Inequalities in referral pathways for young people accessing secondary mental health services in south east London

Zoe Chui,Johnny Downs,Rebecca Rhead,Billy Gazard,Stephani L Hatch,Hannah Harwood,Catherine Polling,Ioannis Bakolis,Shirlee Maccrimmon

doi:10.1007/s00787-020-01603-7

Abstract

Differences in health service use between ethnic groups have been well documented, but little research has been conducted on inequalities in access to mental health services among young people. This study examines inequalities in pathways into care by ethnicity and migration status in 12–29 years old accessing health services in south east London. This study analyses anonymized electronic patient record data for patients aged 12–29 referred to a south east London mental health trust between 2008 and 2016 for an anxiety or non-psychotic depressive disorder (n = 18,931). Multinomial regression was used to examine associations between ethnicity, migration status, and both referral source and destination, stratified by age group. Young people in the Black African ethnic group were more likely to be referred from secondary health or social/criminal justice services compared to those in the White British ethnic group; the effect was most pronounced for those aged 16–17 years. Young people in the Black African ethnic group were also significantly more likely to be referred to inpatient and emergency services compared to those in the White British ethnic group. Black individuals living in south east London, particularly those who identify as Black African, are referred to mental health services via more adverse pathways than White individuals. Our findings suggest that inequalities in referral destination may be perpetuated by inequalities generated at the point of access.

Highlights

In the UK, child and adolescent mental health services (CAMHS) are available for children and young people up to their 18th birthday; and adult mental health services (AMHS) provide specialist care for those aged 18 and over
Regarding the association between referral source and referral destination, we found that those referred from secondary health services were significantly more likely to be referred to inpatient than outpatient services compared to those referred from general practitioner (GP)
The present study found that those who identified as Black African were more likely than those who identified as White British to be referred from secondary health or social/criminal justice services compared to GP, and the effect was most pronounced for those aged 16–17 years, with a sevenfold and sixfold increase in odds for the Black African and Black British groups, respectively

Summary

Introduction

In the UK, child and adolescent mental health services (CAMHS) are available for children and young people up to their 18th birthday; and adult mental health services (AMHS) provide specialist care for those aged 18 and over. Ages 16–17 are a vulnerable time when the young person is more susceptible to mental illness due to physiological changes and making important decisions about education, employment, housing, and relationships [3] Despite their vulnerabilities, young people significantly underutilize mental health services, with ethnic minority groups having the greatest unmet need in both the UK and the US [4,5,6,7,8]. Findings are mixed and there is a dearth of UK studies examining referrals to outpatient, inpatient, and emergency services among ethnic minority youth, especially for those aged 16–17 who are at risk of being lost in the service provision gap between child and adult mental health services [19,20,21,22]. Studies that have examined access to mental health services, primarily conducted in the US, found that ethnic minority youth were less likely to have received a diagnosis or treatment for mental health problems compared with White adolescents [27]

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