Can routine data be used to estimate the mental health service use of children and young people living on Gypsy and Traveller sites in Wales? A feasibility study

Abstract

Introduction Gypsies and Travellers have poorer physical and mental health than the general population, but little is known about mental health service use by Gypsy and Traveller children and young people. Finding this group in routine electronic health data is challenging, due to limited recording of ethnicity. We assessed the feasibility of using geographical markers combined with linked routine datasets to estimate the mental health service use of children and young people living on Traveller sites. Methods Welsh Government supplied a list of Traveller site postcodes included in Caravan Counts between 2012 and 2020. Using spatial filtering with data from the Adolescent Mental Health Data Platform (ADP) at Swansea University’s SAIL Databank, we created a cohort of Traveller site residents aged 11–25 years old, 2010–2019. ADP algorithms were used to describe health service use, and to estimate incidence and prevalence of common mental disorders (CMD) and self-harm. Results Our study found a subgroup of young Gypsies and Travellers (n = 802). We found no significant differences between our cohort and the general population for rates of CMD or self-harm. The rate of non-attendance for psychiatric outpatient follow-up appointments was significantly higher in our cohort. Rates were higher (but not statistically significant) among Gypsies and Travellers for measures suggesting less well-managed care, including emergency department attendance and prescribed CMD medication without follow-up. The small size of the cohort resulted in imprecise estimates with wide confidence intervals, compared with those for the general population. Conclusions Gypsies and Travellers are under-represented in routine health datasets, even using geographical markers, which find only those resident in authorised traveller sites. Routine data is increasingly relied upon for needs assessment and service planning, which has policy and practice implications for this underserved group. To address health inequalities effort is required to ensure that health datasets accurately capture ethnicity.

Machine learning in mental health and its relationship with epidemiological practice

“…The use of routinely collected electronic health records alleviates these issues to some extent; however, many important constructs of interest are subjective and can only be self-reported. Furthermore, minority groups (often the most affected by mental health inequalities) and those with more severe syndromes are frequently excluded and underserved ( 29 ). In addition, outcomes such as self-harm are known to be under-recorded in electronic health records ( 30 ).…”

Experiences of Alcohol Use and Harm among Travellers, Roma, and Gypsies: A Participatory Qualitative Study

“…. .whereas if you've done it where there was no occasion or anything going on, obviously you're automatically an alcoholic and nobody wants you in their company" (Traveller1, F, [16][17][18][19][20][21][22][23][24].…”

“….he's just going out with the lads." (Roma7, F, [16][17][18][19][20][21][22][23][24]. Te high standards of behaviour expected of young unmarried women in Gypsy, Roma, and Irish Traveller communities meant that young women behaving drunkenly in public were judged harshly: "To see a young Travelling girl getting really drunk and falling across the foor, it don't really look very good do it?"…”

“….it's not taken as seriously maybe on the canal, because it's quite a regular occurrence." (Boater2, F, [16][17][18][19][20][21][22][23][24].…”

“…Tere is a lack of knowledge about alcohol use and harm among Gypsies and Travellers as, despite being included as one ethnic group in the census, their ethnicity is not routinely recorded within health databases and they are difcult to trace within routinely collected data [15][16][17]. In Ireland, rates of problematic alcohol use are high among Travellers [18,19] and in a recent survey, Gypsies and Travellers identifed alcohol as their biggest healthcare issue [20].…”