Widening educational inequalities for young people attending child and adolescent mental health services: a longitudinal cohort study

BACKGROUND: A 'mortality gap' is well-documented in individuals with severe mental illness but an 'education gap' emerges much earlier in life, with major long-term consequences. While educational attainment has improved in most high-income countries in recent decades, it is unknown whether these improvements have narrowed the education gap for young people who attend child and adolescent mental health services (CAMHS). METHODS: This nationwide, longitudinal cohort study used linked administrative data from the Secure Anonymised Information Linkage (SAIL) databank for a large cohort of individuals in Wales born between 1992 and 2003 and followed to 2019. We compared performance on the General Certificate of Secondary Education (GCSE) exams, taken at age 16, between young people with and without prior CAMHS contact. We divided the population into two sequential birth cohorts (1992-1997 vs 1998-2003) and tested whether the association between CAMHS contact and failure to achieve key GCSE thresholds changed over time. RESULTS: In the total population, the proportion of young people failing to achieve the basic GCSE level one threshold fell from 6.9% in the older (1992-1997) cohort to 3.7% in the younger (1998-2003) cohort. Young people who attended CAMHS, however, were significantly more likely to fail to achieve level one GCSEs in both cohorts (aOR = 4.28, 95% CI = 4.08, 4.48). Critically, this gap widened over time for GCSE Level-1 attainment, both for CAMHS outpatients (interaction aOR = 1.30, 95% CI = 1.20, 1.40) and CAMHS inpatients (interaction aOR = 1.80, 95% CI = 1.47, 2.19). CONCLUSIONS: Despite overall improvements in educational attainment in the general population, there is a growing gap in educational attainment between young people accessing CAMHS and their peers. The failure to attain basic qualifications may lead to lifelong socioeconomic disadvantage. Research on how to effectively address the educational needs of young people attending CAMHS is an urgent economic and public health issue.