Disparities in adolescent mental health-related National Health Service presentations in England: a secondary school cohort study
Abstract
Abstract Introduction Evidence on demographic and socioeconomic differences in adolescent mental health service use across multiple healthcare settings is vital for equitable health policy and service responses. We quantified inequalities in referrals to National Health Service (NHS)-funded mental health services and NHS hospital use for mental health concerns by social strata for secondary school pupils in England. Methods We used linked education-health records (ECHILD) to create a cohort of pupils entering state-funded secondary schools in England (age 11 years/year 7) from 2012/13 to 2021/22. We measured rates of service use by gender, racial-ethnic group, region of residence, free school meal eligibility and area-level deprivation. Contacts were captured in the Mental Health Services Data Set and Hospital Episode Statistics. Pupils were followed up until service contact, age 21 years, death or study end (31 August 2022). Results Of 5 629 720 pupils, 980 648 (17.4%) were referred to NHS-funded mental health services; a rate of 45.2 per 1000 person-years (95% CI 45.1 to 45.2). Referral rates were higher in females (55.5, 95% CI 55.4 to 55.7) than males (35.7, 95% CI 35.6 to 35.8) and were highest in the North East (58.2, 95% CI 57.7 to 58.7). Rates were highest among White Irish travellers (70.8, 95% CI 66.2 to 75.8) and lowest among Pakistani (20.8, 95% CI 20.5 to 21.1) pupils. Pupils eligible for free school meals had particularly high rates (75.3, 95% CI 75.0 to 75.6), and rates increased with quintiles of area-level deprivation. Sociodemographic patterns were consistent across referrals, emergency department attendances, and hospital admissions. Conclusions We find marked variation in mental health service use across social strata but consistency across different service types, likely reflecting differences in underlying need, symptom recognition, help-seeking, referral pathways, recording practice and the availability and acceptability of services.