Mental health contacts and referrals of children and young people in England, 2016-2021: an epidemiological study, and comparison of young people who have received protective and care interventions and their peers

Background: In England, 18% of children and young people (CYP) experience clinical levels of mental health difficulties. CYP who are involved in children’s social care, either receiving in-home care (i.e., child protection plans; CPP) or out-of-home care (i.e., children looked after; CLA), may be particularly vulnerable. Less is known about actual contacts with mental health services. This study aimed to provide an account of the contacts with mental health services for children with and without CPP and CLA, and reasons for referral. Methods: Data were extracted from NHS Digital for all CYP in England in contact (e.g., through referral, appointment, support) with mental health services between April 2016 and March 2021, and included sociodemographic information, CPP or CLA status, and referral reason. Results: 1,984,827 CYP were in contact with mental health services. The most common referral reasons were anxiety (13%), “in crisis” (10%), and depression (7%). Contacts tended to increase each year for all groups. Overall CPP and CLA were between 2-3 times more likely to be in contact with mental health services compared to peers. However, this represented between 9-18% of CPP and CLA. Conclusion: The findings suggest that there are wide discrepancies between mental health need and contacts with services. CPP and CLA have particularly high levels of unmet need. While these data indicate escalating demand, service contacts have not increased significantly, suggesting an increased threshold for access in a stretched clinical service.