Title: Understanding time trends in child and adolescent mental health and the implications for service planning
Funder: Department of Health and Social Care

Abstract: Psychopathology in children and adolescents has a significant impact in terms of economic and social costs, and lost potential. The UK has seen a trend of rising referrals to child and adolescent mental health services as well as an increase in mental health related emergency attendances. However, up-to-date epidemiological data to assess trends in psychopathology in relation to service contact on a population level has been lacking until now. In particular, despite the trend of rising demand for services, there are currently no mandated national datasets available on mental health related contact with services that are available in conjunction with individual level data on psychopathology and socio-economic status. This means that there is a gap in knowledge about trends in service contact in relation to need, and about the evidence for any changes in inequalities of access. Reports also indicate that policy-makers and commissioners are actively hampered in decision making and planning by a lack of data regarding trends and projected changes in prevalence. With the release of the latest 2017 national survey data, this Fellowship represents a new and timely opportunity to study trends using data from the three national child mental health surveys (1999, 2004, 2017), which included identical measures of psychopathology over an 18 year period. In particular, the Fellowship will examine trends in mental health-related service contact in relation to need, exploring contacts not only with specialist services but also with education and primary care, especially significant given the current emphasis on the school's role in mental health. Fellowship aims and methods The two main aims of my research are: 1. To examine trends in psychopathology, impact of psychopathology, and mental health related service contact in children and young people using national survey data 2. To explore the use of such trend data in modelling projections of prevalence and future levels of mental health related service contact This research will include time trends analysis of previously collected data from the national surveys. In collaboration with the survey team, we will also collect three year follow-up data from 2017 participants on psychopathology and mental health related service contact. This will add further value by providing more powerful, detailed and complete estimates of mental health related contacts. The second part of the programme will use insights from commissioners (from qualitative and stakeholder work) along with the trend data to develop models projecting future prevalence of psychopathology and service contact. This work will involve collaborations with Public Health England and modelling specialists. Impact My Fellowship will have an impact on policy and commissioning by contributing to impact assessments, economic and intervention modelling, policy development, and service planning at national and local levels. The findings can help direct funding to address inequalities, workforce planning and training across public sector services as well as target research into prevention and service access. In the longer-term, this Fellowship aims to contribute to better child and adolescent mental health by informing efforts to improve access to the right services at the right time.

Lay abstract: The main aim of this Fellowship is to study trends over time in mental health difficulties in children and young people and whether they are becoming more or less likely to have contact with different services about their mental health. I will then use this information to forecast how many children might have mental health problems and need services in the future. We know that there has been a trend of rising referrals to child and adolescent mental health services and in the numbers of young people attending emergency departments for self- harm. However, there have also been changes in awareness and recognition of mental health problems, meaning that it is not clear whether and to what extent this is due to an actual increase in the numbers of children and young people experiencing difficulties. This research is especially relevant now as the report from the 2017 national survey of children and young people's mental health has just been released, meaning that the detailed data behind the report will soon be available to help answer these questions. In this Fellowship I aim to answer the following questions: Has there been a 'real terms' increase in children and young people with mental health problems and has the mental health of particular groups got worse over time? (e.g. in those from poorer backgrounds) Have there been changes in the ways that mental health problems affect young people? (e.g. in the impact on them or their families) Is there any evidence that economic problems or other factors are linked to any increase? Are children with problems becoming more or less likely to be in contact with sources of help and support? Can we forecast how many children and young people might have mental health problems and need services in the future?I will use data from the three national population surveys of children and young people from 1999, 2004 and 2017, which used the same measures to assess mental health difficulties. I will also work with the national survey team to follow-up children and young people who took part in the 2017 survey. In 2020, we will collect more information about their difficulties and about the types of help and support they are getting (if any). This will be the most recent and complete available information about the mental health of children and young people and the services they use. I will use the data to predict how many young people might have a mental health problem in the future, and what services they might need. Working with Public Health England, I will produce tools which will help services to plan ahead and improve access for families to the right support at the right time. The results will also help services to identify groups of children who are more at risk of developing mental health problems, potentially leading to earlier identification and treatment. By investigating why mental health problems could have increased, this Fellowship will also identify factors for further study by other researchers, which in the long term could help prevent problems from occurring. A Panel of young people will advise on this research programme and on what the findings mean to them, and will co-produce materials aimed at young people and their families, such as articles, and an animated video of the findings. I will also involve service planners and clinicians in the design of this research. We will work with mental health charities, the media, and Public Health England to make sure that the messages from this research reach national planners and policy-makers.

Research activity codes: 4.4 POPULATION SCREENING;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH