Summary and implications

These analyses from teams across England, Wales and Scotland show it is possible to use local, linked data sources to gain a much more complete picture of who is using services for mental health problems. In North West London, the analysis showed a steep increase in the use of general practice and specialist mental health services. The NDL team in Grampian found increases in the percentage of children and young people receiving prescriptions for mental health problems. They also showed how the patterns of prescribing vary between girls and boys in different age groups (from being dominated by medications for ADHD for boys in the younger age groups to predominantly antidepressants for young adults, particularly young women aged 19–25). Adolescent girls and young women were also found to have the greatest number of contacts with specialist mental health services in Leeds as well as in Liverpool and Wirral, and were the group who most frequently required acute crisis care in Wales.

A persistent theme is the greater likelihood of children and young people from more deprived areas being in contact with primary, specialist mental health or crisis NHS services than those from less deprived areas. Some of these differences are stark. Crisis referrals in Leeds were 60% higher among CAMHS users in the most deprived areas than in the least deprived. Meanwhile there was twice the rate of prescriptions in Grampian and close to twice the rate of crisis events in Wales between the most and least deprived areas.

Limitations

The analyses have limitations. Firstly, the extent to which they can be generalised beyond local areas will vary. Other research suggests that some of the trends we observed are likely to exist in other areas as well, especially the rise in mental illness among adolescent girls and overall rising demand for support. But without comparable national-level data, caution must be exercised in drawing out implications for policy and practice.

A second limitation relates to the data sources, which were primarily routinely collected administrative data from NHS services. No data were available on services accessed outside the NHS that often represent a significant part of mental health support, including in schools, or services funded by local government or the voluntary sector. Data are also lacking on the use of privately funded mental health services, which anecdotal evidence suggests has risen as NHS services have struggled.

This is linked to the third limitation: the fact that these data only capture those who sought and successfully gained access to services. While some of the patterns we found suggest potentially high and rising levels of unmet need, for example falling contacts when young people transition from children to adult services, the data did not allow us to directly quantify unmet need.

Finally, most of the data used are routinely collected administrative data. These data often lack detailed clinical information, do not offer insights into how the severity and acuity of cases has changed (except for crises) and cannot shed light on the outcomes or experiences of care.

Implications for policy and practice

Our results suggest more resources need to be targeted at prevention among those most at risk of developing mental ill health.

Accepting the limitation about generalisability already set out, there were some similarities in the results across all five teams that raise questions for the future development of children and young people’s mental health policy. The high burden of mental ill health being experienced by adolescent girls and young women is a cause for concern, as is the much higher toll that mental illness is taking on those from more deprived areas. While governments from all three nations have committed to expand preventative services, particularly outside the NHS, these results suggest resources need to be more deliberately targeted at those most at risk of future problems.

Linked data sources and data sharing across sector and organisational boundaries are vital to improve services.

Any major shifts in policy should, however, be based on the best available data, including insights about those children and young people who are not getting access to services. At a national level, to take England as an example, there are still major data gaps. The Chief Medical Officer for England, the Children and Young People’s Mental Health and Wellbeing Taskforce and the Health and Social Care Committee have all flagged gaps in nationally available data on children and young people’s mental health, on service provision, and on experiences and outcomes.,, Nevertheless, in the absence of more complete national data, the experience of producing these local analyses from the NDL across the UK, suggests progress is possible using local, linked datasets.

For example, the research in Wales demonstrates how much more can be understood about the scale, location and consequences of mental health crises being experienced by young people than would have been possible by looking at hospital or emergency services data separately. The insights from Wales on higher rates of crisis incidents in more deprived areas mirrors the work done in Liverpool and Wirral, where a comparison of access to specialist mental health services alongside emergency admissions suggests that in some deprived areas, services may not be reaching some children and young people.

In England, the planning and delivery of services are shifting to new integrated care systems (ICSs), which are closer to the integrated models that already exist in Scotland and Wales. The local analyses shown in this briefing illustrate the potential for data-driven population health management that will be at the core of ICSs. It also illustrates the potential uses. In Grampian, for example, the NDL team linked the data on prescribing and access to CAMHS. The team found that while prescribing and referrals went up, acceptances to CAMHS treatment remained the same, resulting in a bottleneck that may have been creating unmet need among younger children, now being addressed by CAMHS.

More national action is needed to improve the data quality for NHS mental health services and data coverage for mental health support provided outside the NHS.

Local data analysis has considerable potential, but national action is still needed to make it feasible. This includes improving the data quality and completeness for NHS mental health services. Several NDL teams reported that CAMHS data quality was poor, with duplicated or incomplete data and a lack of clinical information (eg related to the presenting complaint). Data were also poor for adult services. This prevents national policymakers and local areas from obtaining reliable measures on some of the most critical and challenging pathways, including transition from CAMHS to AMHS. Age thresholds also vary by region but there is no reliable data-driven evidence on the success of local systems at managing transitions and how they have done it. Detail on other key personal and demographic information also needs to be much more complete, including ethnicity and sexual orientation.

There is also a significant blind spot about support outside NHS specialist mental health services. While specialist mental health services are under pressure, it is vital that those planning and designing services understand what happens to the children and young people turned away from specialist services. This includes whether they are able to access alternative services or other forms of support outside the NHS, or whether they deteriorate to the point of needing more intensive care.

If the findings from North West London are typical of other regions, then general practice is providing an increasingly large share of mental health services, particularly to young people, and will need increased support to do so. GPs report a number of barriers in supporting children and young people with mental health problems, including lack of time, knowledge, access to mental health providers, and resources. Other research suggests that GPs can find it challenging because of a lack of emphasis on mental health in their medical training, lack of clinical experience around young people who present with complex difficulties, or in managing transition to adult mental health services, as well as a lack of tools and resources.,,

A 2021 survey by YoungMinds of young people aged 16–25 in the UK found that although the majority had a positive experience of receiving support from their GP, 2 out of 3 would prefer to be able to access mental health support without going to see their GP. General practice is only one strand of tier 1 mental health services. Other forms of non-NHS community and school-based mental health services are being developed in all three countries, but data are either not available or not linked up with other datasets. National support is required to explore how a more complete dataset for children and young people’s mental health services can be created in all three countries – reliable enough to inform national oversight of who is using which services, and available for analysis at a local level.

More regular collection and publication of robust prevalence data, including for Scotland and Wales, would allow services to be expanded in line with need and realistic targets to be set.

As well as more frequent prevalence surveys, national bodies should also explore the feasibility of collecting more detailed data on groups likely to be at highest risk of mental illness, or most disadvantaged from accessing services. The NDL analysis found clear variation in use of services by socioeconomic group, but without corresponding estimates of need it is not possible to say whether services are being accessed equitably, relative to underlying need.

An investigation of local inequalities in access for children and young people in the West Midlands drew on qualitative evidence, suggesting that children from more deprived areas were less likely to have parental support in navigating services and faced additional barriers including the cost of transport to appointments. Evidence of equitable access to services might, therefore, need to see an even steeper gradient in the patterns of service use.

Conclusion

The scale of the challenge facing children and young people’s mental health services has been recognised by governments in all three countries. Policies are in place to expand services and support in the NHS, schools and the community, but services are not being expanded fast enough to meet the rising levels of need among children and young people. The analysis presented in this briefing illustrates how crucial high-quality data and analytics will be to understand where services need to expand in order to meet needs and reduce inequalities. This will be essential to targeting preventative interventions, planning services and improving children and young people’s mental health.

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