The impact of expanding the PACE clinic: Closing the gap by including complex presentations in youth mental health

Objective: This paper evaluated the impact of expanding the intake criteria at the Personal Assessment and Crisis Evaluation (PACE) clinic, a Melbourne based specialized early psychosis service, on its clinical governance, by including young people with complex mental health presentations. Methods: Electronic medical records of 80 consecutive individuals aged 15–25 enrolled at PACE in 2020 were audited. A typical episode of care at PACE lasts six months. Service users were classified into three groups: At-Risk Mental State (ARMS), First Episode Psychosis (FEP), and Complex Presentations (CP). Demographic, clinical, and treatment characteristics were compared. Outcomes included clinical characteristics, comorbidities, length of care, and transition to psychosis during clinical care. Results: Of 80 people, 56 % met ARMS criteria, 14 % FEP, and 31 % CP at Youth Access Team assessment, the port of entry of Orygen Specialist Program. Among the Complex group, 40 % later met ARMS criteria at entry into PACE. 12-month psychosis transition rate for ARMS was 20 % whilst none in the CP transitioned. Despite not meeting threshold for psychosis, 91 % of the CP had an episodes of care of more than 12 months. There were high rates of comorbidity including major depression (39 %), autism spectrum disorder (21 %), and substance use (39 %). Conclusions: Expanding PACE's intake criteria to include CP allowed for the engagement of young people with substantial unmet care needs. Importantly, 40 % of individuals with CP also met criteria for ARMS. Furthermore, over 90 % of those with CP required treatment for more than one year, highlighting a persistent need for long-term care. The study also highlighted challenges in applying evidence-based evaluation tools to systematically identify young people presenting with an at-risk syndrome, impacting the provision of stage-based care. Inclusion of CP in an ARMS clinic increased heterogeneity in an already diverse ARMS population and potentially undermined the consistency of the ARMS construct. Therefore, ARMS clinics should focus primarily on assessing and supporting people with ARMS only. There remains an ongoing need for professional development to maintain standards of care in early intervention, and consistent efforts should be made to successfully integrate evidence into clinical practice.