Inequalities in children’s mental health prescribing and referrals for specialist mental health services

William Ball; Helen Rowlands; Corri Black; Shantini Paranjothy; Adelene Rasalam; David Ritchie; Magdalena Rzewuska; Elaine  Thompson; Katie Wilde; Jessica Butler

doi:10.23889/ijpds.v7i3.1980

Inequalities in children’s mental health prescribing and referrals for specialist mental health services

William Ball, Helen Rowlands, Corri Black, Shantini Paranjothy, Adelene Rasalam, David Ritchie, Magdalena Rzewuska, Elaine Thompson, Katie Wilde, Jessica Butler

NHS Grampian

Research output: Contribution to journal › Conference article › peer-review

Abstract

Objective
1 in 8 young people in the United Kingdom are estimated to have a diagnosable mental health condition. Prevalence is increasing over time, many are untreated, and need is not evenly distributed across the population. We aimed to investigate trends in children’s mental health prescribing and referrals to specialist outpatient services.

Approach
We linked individual-level healthcare administrative records on community prescribing and referrals to outpatient Child and Adolescent Mental Health Services (CAMHS). The study cohort included all children aged 2 through 17 in the NHS Grampian Health Board region from 2015 to 2021 (average annual population circa 100,000) with a mental health prescription or CAMHS referral.

We measured prevalence of mental health prescribing and referrals to CAMHS over time. We investigated demographic and socioeconomic differences, including comparison of rates by age, sex, and residential area deprivation. We also investigated socioeconomic and demographic differences in referral acceptance and rejection.

Results
Prescriptions for mental health drugs have risen 40%: from 5,000 per month in 2015 to 7,000 in 2021. 75% of prescriptions to primary schoolers are to boys, mostly for attention deficit hyperactivity disorder medications. Prescriptions to girls rise during secondary school, mostly for anti-depressants. Prescribing rates are 2.6-fold higher in the most versus least deprived areas.

Referrals to CAMHS have risen 20% over the study period, and the proportion of referrals rejected has increased from 18% to 31% – leaving the number of children accepted to specialist care stable. Boys are referred twice as often at younger ages, while girls’ referrals spike during puberty. Since 2015, boys have been referred less and rejected more, with girls now making up 61% of those treated. Referral rates are two-fold higher in the most versus least deprived areas.

Conclusions
Both mental health prescribing and referrals to CAMHS have increased in this population, but the CAMHS service size remained fixed. Presentation and treatment patterns vary dramatically by age and sex, and socioeconomic inequalities are clear and persistent.

Original language	English
Number of pages	1
Journal	International Journal of Population Data Science
Volume	7
Issue number	3
Early online date	25 Aug 2022
DOIs	https://doi.org/10.23889/ijpds.v7i3.1980
Publication status	Published - 25 Aug 2022
Event	International Population Data Linkage Network Conference - The Scholar Hotel, University of Edinburgh, Edinburgh , United Kingdom Duration: 7 Sept 2022 → 9 Sept 2022 Conference number: 2022 conference https://ipdln.org/2022-conference

Keywords

Mental Health
Children & Young People,
Health Inequalities

UN SDGs

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

Access to Document

10.23889/ijpds.v7i3.1980Licence: CC BY

Ball_etal_IJPDS_Inequalities_In_Children's_VoR
September 2022©The Authors. Open Access under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/deed.en)
Final published version, 198 KBLicence: CC BY

1 Attending/organising Workshop, seminar, or course
1 Presentation

“All about communication" - a perspective on our public involvement practices in the Networked Data Lab in Grampian
Magdalena Rzewuska (Speaker), Sharon Gordon (Author), William Ball (Author) & Jessica Butler (Author)
7 Sept 2022 → 9 Sept 2022
Activity: Disseminating Research › Presentation

