Analytics and Modellinghttp://hdl.handle.net/20.500.12904/161252024-03-28T18:38:08Z2024-03-28T18:38:08ZInequities in children and young people’s mental health servicesHood, AndyMulla, AbedaCallaghan, DavidWard, Richardhttp://hdl.handle.net/20.500.12904/164632023-03-16T02:43:02Z2021-07-01T00:00:00ZInequities in children and young people’s mental health services
Hood, Andy; Mulla, Abeda; Callaghan, David; Ward, Richard
Good mental health during early years and childhood has a great bearing on health throughout life. By contrast, poor mental health can cast a long shadow. Consequences may include depression, self-harm, and poor physical health. Services recognise this. They aim to provide access to support in a timely and suitable way. A national target has been set, namely that 35% of children and young people with diagnosable needs should be able to access the necessary services. But there is some way to go. There has been an increasing focus on young people’s mental health, which appears to be poor relative to comparable nations and the recent past. So, to gain a clearer sense of need, and patterns of access to services, the Strategy Unit has undertaken specific analysis for the 11 Integrated Care Systems (ICSs) in the Midlands. This is another significant analytical project for the Midlands Decision Support Network. The ICS have further evidence to understand and address the problems in their area. Our findings 1. Services are struggling to keep pace with existing demand In the Midlands there are an estimated 350,000 children and young people with a range of mental health needs. At present, only 43,000 of these are receiving some kind of specialist support. Identifying the children and young people who most need support is difficult, with health and care professionals finding it increasingly challenging to reach those concerned. When they do, there is simply not enough support available. For example, our research found that only 2% of the estimated 160,000 children and young people in the Midlands with eating disorders are finding their way to specialist support. 2. There is wide variation in access to services in the region Even the better-performing areas are only able to provide the necessary support to 30% of those who need it. Children and young people who are Black / socially deprived / aged 18 to 24 / have learning disabilities or autism, tend to struggle more with accessing appropriate support. Health and care professionals suspect that services are not being provided equitably, but current data doesn’t provide clear enough evidence of this. 3. Access targets are a necessary focus, but there needs to be more meaningful analysis on who is, and who should be, using existing services ICSs need to measure what they are proposing to change. Without the correct data and subsequent analysis, this will prove almost impossible. 4. Routes into and through services need to be clearer Those that need support often don’t know how to access it. Health and care professionals acknowledge that those better able to navigate the complex services, for example through parental advocacy, tend to have an advantage in accessing support. 5. Children and young people should be involved in improving services There is limited involvement of young people in improving services. Mental health and care professionals also want this to happen more. Conclusions There is no single or quick fix to the problems highlighted in the research. Evidence suggests that the pandemic will have placed an even greater strain on already stretched services. Children and young people, as well as professionals, deserve these services to be given far greater priority, as well as improved resources. Especially at a time of stretched resources, ‘fixes’ on this scale are not straightforward. This is a long-term, cross-societal challenge: how much do we value young people’s mental health? This question is well outside the scope of our work. So we have focused our recommendations on more achievable improvements that are within current services’ control. They are to: Collect better data and use it Services could improve data collection around aspects of inequity and access. Greater precision is needed. Datasets in primary care, education, social care, criminal justice, and specialist services could all be linked. All data should be disaggregated by gender and ethnicity. Services could consider an investment in analysis and learning from the data, as well as needs assessments. Measure, monitor and maintain All new initiatives and interventions should be robustly evaluated, for equity as well as efficacy. It is essential that we all learn what works in what circumstances and that it is shared systematically. Establishing a serious learning system will inform the development and adaptation of promising service improvements; it will also provide evidence to stop any services that are not working and allow resources to be redirected. Co-design and co-produce Children and young people deserve to be meaningfully involved in their services, and their voices should be heard. A rollout of targeted engagement programmes would provide a way of reaching them. The detail: The full report is here. The evidence map is here. A webinar exploring findings can be viewed here. ICS level data on unmet needs and pathway inequalities are listed below:
