Investigating inequalities in children and young people's mental health care and outcomes: prospective longitudinal analysis from the 'STADIA' trial

Background: Many children and young people (CYP) with significant mental health difficulties face barriers with accessing care from mental health services, impacting their clinical outcomes and recovery. Socio-demographic and socio-economic factors may contribute to inequalities in access and outcomes.Aims: To investigate the roles of socio-demographic, socio-economic and clinical factors in influencing access to services, receipt of clinical care or diagnoses, and clinical outcomes.Method: Using data from a large nationally representative randomised controlled trial in England (‘STADIA’), 1,225 5-17-year-olds with emotional difficulties referred to child and adolescent mental health services (CAMHS) were followed up over 18 months post-referral to investigate predictors of referral acceptance, receipt of care and their clinical outcomes.Results: Older CYP (for each 1-year increase in age: odds ratio (OR) 1.07, 95% confidence interval (CI) 1.02, 1.11) and those living in the least deprived neighbourhoods (deprivation index, least vs. most deprived quintile: OR 1.60, 95% CI: 1.05, 2.43) were more likely to have their referral accepted by CAMHS. Clinical severity (i.e. scoring above cut-off for symptoms and/or impact) was not associated with receipt of a clinical diagnosis or treatment/intervention. At 12-months post-referral, 61% met mental health ‘caseness’ criteria (vs. 67% at baseline). CYP living in less deprived neighbourhoods had better clinical outcomes at 12-months follow-up (least vs. most deprived quintile: OR 0.49, 95% CI: 0.30, 0.81, for meeting ‘caseness’ criteria i.e. the presence of clinically significant symptoms and impairment). Females were more likely than males to have clinically significant levels of depression at 12-months follow-up (OR 1.77, 95% CI: 1.28, 2.45).Conclusions: There appear to be socio-demographic and socio-economic inequalities in access to care and outcomes for clinically-referred CYP with emotional mental health difficulties, with limited improvements in clinical outcomes one year after being referred to CAMHS. CYP living in more deprived areas and younger children (aged <11 years) appear less likely to receive help, hampering earlier intervention efforts even in help-seeking populations.