Variation in spend on young mental health across Clinical Commissioning Groups in England: a cross-sectional observational study

Rocks, Stephen; Fazel, Mina; Tsiachristas, Apostolos

doi:10.1136/bmjopen-2019-030011

Cited by 7 publications

(8 citation statements)

References 19 publications

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“…Excluding London from an unadjusted analysis of trend over deprivation changed the estimates in 12-to 17-year-olds from 0.96 (p < 0.001) in both sexes to 1.06 in females and 1.05 in males (both p < 0.001) (S3 Table). Measures of deprivation were not found to be statistically significantly associated with spending on CYP mental health per child at the Clinical Commissioning Group level in a study by Rocks and colleagues [31]. This study included early help and targeted services (tier 2) and specialised Child and Adolescent Mental Health Services (CAMHS) (tier 3).…”

Section: Comparison With Other Studiesmentioning

confidence: 96%

Incidence and prevalence of primary care antidepressant prescribing in children and young people in England, 1998–2017: A population-based cohort study

et al. 2020

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Background The use of antidepressants in children and adolescents remains controversial. We examined trends over time and variation in antidepressant prescribing in children and young people in England and whether the drugs prescribed reflected UK licensing and guidelines. Methods and findings QResearch is a primary care database containing anonymised healthcare records of over 32 million patients from more than 1,500 general practices across the UK. All eligible children and young people aged 5-17 years in 1998-2017 from QResearch were included. Incidence and prevalence rates of antidepressant prescriptions in each year were calculated overall, for 4 antidepressant classes (selective serotonin reuptake inhibitors [SSRIs], tricyclic and related antidepressants [TCAs], serotonin and norepinephrine reuptake inhibitors [SNRIs], and other antidepressants), and for individual drugs. Adjusted trends over time and differences by social deprivation, region, and ethnicity were examined using Poisson regression, taking clustering within general practitioner (GP) practices into account using multilevel modelling. Of the 4.3 million children and young people in the cohort, 49,434 (1.1%) were prescribed antidepressants for the first time during 20 million years of follow-up. Males

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Section: Comparison With Other Studiesmentioning

confidence: 96%

Incidence and prevalence of primary care antidepressant prescribing in children and young people in England, 1998–2017: A population-based cohort study

et al. 2020

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“…The funding allocated by each commissioning group to the studied CAMHS from 2015 to 2019 is included in Supporting information 2 in S2 Appendix . As described elsewhere, we excluded inpatient spend and adjusted for the population [ 21 ]. Specifically, we estimated the target population by multiplying the population aged under 18 by the estimated prevalence of common mental disorders in that age group.…”

Section: Results (Including Refined Methods)mentioning

confidence: 99%

How does reorganisation in child and adolescent mental health services affect access to services? An observational study of two services in England

et al. 2021

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Background Child and Adolescent Mental Health Services (CAMHS) in England are making significant changes to improve access and effectiveness. This ‘transformation’ variously involves easier access to services through a Single Point of Access (SPA), more integrated services within CAMHS and enhanced co-provision across education and third sector or non-profit organisations. Methods A mixed-methods observational study was conducted to explore the process and impact of transformation over four years in two services. Ethnographic observations and in-depth interviews were conducted and Electronic Patient Records with over one million contacts analysed. Difference-in-differences analysis with propensity score matching to estimate the causal impact of the transformation on patient access was utilised. Outcomes Spend and staffing increased across both CAMHS. The SPA had growing rates of self-referral and new care pathways were seeing patients according to expected degree of psychopathology. Third sector partners were providing increasing numbers of low-intensity interventions. Although the majority of staff were supportive of the changes, the process of transformation led to service tensions. In the first year after transformation there was no change in the rate of new patients accessing services or new spells (episodes of care) in the services. However, by year three, the number of new patients accessing CAMHS was 19% higher (Incidence Rate Ratio: 1·19, CI: 1·16, 1·21) and the rate of new spells was 12% higher (Incidence Rate Ratio: 1·12, CI: 1·05, 1·20). Interpretation Transformation investment, both financial and intellectual, can help to increase access to CAMHS in England, but time is needed to realise the benefits of reorganisation.

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“…Importantly, however, the breadth of public targets and interventions (as illustrated in Figure 1's interactional public mental health schema) necessitates action and cooperation across a number of institutions in addition to public health bodies, including health, education, social care, law enforcement and local and national government. Yet the multi‐system approach that is needed can – especially in times of austerity – be marginalised and diminished, as institutions might fight shy of the mental health agenda when other areas, such as acute medical care, are also in need (Rocks, Fazel, & Tsiachristas, 2019). This may result in a ‘fire‐fighting’ approach, whereby institutions respond reactively rather than proactively to prevent onset.…”

Section: Evidence Reviewmentioning

confidence: 99%

Current evidence and opportunities in child and adolescent public mental health: a research review

Fazel,

Soneson

2023

Child Psychology Psychiatry

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BackgroundA public mental health lens is increasingly required to better understand the complex and multifactorial influences of interpersonal, community and institutional systems on the mental health of children and adolescents.MethodsThis research review (1) provides an overview of public mental health and proposes a new interactional schema that can guide research and practice, (2) summarises recent evidence on public mental health interventions for children and adolescents, (3) highlights current challenges for this population that might benefit from additional attention and (4) discusses methodological and conceptual hurdles and proposes potential solutions.ResultsIn our evidence review, a broad range of universal, selective and indicated interventions with a variety of targets, mechanisms and settings were identified, some of which (most notably parenting programmes and various school‐based interventions) have demonstrated small‐to‐modest positive effects. Few, however, have achieved sustained mental health improvements.ConclusionsThere is an opportunity to re‐think how public mental health interventions are designed, evaluated and implemented. Deliberate design, encompassing careful consideration of the aims and population‐level impacts of interventions, complemented by measurement that embraces complexity through more in‐depth characterisation, or ‘phenotyping’, of interpersonal and environmental elements is needed. Opportunities to improve child and adolescent mental health outcomes are gaining unprecedented momentum. Innovative new methodology, heightened public awareness, institutional interest and supportive funding can enable enhanced study of public mental health that does not shy away from complexity.

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Variation in spend on young mental health across Clinical Commissioning Groups in England: a cross-sectional observational study

Cited by 7 publications

References 19 publications

Incidence and prevalence of primary care antidepressant prescribing in children and young people in England, 1998–2017: A population-based cohort study

Incidence and prevalence of primary care antidepressant prescribing in children and young people in England, 1998–2017: A population-based cohort study

How does reorganisation in child and adolescent mental health services affect access to services? An observational study of two services in England

Current evidence and opportunities in child and adolescent public mental health: a research review

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