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 BackgroundHard-to-reach young people (HTRYP) can be defined as YP at risk, disadvantaged, marginalised, who slip through the healthcare system and are unwilling to engage with services. MethodThis case control study compared the outcomes from two HTRYP services, Innovations Team Malta (IT Malta) and Innovations Project UK (IP UK) and a matched control from a UK based Community Mental Health Team (CMHT) over a 12 month period. IT Malta included HTRYP 13-25 years and IP UK 15-25 years. An in-depth 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. HTRYP meeting criteria were offered intensive individual tailored therapy. Results38 YP were referred to IT Malta, 34 (89.5%) assessed and 22 (57.9%) treated in 2018. 40 referrals to IP UK, 36 (90%) assessed, 31 (86%) met criteria and 15(48%) were treated. The HoNOSCA for IT Malta and IP 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 IP UK (51.1) and CMHT (58.9). The total mean contact time (hours) per YP were; IT Malta (24.5), IP UK (18.2) and CMHT (8.6). ConclusionIT Malta and IP UK identified, engaged and treated YP with multiple complex mental disorders whose needs were not being met by other mental health services. HTRYP may benefit from a flexible YP oriented service, including outreach capability and a focus on engagement. Despite improvement, HTRYP’s mental and social functioning remained clinically worse than CMHT.