Abstract
This study examined the influence of stigma, psychopathology, and sociodemographic characteristics on mental health-related service use and costs related to service use in a cohort of young people in the UK. Using data from a community sample of young people aged 9–17 years and their caregivers, we assessed 407 young people’s use of services due to mental health problems, young people’s psychopathology, demographic characteristics, maternal education and caregivers’ stigma-related beliefs. Unit costs related to services were gathered from national annual compendia and other widely used sources. We assessed predictors of service use through logistic regression analysis and developed generalised linear models to identify factors associated with costs of mental health-related service utilisation. Persistent psychopathology, socioeconomic disadvantage, and low caregiver intended stigma-related behaviour were associated with increased likelihood of service use among young people. Older age and socioeconomic disadvantage were associated with increased costs. Different factors influenced contact with services and the cost associated with their use — persistent psychopathology and socioeconomic disadvantage increased, and caregivers’ intended stigma-related behaviour decreased the likelihood of using services, whereas socioeconomic disadvantage and older age were associated with increased costs. Social determinants of mental health problems play an important role in the use and costs of different types of mental health-related services for young people. Discordance between drivers of service use and costs implies that young people who are more likely to access services due to mental health problems do not necessarily receive care at the intensity they need.
Highlights
Mental health problems affect a significant proportion of children and adolescents worldwide [1]
According to a report from Children’s Commissioner [3], only “a small fraction of those who need help” in the United Kingdom (UK) accessed child and adolescent mental health services (CAMHS) in that same year: of the 338,000 children referred to CAMHS in 2017, 31% received treatment, 37% were denied treatment or discharged after the first assessment and 32% remained on waiting lists at least until the end of the year
Just one in five young people used any services due to mental health problems in the past 12 months, and the mean annual cost per participant who used services was nearly £ 2,400 — we provide details on the proportion of young people using each service included in our assessment, frequency of use, unit costs and mean annual costs for each service and by sector in Supplemental Table 1
Summary
Mental health problems affect a significant proportion of children and adolescents worldwide [1]. In England, estimates from 2017 indicated that around one in eight children and young people had a mental disorder [2] This survey reported that two-thirds of children and adolescents with mental disorders used services in the past year, a closer look at the data shows that a significant proportion of young people with mental health problems do not receive the care they need. Given that a high proportion of young people do not have access to mental health care, it is important to understand the factors that hinder their access to services. Considering that children comprise 20% of the population, but only 9% of the overall mental health budget is invested in CAMHS, the Children’s Commissioner [3] estimated that an additional £1.7 billion per year is needed just to achieve parity between child and adult services provision. It is crucial to understand which factors are associated with access to care and costs of using services
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