspace, two independent evaluations3,4 (a third is in progress), and the huge national dataset routinely collected by headspace are also broadly consistent with the findings of this article. It is true, as Wallis and colleagues state, that in headspace, as in general practice more widely, there is a large subset of patients with multiple morbidity and more complex and persistent conditions. That is the whole point of the article. While most patients in primary care with medical complexity are generally able to access and secure tenure within the next tier of care (ie, specialist care), that is simply not the case for young people with mental ill health and mental illness.

This leads to Wallis and colleagues’ critique of the solution that Iorfino et al proposed, and upon which I elaborated in my editorial.5 This solution — namely that platforms of multidisciplinary care with more secure tenure be established as a back‐up system — is pretty obvious and is a feature in all credible recent blueprints for reform. For young people aged 12–25years, this means expanding the diagnostic reach and national coverage of the six (soon to be eight) regional early psychosis platforms. Wallis et al describe my characterisation of such a proposal as “rhetoric”. In fact, the early psychosis model of care is supported by Cochrane level 1 evidence and three decades of worldwide experience and scaling up across many high income countries, including the United Kingdom, the United States, Canada, Denmark and Hong Kong. They are now the international standard of care for this group of patients. Indeed, the existing early psychosis programs funded by the federal government are producing functional outcomes as good or better than anywhere in the world, with high fidelity.6 They most assuredly save lives and futures. In any event, we can all agree that “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”. That is exactly the approach that my colleagues and I, and indeed the whole early intervention field, have always pursued, and continue to, as we expand the diagnostic coverage of these programs.