Inequalities in children's mental health care: analysis of routinely collected data on prescribing and referrals to secondary care

William P Ball; Corri Black; Sharon Gordon; Bārbala Ostrovska; Shantini Paranjothy; Adelene Rasalam; David Ritchie; Helen Rowlands; Magdalena Rzewuska; Elaine Thompson; Katie Wilde; Jessica E Butler

doi:10.1186/s12888-022-04438-5

Inequalities in children's mental health care: analysis of routinely collected data on prescribing and referrals to secondary care

William P Ball, Corri Black, Sharon Gordon, Bārbala Ostrovska, Shantini Paranjothy, Adelene Rasalam, David Ritchie, Helen Rowlands, Magdalena Rzewuska, Elaine Thompson, Katie Wilde, Jessica E Butler^* (Corresponding Author)

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

BACKGROUND: One in eight children in the United Kingdom are estimated to have a mental health condition, and many do not receive support or treatment. The COVID-19 pandemic has negatively impacted mental health and disrupted the delivery of care. Prevalence of poor mental health is not evenly distributed across age groups, by sex or socioeconomic groups. Equity in access to mental health care is a policy priority but detailed socio-demographic trends are relatively under-researched.

METHODS: We analysed records for all mental health prescriptions and referrals to specialist mental health outpatient care between the years of 2015 and 2021 for children aged 2 to 17 years in a single NHS Scotland health board region. We analysed trends in prescribing, referrals, and acceptance to out-patient treatment over time, and measured differences in treatment and service use rates by age, sex, and area deprivation.

RESULTS: We identified 18,732 children with 178,657 mental health prescriptions and 21,874 referrals to specialist outpatient care. Prescriptions increased by 59% over the study period. Boys received double the prescriptions of girls and the rate of prescribing in the most deprived areas was double that in the least deprived. Mean age at first mental health prescription was almost 1 year younger in the most deprived areas than in the least. Referrals increased 9% overall. Initially, boys and girls both had an annual referral rate of 2.7 per 1000, but this fell 6% for boys and rose 25% for girls. Referral rate for the youngest decreased 67% but increased 21% for the oldest. The proportion of rejected referrals increased steeply since 2020 from 17 to 30%. The proportion of accepted referrals that were for girls rose to 62% and the mean age increased 1.5 years.

CONCLUSIONS: The large increase in mental health prescribing and changes in referrals to specialist outpatient care aligns with emerging evidence of increasing poor mental health, particularly since the start of the COVID-19 pandemic. The static size of the population accepted for specialist treatment amid greater demand, and the changing demographics of those accepted, indicate clinical prioritisation and unmet need. Persistent inequities in mental health prescribing and referrals require urgent action.

Original language	English
Article number	22
Number of pages	18
Journal	BMC Psychiatry
Volume	23
Issue number	1
Early online date	11 Jan 2023
DOIs	https://doi.org/10.1186/s12888-022-04438-5
Publication status	Published - 11 Jan 2023

Bibliographical note

Funding Information:
This work was supported by the Health Foundation Networked Data Lab Programme.

Funding Information:
We thank The Health Foundation for providing financial support to allow this analysis to be conducted and for facilitating the Networked Data Lab partnerships which have informed this work. The Health Foundation is an independent charity committed to bringing about better health and healthcare for people in the UK. We thank the NHS Grampian Health Intelligence team for facilitating use of this data. We also thank the Grampian Data Safe Haven (DaSH) for processing the data used in this study, as well as providing the secure platform used in this analysis and administrative support. We are grateful to members of the public who have made invaluable contributions to this work. This work uses data provided by patients and collected by the NHS as part of their care and support. We thank the anonymous reviewers for their careful reading of this manuscript and for their constructive comments. There is widespread agreement that public participation is necessary for health data-intensive projects [44]. We formed, trained, and involved a PPIE group of nine persons interested in health data usage for public benefit through a series of interactions throughout the research cycle including narrowing the focus of the research topic, developing analytical plans, sense-checking interpretations and improving the readability and accessibility of the results. We also held group meetings with nine carers/parents and community workers who work with families and children. They reviewed near-final findings, remarked on usefulness and relevance, and suggested areas for further investigation. A comprehensive report of this effort utilising the GRIPP-2 reporting checklist for public involvement [45] is available in the supplementary materials (Table S1).

