1356 ‘But what does that mean for me?’ Developing evidence-based statements for health practitioners to reduce variation in adoption medical advice

Abstract

destination, safeguarding outcomes for all CAMHS referrals (n=115). We compared this to corresponding data from all patient attendances (n=13,451) and CAMHS referrals (n=106) during the same time periods in 2019. Patient demographics were compared to national secondary school 2019 census data from the Department of Education 2 . Results The proportion of CAMHS referrals among <18yrolds in PED during each lockdown was significantly greater than during 2019 (Chi squared L1=5.1x10 -4 ; L2=2.3x10 -4 ; L3=1.7x10 -4 ), representing an almost 3-fold increase overall. Fewer than one in five of these children triggered pre-existing safeguarding alerts at triage.The second lockdown coincided with the greatest proportion of CAMHS referrals (<18yr-olds 3.1%; <13yr-olds n=7 and 13-17yrs n=49), representing a significant increase compared to the first lockdown (p=1.4x10 5 ). There was no significant difference between the second and third lockdowns.Up to one third of 13-17yr-olds referred to CAMHS were unaccompanied during the third lockdown, coinciding with the highest proportion of admissions and transfers in this age group (n=12; 36%).Consistently, the most common indication for CAMHS referral among <13yr-olds was depression and/or anxiety, while among 13-17yr-olds it was intentional overdose (IOD) or deliberate self-harm (DSH). While an upward trend in the number of 13-17yr-olds presenting with DSH and IOD was observed between the first and second lockdowns, our current sample size is insufficient to establish statistical significance.While the majority of CAMHS referrals among 13-17yrolds across all three lockdowns were from ethnic minority groups (L1 74%; L2 76%; L3 56%), this was consistent with the general paediatric population in Southwark & Lambeth. However, our sample size was insufficient to establish significant differences between individual ethnic groups. The majority of 13-17yr-olds referred to CAMHS were female (L1 63%; L2 85%; L3 87%) across all three lockdowns. Conclusions Our findings suggest there was a significantly higher proportion of acute mental health presentations in PED during lockdown, especially amongst 13-17yr olds, and an upward trend in DSH and IOD. This has significant implications for the future provision of child and adolescent mental health services in hospitals and the community and the ramifications of this phenomenon post-lockdown have yet to be seen.