• HTRYP presented with more disadvantage and psychopathology than those YP attending standard community mental health teams (CMHT). • HTRYP may benefit from a flexible, individualized, resource intense service that includes an outreach capability to maximise engagement, assessment and intervention planning. The HTRYP who engaged with IP, received a package of care with low use of medication and low admission rates to inpatient beds compared with those YP attending regular CMHT. • For some HTRYP at 2 year follow up, the absence of unstable accommodation together with positive change in both mental state and social function at follow up review could be con-sidered as positive outcomes in contrast to the poor prognosis that is usually associated with the term ‘Hard to Reach’. • Perhaps the term ‘Hard to Reach’ would be more appropriate as a descriptor of an aspect of current circumstances for some individuals with complex mental disorders rather than a de-scriptor of both poor engagement with services and poor longer term prognosis. • Despite multiple attempts by the Innovations Project, some HTRYP could not be engaged.