Mental Health-related School Provision and Hospital Contacts among Pupils enrolled in Alternative Provision

Background. Pupils enrolled in Alternative Provision (AP) represent a highly vulnerable population, with heightened mental health need at risk of long-term educational disengagement. Examining AP enrolment in relation to mental health-related school support and hospital contacts may inform early intervention and prevention approaches to address unmet mental health need. Methods. We analysed population-level linked school and hospital administrative data for 1.7m pupils (born 2000-2002) who attended state schools in England. We examined differences by racial-ethnic group and gender in rates and timing of AP enrolment and recording patterns of mental health-related provision and hospital contacts among pupils with AP enrolment. Results. A majority (62.4%) of pupils with AP enrolment had recorded mental health need, highest among Mixed White-Black Caribbean pupils (74.0%). Among those in AP, 52.0% of girls with a mental health-related hospital contact had school provision, compared to 67.3% boys. For some racial-ethnic groups, schools appeared less likely to record need evident in hospital records; 17.5% boys and 36.2% girls from Mixed White-Asian backgrounds enrolled in AP had mental health-related hospital contact without school provision. Conclusion. Among pupils enrolled in AP, documented mental health need is high but unevenly recorded across systems, with inequalities by racial-ethnic group and gender.