Mental Health Needs of Children and Young People in England, 2016-2021: An Epidemiological Study, and Comparison of Young People Who Have Received Protective and Care Interventions and Their Peers

Aims: In England, around 18% of children and young people (CYP) experience clinical levels of mental health difficulties. CYP who receive protective (child protection plans; CPP) and care interventions (children looked after; CLA) may be particularly vulnerable, with epidemiological work suggesting that nearly half of CLA experience clinical levels of mental health difficulties. Less is known about actual contacts with mental health services. To address this gap, this study aimed to provide an account of the contacts with mental health services for children with and without CPP and CLA, exploring changes over time and reasons for referral. Methods: Data were extracted from NHS Digital for all CYP in England in contact with mental health services between April 2016 and March 2021, and included sociodemographic information, CPP or CLA status, and referral reasons. Odds ratios (OR) were used to estimate associations between relevant exposures (e.g. CPP) and outcomes (e.g. contacts).Results: We found 1,984,827 CYP in contact with mental health services, with evidence of underrepresentation of some groups (e.g., Asian CYP). The most common referral reasons were anxiety (13%), “in crisis” (10%), depression (7%), neurodevelopmental conditions (excluding autism; 6%), self-harm (6%), and conduct disorder (5%). Contacts tended to increase each year for all groups. We did not find evidence of a particular spike in contact during the COVID-19 pandemic for all CYP. Finally, overall CPP and CLA were between 2-3 times more likely to be in contact with mental health services compared to peers. However, in any given year, this represented between 9-18% of CPP and CLA. CPP and CLA were at increased risk for being referred for common (e.g., depression, self-harm) and less common problems (e.g. attachment difficulties). Conclusions: The findings from this study suggest that relative to need identified in epidemiological surveys there are wide discrepancies between mental health need and contacts with services. There are also disparities in access affecting CYP from certain groups. In particular, CPP and CLA have particularly high levels of unmet need. Policy makers and service providers need to review their referral and contact data in comparison with epidemiological data and their population context to mitigate inequitable access. While these data indicate escalating demand, service contacts have not increased significantly, suggesting an increased threshold for access in a stretched clinical service.