File
Demystifying Patient and Public Involvement and Engagement in health data research: early lessons from a framework approach
Olivia Ross-Hurst (Participant), Lynn Laidlaw (Participant), Magdalena Rzewuska (Participant), William Ball (Participant), Alan Johnstone (Participant), Norman Deans (Participant), Joanna Dundon (Participant), Claire E. Newman (Participant), Lesley Bethell (Participant) & Dot Williams (Participant)
8 Jul 2021
Activity: Attending or organising an event › Attending/organising Workshop, seminar, or course

Cite this

@article{896c0d74f0954d11b74071bd22b94e21,

title = "Inequalities in children{\textquoteright}s mental health prescribing and referrals for specialist mental health services",

abstract = "Objective1 in 8 young people in the United Kingdom are estimated to have a diagnosable mental health condition. Prevalence is increasing over time, many are untreated, and need is not evenly distributed across the population. We aimed to investigate trends in children{\textquoteright}s mental health prescribing and referrals to specialist outpatient services.ApproachWe linked individual-level healthcare administrative records on community prescribing and referrals to outpatient Child and Adolescent Mental Health Services (CAMHS). The study cohort included all children aged 2 through 17 in the NHS Grampian Health Board region from 2015 to 2021 (average annual population circa 100,000) with a mental health prescription or CAMHS referral.We measured prevalence of mental health prescribing and referrals to CAMHS over time. We investigated demographic and socioeconomic differences, including comparison of rates by age, sex, and residential area deprivation. We also investigated socioeconomic and demographic differences in referral acceptance and rejection.ResultsPrescriptions for mental health drugs have risen 40%: from 5,000 per month in 2015 to 7,000 in 2021. 75% of prescriptions to primary schoolers are to boys, mostly for attention deficit hyperactivity disorder medications. Prescriptions to girls rise during secondary school, mostly for anti-depressants. Prescribing rates are 2.6-fold higher in the most versus least deprived areas.Referrals to CAMHS have risen 20% over the study period, and the proportion of referrals rejected has increased from 18% to 31% – leaving the number of children accepted to specialist care stable. Boys are referred twice as often at younger ages, while girls{\textquoteright} referrals spike during puberty. Since 2015, boys have been referred less and rejected more, with girls now making up 61% of those treated. Referral rates are two-fold higher in the most versus least deprived areas.ConclusionsBoth mental health prescribing and referrals to CAMHS have increased in this population, but the CAMHS service size remained fixed. Presentation and treatment patterns vary dramatically by age and sex, and socioeconomic inequalities are clear and persistent.",

keywords = "Mental Health, Children & Young People,, Health Inequalities",

author = "William Ball and Helen Rowlands and Corri Black and Shantini Paranjothy and Adelene Rasalam and David Ritchie and Magdalena Rzewuska and Elaine Thompson and Katie Wilde and Jessica Butler",

year = "2022",

month = aug,

day = "25",

doi = "10.23889/ijpds.v7i3.1980",

language = "English",

volume = "7",

journal = "International Journal of Population Data Science",

issn = "2399-4908",

publisher = "Swansea University",

number = "3",

note = "International Population Data Linkage Network Conference , IPDLN2022 ; Conference date: 07-09-2022 Through 09-09-2022",

url = "https://ipdln.org/2022-conference",

}

TY - JOUR

T1 - Inequalities in children’s mental health prescribing and referrals for specialist mental health services