Funding Information:
We thank The Health Foundation for providing financial support to allow this analysis to be conducted and for facilitating the Networked Data Lab partnerships which have informed this work. The Health Foundation is an independent charity committed to bringing about better health and healthcare for people in the UK. We thank the NHS Grampian Health Intelligence team for facilitating use of this data. We also thank the Grampian Data Safe Haven (DaSH) for processing the data used in this study, as well as providing the secure platform used in this analysis and administrative support. We are grateful to members of the public who have made invaluable contributions to this work. This work uses data provided by patients and collected by the NHS as part of their care and support. We thank the anonymous reviewers for their careful reading of this manuscript and for their constructive comments.

Publisher Copyright:
© 2022, The Author(s).

Keywords

Child & adolescent mental health
Mental health prescribing
CAMHS
Health inequalities

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Children's Mental Health Prescribing and Referrals to CAMHS
William Ball
11/01/23 → 16/01/23
3 items of Media coverage, 2 Media contributions
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Ball, W. P., Black, C., Gordon, S., Ostrovska, B., Paranjothy, S., Rasalam, A., Ritchie, D., Rowlands, H., Rzewuska, M., Thompson, E., Wilde, K., & Butler, J. E. (2023). Inequalities in children's mental health care: analysis of routinely collected data on prescribing and referrals to secondary care. BMC Psychiatry, 23(1), Article 22. https://doi.org/10.1186/s12888-022-04438-5

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title = "Inequalities in children's mental health care: analysis of routinely collected data on prescribing and referrals to secondary care",

abstract = "BACKGROUND: One in eight children in the United Kingdom are estimated to have a mental health condition, and many do not receive support or treatment. The COVID-19 pandemic has negatively impacted mental health and disrupted the delivery of care. Prevalence of poor mental health is not evenly distributed across age groups, by sex or socioeconomic groups. Equity in access to mental health care is a policy priority but detailed socio-demographic trends are relatively under-researched.METHODS: We analysed records for all mental health prescriptions and referrals to specialist mental health outpatient care between the years of 2015 and 2021 for children aged 2 to 17 years in a single NHS Scotland health board region. We analysed trends in prescribing, referrals, and acceptance to out-patient treatment over time, and measured differences in treatment and service use rates by age, sex, and area deprivation.RESULTS: We identified 18,732 children with 178,657 mental health prescriptions and 21,874 referrals to specialist outpatient care. Prescriptions increased by 59% over the study period. Boys received double the prescriptions of girls and the rate of prescribing in the most deprived areas was double that in the least deprived. Mean age at first mental health prescription was almost 1 year younger in the most deprived areas than in the least. Referrals increased 9% overall. Initially, boys and girls both had an annual referral rate of 2.7 per 1000, but this fell 6% for boys and rose 25% for girls. Referral rate for the youngest decreased 67% but increased 21% for the oldest. The proportion of rejected referrals increased steeply since 2020 from 17 to 30%. The proportion of accepted referrals that were for girls rose to 62% and the mean age increased 1.5 years.CONCLUSIONS: The large increase in mental health prescribing and changes in referrals to specialist outpatient care aligns with emerging evidence of increasing poor mental health, particularly since the start of the COVID-19 pandemic. The static size of the population accepted for specialist treatment amid greater demand, and the changing demographics of those accepted, indicate clinical prioritisation and unmet need. Persistent inequities in mental health prescribing and referrals require urgent action.",

keywords = "Child & adolescent mental health, Mental health prescribing, CAMHS, Health inequalities",

author = "Ball, {William P} and Corri Black and Sharon Gordon and Bārbala Ostrovska and Shantini Paranjothy and Adelene Rasalam and David Ritchie and Helen Rowlands and Magdalena Rzewuska and Elaine Thompson and Katie Wilde and Butler, {Jessica E}",

