Mental health service use in children at risk of significant harm: a record linkage study of a child protection register.

Ball, William P.; Anderson, Caroline; Black, Corri; Gordon, Sharon; Lackenby, Michael; Murchie, Martin; Ostrovska, Bārbala; O'Sullivan, Katherine; Rowlands, Helen; Rzewuska Díaz, Magdalena; Butler, Jessica E.

Abstract

Children with experience of maltreatment, abuse or neglect have higher prevalence of poor mental health. In the United Kingdom, child protection services identify children at risk of significant harm on the Child Protection Register (CPR) and intervene to reduce risk. Prevalence and incidence of mental health service use among this population of children are not well understood. We analysed records from one Scottish Local Authority's CPR, linked to electronic health records for all children in the broader health board region aged 0-17 years. We described mental health service use among children with a CPR registration using measures of mental health prescribing and referrals to child and adolescent mental health services (CAMHS). We calculated age- and sex-specific incidence rates for comparison with the general population. Between 2012 and 2022, we found 1,498 children with a CPR registration, with 69% successfully linked to their health records. 20% were registered before birth and median age at registration was 3 years. Incidence rates in all measures of mental health service use were higher in children with a CPR record across all ages (at outcome) and genders compared to the general population. The largest absolute difference was for boys aged 5-9 with a CPR record, who had 31.8 additional mental health prescriptions per 1,000 person-years compared to the general population (50.4 vs. 18.6 prescriptions per 1,000 person-years, IRR: 2.7). Girls aged 0-4 years with a CPR registration had the largest relative difference, with a rate of CAMHS referral 5.4 times higher than the general population (12.3 vs. 2.3 per 1,000 person-years). Our reproducible record linkage of the CPR to health records reveals an increased risk of mental health service use during childhood. Our findings have relevance to public mental health surveillance, service prioritisation and wider policy aiming to reduce childhood exposure to risk of harm.

Citation

BALL, W.P., ANDERSON, C., BLACK, C., GORDON, S., LACKENBY, M., MURCHIE, M., OSTROVSKA, B., O'SULLIVAN, K., ROWLANDS, H., RZEWUSKA DÍAZ, M. and BUTLER, J.E. 2024. Mental health service use in children at risk of significant harm: a record linkage study of a child protection register. Social science and medicine [online], 353, article number 117057. Available from: https://doi.org/10.1016/j.socscimed.2024.117057

• Journal Article Type: Article
• Acceptance Date: Jun 14, 2024
• Online Publication Date: Jun 19, 2024
• Publication Date: Jul 31, 2024
• Deposit Date: Jun 19, 2024
• Publicly Available Date: Jun 19, 2024
• Journal: Social science and medicine
• Print ISSN: 0277-9536
• Electronic ISSN: 1873-5347
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 353
• Article Number: 117057
• DOI: https://doi.org/10.1016/j.socscimed.2024.117057
• Keywords: Children and mental health; Mental health services; Child protection
• Public URL: https://rgu-repository.worktribe.com/output/2377775
• Additional Information: This article has been published with separate supporting information. This supporting information has been incorporated into a single file on this repository and can be found at the end of the file associated with this output.