The mental health of all children in contact with social services: a population-wide record-linkage study in Northern Ireland

Abstract

Aims Children in contact with social services are at high risk for mental ill health, but it is not known what proportion of the child population has contact with social services or how risk varies within this group compared to unexposed peers. We aim to quantify the extent and nature of contact with social services within the child population in Northern Ireland (NI) and the association with mental ill health. We also examine which social care experiences identify those most at risk. Methods This is a population-based record-linkage study of 497,269 children (aged under 18 years) alive and resident in NI in 2015 using routinely collected health and social care data. Exposure was categorized as (1) no contact, (2) referred but assessed as not in need (NIN), (3) child in need (CIN) and (4) child in care (CIC). Multilevel logistic regression analyses estimated odds ratios (ORs) for mental ill health indicated by receipt of psychotropic medication (antidepressants, anxiolytics, antipsychotics and hypnotics), psychiatric hospital admission and hospital-presenting self-harm or ideation. Results Over one in six children (17.2%, n = 85,792) were currently or previously in contact with social services, and almost one child in every 20 (4.8%, n = 23,975) had contact in 2015. Likelihood of any mental ill health outcome increased incrementally with the level of contact with social services relative to unexposed peers: NIN (OR 5.90 [95% confidence interval (CI) 5.10–6.83]), CIN (OR 5.99 [95% CI 5.50–6.53]) and CIC (OR 12.60 [95% CI 10.63–14.95]). All tiers of contact, number of referrals, number of care episodes and placement type were strongly associated with the likelihood of mental ill health. Conclusion Children who have contact with social services account for a large and disproportionate amount of mental ill health in the child population. Likelihood of poor mental health across indicators is highest in care experienced children but also extends to the much larger population of children in contact with social services but never in care. Findings suggest a need for targeted mental health screening and enhanced support for all children in contact with social services.

Childhood contact with social services and risk of suicide or sudden death in young adulthood: identifying hidden risk in a population-wide cohort study

“…The finding that adults assessed as ‘not in need’ in childhood who received no services face an equivalent risk of premature death to those assessed as a CIN highlights a potential missed opportunity for intervention. Although these individuals may not need traditional social services support they have been shown to be at an increased risk of both poor mental health 24 and premature mortality. Direct comparison with existing studies is challenged by heterogeneity in how exposure subgroups are defined, and cross-national differences in social care systems and populations.…”

“…5 23 In earlier work, we identified that children referred to social services but assessed as not in need (NIN) of any help or protection have a fivefold increased risk of mental ill health compared with those with no contact. 24 We hypothesise this group will have an increased risk of death by suicide given the established link between mental ill health and suicide. 25 The potentially increased cause-specific mortality risk among this ‘hidden’ population, who are known to social services but have not experienced placement in care, has not been previously examined.…”

A Scoping Review of Mental Health and Wellbeing Outcome Measures for Children and Young People: Implications for Children in Out-of-home Care

“…Yet, some of their experiences will be unique and it is important for researchers to be aware of this. Young people who are looked after have consistently been found to have much higher rates of mental health difficulties than the general youth population, with almost half of looked after children (and three quarters of those living in residential group care) meeting the criteria for a psychiatric disorder in the UK (Fleming et al, 2021 ; McKenna et al, 2023 ). There are many reasons for this, including the adversities experienced by children before coming into state care, such as abuse, neglect, exploitation and poverty, along with the difficulties children may experience during their time in care, which can both add to and exacerbate their needs.…”

Serious mental health diagnoses in children on the Child Protection Register: a record linkage study

“…Other research found that almost half of children with experience of child welfare services had clinically significant emotional or behavioural problems, as well as an increased likelihood of receiving mental health care [15]. Another study found an increased risk of receiving a psychotropic prescription, hospital admission or emergency presentation for self-harm compared to children without interaction with social services [16]. Conducting this kind of analysis is important to inform the design and provision of mental healthcare services, as well as social policy aimed at reducing the prevalence of poor mental health.…”