note = "Funding Information: This work was supported by the Health Foundation Networked Data Lab Programme. Funding Information: We thank The Health Foundation for providing financial support to allow this analysis to be conducted and for facilitating the Networked Data Lab partnerships which have informed this work. The Health Foundation is an independent charity committed to bringing about better health and healthcare for people in the UK. We thank the NHS Grampian Health Intelligence team for facilitating use of this data. We also thank the Grampian Data Safe Haven (DaSH) for processing the data used in this study, as well as providing the secure platform used in this analysis and administrative support. We are grateful to members of the public who have made invaluable contributions to this work. This work uses data provided by patients and collected by the NHS as part of their care and support. We thank the anonymous reviewers for their careful reading of this manuscript and for their constructive comments. There is widespread agreement that public participation is necessary for health data-intensive projects [44]. We formed, trained, and involved a PPIE group of nine persons interested in health data usage for public benefit through a series of interactions throughout the research cycle including narrowing the focus of the research topic, developing analytical plans, sense-checking interpretations and improving the readability and accessibility of the results. We also held group meetings with nine carers/parents and community workers who work with families and children. They reviewed near-final findings, remarked on usefulness and relevance, and suggested areas for further investigation. A comprehensive report of this effort utilising the GRIPP-2 reporting checklist for public involvement [45] is available in the supplementary materials (Table S1). Funding Information: We thank The Health Foundation for providing financial support to allow this analysis to be conducted and for facilitating the Networked Data Lab partnerships which have informed this work. The Health Foundation is an independent charity committed to bringing about better health and healthcare for people in the UK. We thank the NHS Grampian Health Intelligence team for facilitating use of this data. We also thank the Grampian Data Safe Haven (DaSH) for processing the data used in this study, as well as providing the secure platform used in this analysis and administrative support. We are grateful to members of the public who have made invaluable contributions to this work. This work uses data provided by patients and collected by the NHS as part of their care and support. We thank the anonymous reviewers for their careful reading of this manuscript and for their constructive comments. Publisher Copyright: {\textcopyright} 2022, The Author(s).",

year = "2023",

month = jan,

day = "11",

doi = "10.1186/s12888-022-04438-5",

language = "English",

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T1 - Inequalities in children's mental health care

T2 - analysis of routinely collected data on prescribing and referrals to secondary care

AU - Ball, William P

AU - Black, Corri

AU - Gordon, Sharon

AU - Ostrovska, Bārbala

AU - Paranjothy, Shantini

AU - Rasalam, Adelene

AU - Ritchie, David

AU - Rowlands, Helen

AU - Rzewuska, Magdalena

AU - Thompson, Elaine

AU - Wilde, Katie

AU - Butler, Jessica E

N1 - Funding Information: This work was supported by the Health Foundation Networked Data Lab Programme. Funding Information: We thank The Health Foundation for providing financial support to allow this analysis to be conducted and for facilitating the Networked Data Lab partnerships which have informed this work. The Health Foundation is an independent charity committed to bringing about better health and healthcare for people in the UK. We thank the NHS Grampian Health Intelligence team for facilitating use of this data. We also thank the Grampian Data Safe Haven (DaSH) for processing the data used in this study, as well as providing the secure platform used in this analysis and administrative support. We are grateful to members of the public who have made invaluable contributions to this work. This work uses data provided by patients and collected by the NHS as part of their care and support. We thank the anonymous reviewers for their careful reading of this manuscript and for their constructive comments. There is widespread agreement that public participation is necessary for health data-intensive projects [44]. We formed, trained, and involved a PPIE group of nine persons interested in health data usage for public benefit through a series of interactions throughout the research cycle including narrowing the focus of the research topic, developing analytical plans, sense-checking interpretations and improving the readability and accessibility of the results. We also held group meetings with nine carers/parents and community workers who work with families and children. They reviewed near-final findings, remarked on usefulness and relevance, and suggested areas for further investigation. A comprehensive report of this effort utilising the GRIPP-2 reporting checklist for public involvement [45] is available in the supplementary materials (Table S1). Funding Information: We thank The Health Foundation for providing financial support to allow this analysis to be conducted and for facilitating the Networked Data Lab partnerships which have informed this work. The Health Foundation is an independent charity committed to bringing about better health and healthcare for people in the UK. We thank the NHS Grampian Health Intelligence team for facilitating use of this data. We also thank the Grampian Data Safe Haven (DaSH) for processing the data used in this study, as well as providing the secure platform used in this analysis and administrative support. We are grateful to members of the public who have made invaluable contributions to this work. This work uses data provided by patients and collected by the NHS as part of their care and support. We thank the anonymous reviewers for their careful reading of this manuscript and for their constructive comments. Publisher Copyright: © 2022, The Author(s).