AU - Ball, William

AU - Rowlands, Helen

AU - Black, Corri

AU - Paranjothy, Shantini

AU - Rasalam, Adelene

AU - Ritchie, David

AU - Rzewuska, Magdalena

AU - Thompson, Elaine

AU - Wilde, Katie

AU - Butler, Jessica

N1 - Conference code: 2022 conference

PY - 2022/8/25

Y1 - 2022/8/25

N2 - Objective1 in 8 young people in the United Kingdom are estimated to have a diagnosable mental health condition. Prevalence is increasing over time, many are untreated, and need is not evenly distributed across the population. We aimed to investigate trends in children’s mental health prescribing and referrals to specialist outpatient services.ApproachWe linked individual-level healthcare administrative records on community prescribing and referrals to outpatient Child and Adolescent Mental Health Services (CAMHS). The study cohort included all children aged 2 through 17 in the NHS Grampian Health Board region from 2015 to 2021 (average annual population circa 100,000) with a mental health prescription or CAMHS referral.We measured prevalence of mental health prescribing and referrals to CAMHS over time. We investigated demographic and socioeconomic differences, including comparison of rates by age, sex, and residential area deprivation. We also investigated socioeconomic and demographic differences in referral acceptance and rejection.ResultsPrescriptions for mental health drugs have risen 40%: from 5,000 per month in 2015 to 7,000 in 2021. 75% of prescriptions to primary schoolers are to boys, mostly for attention deficit hyperactivity disorder medications. Prescriptions to girls rise during secondary school, mostly for anti-depressants. Prescribing rates are 2.6-fold higher in the most versus least deprived areas.Referrals to CAMHS have risen 20% over the study period, and the proportion of referrals rejected has increased from 18% to 31% – leaving the number of children accepted to specialist care stable. Boys are referred twice as often at younger ages, while girls’ referrals spike during puberty. Since 2015, boys have been referred less and rejected more, with girls now making up 61% of those treated. Referral rates are two-fold higher in the most versus least deprived areas.ConclusionsBoth mental health prescribing and referrals to CAMHS have increased in this population, but the CAMHS service size remained fixed. Presentation and treatment patterns vary dramatically by age and sex, and socioeconomic inequalities are clear and persistent.

AB - Objective1 in 8 young people in the United Kingdom are estimated to have a diagnosable mental health condition. Prevalence is increasing over time, many are untreated, and need is not evenly distributed across the population. We aimed to investigate trends in children’s mental health prescribing and referrals to specialist outpatient services.ApproachWe linked individual-level healthcare administrative records on community prescribing and referrals to outpatient Child and Adolescent Mental Health Services (CAMHS). The study cohort included all children aged 2 through 17 in the NHS Grampian Health Board region from 2015 to 2021 (average annual population circa 100,000) with a mental health prescription or CAMHS referral.We measured prevalence of mental health prescribing and referrals to CAMHS over time. We investigated demographic and socioeconomic differences, including comparison of rates by age, sex, and residential area deprivation. We also investigated socioeconomic and demographic differences in referral acceptance and rejection.ResultsPrescriptions for mental health drugs have risen 40%: from 5,000 per month in 2015 to 7,000 in 2021. 75% of prescriptions to primary schoolers are to boys, mostly for attention deficit hyperactivity disorder medications. Prescriptions to girls rise during secondary school, mostly for anti-depressants. Prescribing rates are 2.6-fold higher in the most versus least deprived areas.Referrals to CAMHS have risen 20% over the study period, and the proportion of referrals rejected has increased from 18% to 31% – leaving the number of children accepted to specialist care stable. Boys are referred twice as often at younger ages, while girls’ referrals spike during puberty. Since 2015, boys have been referred less and rejected more, with girls now making up 61% of those treated. Referral rates are two-fold higher in the most versus least deprived areas.ConclusionsBoth mental health prescribing and referrals to CAMHS have increased in this population, but the CAMHS service size remained fixed. Presentation and treatment patterns vary dramatically by age and sex, and socioeconomic inequalities are clear and persistent.

KW - Mental Health

KW - Children & Young People,

KW - Health Inequalities

U2 - 10.23889/ijpds.v7i3.1980

DO - 10.23889/ijpds.v7i3.1980

M3 - Conference article

SN - 2399-4908

VL - 7

JO - International Journal of Population Data Science

JF - International Journal of Population Data Science

IS - 3

T2 - International Population Data Linkage Network Conference

Y2 - 7 September 2022 through 9 September 2022

ER -

Inequalities in children’s mental health prescribing and referrals for specialist mental health services

Abstract

Keywords

UN SDGs

Access to Document

Fingerprint

Activities

“All about communication" - a perspective on our public involvement practices in the Networked Data Lab in Grampian

Demystifying Patient and Public Involvement and Engagement in health data research: early lessons from a framework approach

Cite this