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.

No abstract

Introduction One in eight children in the United Kingdom are estimated to have a mental health condition, and many do not receive support or treatment. Childhood is a key period for long-term mental health trajectories and the prevalence of poor mental health is not evenly distributed across age-groups, by sex or socioeconomic groups. Equity in access to health care is a policy priority but relatively under-researched. This work aims to inform service planning and provision by linking previously unlinked individual-level data from community and specialist outpatient settings. We describe the trends in treatment and service use among children and adolescents in NHS Grampian to understand the socio-demographic characteristics and inequalities in access to mental health services and care. Methods We linked records for all mental health prescriptions and all referrals to specialist CAMHS between the years of 2015 and 2021 for children aged 2 to 17 in the NHS Grampian health board (North East of Scotland). 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 individuals across the two datasets and a total of 178,657 mental health prescriptions and 21,874 referrals to specialist CAMHS. Monthly prescriptions of mental health medications increased by 59% over the study period. Boys received almost double the number of prescriptions than girls. Primary school aged boys were more likely to receive medications to treat attention deficit hyperactivity disorder (ADHD) and high-school aged girls were more likely to receive anti-depressant medications. The rate of prescribing in the most deprived 10% of areas was double that of the 10% least deprived. The monthly referral rate for specialist CAMHS was roughly static between 2015 & the end of 2019 but increased by 9% since the start of 2020. The rate of rejected referrals increased over time and the number of accepted referrals has remained static. However, there have been demographic changes in who is accepted for treatment. The proportion of accepted referrals who are girls has increased from 48% in 2015 to 62% in 2021. Discussion The large and consistent increase in mental health prescribing for children and young people since 2015 and the increase in referrals to specialist CAMHS since 2020 aligns with emerging evidence of increasing prevalence of poor mental health over time and particularly since the start of the COVID-19 pandemic. The static size of referrals accepted by specialist CAMHS amid greater demand and changing demographics may represent unmet need. Data for alternative sources of treatment such as community based CAMHS is not currently available and future analysis should explore treatment trajectories of those not accepted for specialist CAMHS treatment.