PY - 2023/1/11

Y1 - 2023/1/11

N2 - BACKGROUND: One in eight children in the United Kingdom are estimated to have a mental health condition, and many do not receive support or treatment. The COVID-19 pandemic has negatively impacted mental health and disrupted the delivery of care. Prevalence of poor mental health is not evenly distributed across age groups, by sex or socioeconomic groups. Equity in access to mental health care is a policy priority but detailed socio-demographic trends are relatively under-researched.METHODS: We analysed records for all mental health prescriptions and referrals to specialist mental health outpatient care between the years of 2015 and 2021 for children aged 2 to 17 years in a single NHS Scotland health board region. We analysed trends in prescribing, referrals, and acceptance to out-patient treatment over time, and measured differences in treatment and service use rates by age, sex, and area deprivation.RESULTS: We identified 18,732 children with 178,657 mental health prescriptions and 21,874 referrals to specialist outpatient care. Prescriptions increased by 59% over the study period. Boys received double the prescriptions of girls and the rate of prescribing in the most deprived areas was double that in the least deprived. Mean age at first mental health prescription was almost 1 year younger in the most deprived areas than in the least. Referrals increased 9% overall. Initially, boys and girls both had an annual referral rate of 2.7 per 1000, but this fell 6% for boys and rose 25% for girls. Referral rate for the youngest decreased 67% but increased 21% for the oldest. The proportion of rejected referrals increased steeply since 2020 from 17 to 30%. The proportion of accepted referrals that were for girls rose to 62% and the mean age increased 1.5 years.CONCLUSIONS: The large increase in mental health prescribing and changes in referrals to specialist outpatient care aligns with emerging evidence of increasing poor mental health, particularly since the start of the COVID-19 pandemic. The static size of the population accepted for specialist treatment amid greater demand, and the changing demographics of those accepted, indicate clinical prioritisation and unmet need. Persistent inequities in mental health prescribing and referrals require urgent action.

AB - BACKGROUND: One in eight children in the United Kingdom are estimated to have a mental health condition, and many do not receive support or treatment. The COVID-19 pandemic has negatively impacted mental health and disrupted the delivery of care. Prevalence of poor mental health is not evenly distributed across age groups, by sex or socioeconomic groups. Equity in access to mental health care is a policy priority but detailed socio-demographic trends are relatively under-researched.METHODS: We analysed records for all mental health prescriptions and referrals to specialist mental health outpatient care between the years of 2015 and 2021 for children aged 2 to 17 years in a single NHS Scotland health board region. We analysed trends in prescribing, referrals, and acceptance to out-patient treatment over time, and measured differences in treatment and service use rates by age, sex, and area deprivation.RESULTS: We identified 18,732 children with 178,657 mental health prescriptions and 21,874 referrals to specialist outpatient care. Prescriptions increased by 59% over the study period. Boys received double the prescriptions of girls and the rate of prescribing in the most deprived areas was double that in the least deprived. Mean age at first mental health prescription was almost 1 year younger in the most deprived areas than in the least. Referrals increased 9% overall. Initially, boys and girls both had an annual referral rate of 2.7 per 1000, but this fell 6% for boys and rose 25% for girls. Referral rate for the youngest decreased 67% but increased 21% for the oldest. The proportion of rejected referrals increased steeply since 2020 from 17 to 30%. The proportion of accepted referrals that were for girls rose to 62% and the mean age increased 1.5 years.CONCLUSIONS: The large increase in mental health prescribing and changes in referrals to specialist outpatient care aligns with emerging evidence of increasing poor mental health, particularly since the start of the COVID-19 pandemic. The static size of the population accepted for specialist treatment amid greater demand, and the changing demographics of those accepted, indicate clinical prioritisation and unmet need. Persistent inequities in mental health prescribing and referrals require urgent action.

KW - Child & adolescent mental health

KW - Mental health prescribing

KW - CAMHS

KW - Health inequalities

U2 - 10.1186/s12888-022-04438-5

DO - 10.1186/s12888-022-04438-5

M3 - Article

C2 - 36627578

SN - 1471-244X

VL - 23

JO - BMC Psychiatry

JF - BMC Psychiatry

IS - 1

M1 - 22

ER -

Inequalities in children's mental health care: analysis of routinely collected data on prescribing and referrals to secondary care

Abstract

Bibliographical note

Keywords

UN SDGs

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Children's Mental Health Prescribing and Referrals to CAMHS

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