Mental health service provision for children in state care in England

This project will provide evidence for the prevalence of mental health concerns among children in care, the characteristics of children in care referred to mental health services and the mental health provision they receive.

At any given time in England, there are more than 70,000 children being looked after by the state and the majority are taken into care due to experiences of extreme maltreatment. As many as 50% of children in care have a diagnosable mental health concern, in comparison to 12% of children in the general population. However, it is unknown how many children in care with mental health concerns are referred to mental health services and there is no information on the characteristics and histories of children who are referred.

This research will provide an accurate overview of the provision of mental health services to children in care, including prevalence of different mental health conditions, treatment, referral times, re-referrals and outcomes.

This study will be the first in the UK to link the national administrative dataset on children in care with the NHS’ national dataset on mental health service provision for children and young people. Every year, all local authorities in the UK must provide the DfE with detailed data on every child in care, including characteristics (such as age, gender, ethnicity and reason for entry into care), care trajectories (such as placement changes) and mental health assessment scores via the Strengths and Difficulties Questionnaire (SDQ).

The NHS Child and Adult Mental Health Services Dataset includes information from 2016 onwards on children and young people in contact with mental health services in both hospitals and outpatient clinics. It provides data on reasons for referral, assessment outcomes, diagnoses, treatment programmes and waiting times, and identifies children in state care.

The first phase of research will use secure data linkage to create a new dataset, enabling analysis of children in receipt of mental health services over a four-year period.

The second phase of research will analyse the data to explore characteristics and mental health outcomes across three comparison groups. Children in care who are referred to mental health services will be compared with those who are not; children with high SDQ scores will be compared with those without, and; children in the general population who access mental health services will be compared with children in care. Descriptive and bivariate statistics will be used to compare differences in referrals by children’s characteristics and preceding care experiences. These analyses will be extended to identify any differences between local authorities and multinomial logistic regression will be used to explore differences between children in care and the general population.

The research will describe children’s journey from referral to discharge, explore the association between yearly SDQ scores and mental health service provision, and will identify the groups of children in care who are most at risk of referral to mental health services.

This research will provide important evidence to inform service provision and evidence-based commissioning and will provide a foundation for future longitudinal study on the impacts of mental health interventions on children’s care pathways and outcomes.

The findings will be communicated to policymakers, practitioners and third sector organisations campaigning for children’s rights and better service provision for children in care. The study will be publicised through press releases, policy blogs and briefing papers, with at least three academic papers submitted to leading journals, and the final report will be made publicly available.