2021-07-01T00:00:00ZAccessibility of perinatal mental health services for women from Ethnic Minority groupsParsons, Jakehttp://hdl.handle.net/20.500.12904/164382023-03-15T01:38:51Z2020-09-01T00:00:00ZAccessibility of perinatal mental health services for women from Ethnic Minority groups
Parsons, Jake
Mental illness is common during pregnancy and first postnatal year (perinatal period), and up to 20% of women experience a wide range of mental health conditions. Barriers to accessing mental health care during pregnancy and the first postnatal year (perinatal period) seem to be greater for ethnic minority women. As a consequence of these barriers, mental illness during the peri-natal period frequently remains untreated. This can have a significant negative impact on the health of the mother and the health of their children, on her partner and the wider family and on the society as a whole. The Strategy Unit was commissioned to collaborate with Birmingham and Solihull Mental Health Trust and East London Foundation Trust on an NIHR funded research project “Accessibility and acceptability of perinatal mental health services for women from Ethnic Minority groups”. Our role was to provide analytical support to phase 1 of the study which aimed to explore access rates to secondary mental health services and patterns of engagement with these services for women from ethnic minority groups in the perinatal period in England. The analysis used national patient level linked inpatient and mental health datasets. Large and statistically significant differences were found in access to both community mental health services and psychiatric inpatient care. In particular Black African and Asian women (all sub-groups) had much lower rates of access to community mental health services. The study also found that higher proportions of admissions for Black African and Asian women were involuntary. The study concluded that access to community mental health services should be facilitated for these groups which may help to reduce the level of involuntary admissions. The results of this work have been published in the peer reviewed journal BMC Medicine.
2020-09-01T00:00:00ZChanges in Dementia Incidence, Prevalence, Severity and MortalityHood, Andyhttp://hdl.handle.net/20.500.12904/164202023-03-14T01:41:22Z2017-09-01T00:00:00ZChanges in Dementia Incidence, Prevalence, Severity and Mortality
Hood, Andy
Dementia is a key priority for NHS England and is estimated to affect around 676,000 people in the country. Our analysis is intended to help understand the need for future dementia diagnosis and treatment services in a specific area and to help commissioners to identify and prioritise interventions.
2017-09-01T00:00:00ZHealth service use in the last two years of lifeWiltshire, JustineBattye, FraserWyatt, StevenSpilsbury, Peterhttp://hdl.handle.net/20.500.12904/164162023-03-13T14:18:31Z2020-10-01T00:00:00ZHealth service use in the last two years of life
Wiltshire, Justine; Battye, Fraser; Wyatt, Steven; Spilsbury, Peter
Health and care services get just one opportunity to support people at the end of their life. When this support is compassionate and appropriate, unnecessary suffering can be avoided and grieving can be eased. When this is not the case, harm and distress can result. The difference in these experiences can be profound. Providing the best possible end of life care, within the limited resources available, is not a simple task. It requires a dispassionate assessment of the current situation; it demands detailed insight into the local population; and it needs the perspectives of professionals and the people they serve. Good care is founded on the intelligent use of this information. The Strategy Unit has produced a series of reports that describe the health services that patients use in the last 2 years of their lives. Reports are available for the Midlands region as a whole and for each of the 11 Sustainability and Transformation Partnerships (STP) or Integrated Care Systems in the region. The reports contain important insights into the services that patients use, how the patterns of service use change as patients approach death, differences in experience by ethnicity, deprivation and cause of death the costs of hospital treatment at the end of life and how this varies by STP levels of non-beneficial treatments the additional hospital capacity that may be required to accommodate the projected increase in deaths over the next decade These reports present a detailed account of ‘what is’. Moving on from this and deciding ‘what ought to be’ is a more complex undertaking. It involves professional judgement, evidence and clinical standards. But it also involves personal preference, values and cultural differences. Combining such diverse perspectives requires care, humanity, and skill.
2020-10-01T00:00:00Z