Abstract
BackgroundIn the Swedish society, as in many other societies, many children and adolescents with mental health problems do not receive the help they need. As the Swedish society becomes increasingly multicultural, and as ethnic and economic residential segregation become more pronounced, this study utilises ethnicity and neighbourhood context to examine referral pathways to child and adolescent psychiatric (CAP) clinics.MethodsThe analysis examines four different sources of referrals: family referrals, social/legal agency referrals, school referrals and health/mental health referrals. The referrals of 2054 children aged 11-19 from the Stockholm Child-Psychiatric Database were studied using multilevel logistic regression analyses.ResultsResults indicate that ethnicity played an important role in how children and adolescents were referred to CAP-clinics. Family referrals were more common among children and adolescents with a Swedish background than among those with an immigrant background. Referrals by social/legal agencies were more common among children and adolescents with African and Asian backgrounds. Children with Asian or South American backgrounds were more likely to have been referred by schools or by the health/mental health care sector. A significant neighbourhood effect was found in relation to family referrals. Children and adolescents from neighbourhoods with low levels of socioeconomic deprivation were more likely to be referred to CAP-clinics by their families in comparison to children from other neighbourhoods. Such differences were not found in relation in relation to the other sources of referral.ConclusionsThis article reports findings that can be an important first step toward increasing knowledge on reasons behind differential referral rates and uptake of psychiatric care in an ethnically diverse Swedish sample. These findings have implications for the design and evaluation of community mental health outreach programs and should be considered when developing measures and strategies intended to reach and help children with mental health problems. This might involve providing information about the availability and accessibility of health care for children and adolescents with mental health problems to families in certain neighbourhoods and with different ethnic backgrounds.
Highlights
In the Swedish society, as in many other societies, many children and adolescents with mental health problems do not receive the help they need
The child and adolescent psychiatric (CAP)-system comprises the county of Stockholm’s outpatient child psychiatric guidance clinics for children and adolescents up to the age of 20. These clinics maintain a computerised system for patient statistics based on structured information that is gathered in relation to each child who attends a CAPclinic
This study has addressed the question of how children and adolescents are referred to CAP-clinics, and whether referral patterns vary by ethnicity and neighbourhood of residence
Summary
In the Swedish society, as in many other societies, many children and adolescents with mental health problems do not receive the help they need. Since the late 1920s and using the Health Registers in Sweden, cohorts of child and adolescent psychiatric (CAP) patients have been described and followed over different periods of time up to 30 years[1,2,3,4]. These studies have given information regarding the characteristics. As the Swedish society, like that of most other Western European countries, becomes increasingly multicultural, and as residential segregation, economic as well as ethnic, becomes more pronounced, the challenge of meeting children’s and adolescents’ mental health needs requires us to focus more attention on the issues of ethnicity and residential neighbourhood. Less is known about how ethnicity and neighbourhood characteristics affect the way children and adolescents come into contact with mental healthcare services
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