{
  "abstract": "Background Rates of mental health difficulties and use of mental health services among adolescents have increased in the last decade. Understanding patterns of this service use is a vital step to ensuring equity in access. We described referrals to mental health services amongst secondary school pupils in England, by social strata.Methods We used linked administrative educational-health records from Education and Child Health Insights from Linked Data (ECHILD). We created a national cohort of pupils in Year 7 of state-funded school (age 11 years at entry) from 2012/13 to 2021/22. Social strata, indicated by gender, racial-ethnic group, free school meal (FSM) eligibility, the index of multiple deprivation (IMD) and region of residence were measured at Year 7. Referrals to mental health services were captured by records in the mental health services dataset. Pupils were followed up until the first chronological event of: a referral, death or end of study (31st August 2022).Results Of 5,649,051 pupils,18.3% (1,033,186) had ≥1 referral to mental health services recorded during follow up, a rate of 47.9 per 1000 person-years (95% confidence interval 47.9–48.0). Females had higher than average rates of referrals than males (57.5, 57.4–57.7), which peaked at age 15 years. Rates of referrals in males (39.1, 39.0–39.2) peaked at age 11 years. White Irish Traveller (75.5, 70.7–80.5) and Mixed Black Caribbean and White (69.1, 68.2–70.0) pupils had the highest rates within racial-ethnic groups, whereas pupils from all Asian groups had the lowest rates (21.2, 21.0–21.3). Pupils with FSM eligibility (80.4, 80.1, 80.7) had double the rates compared to those not FSM eligible (41.9, 41.8, 42.0), and a socioeconomic gradient was present by IMD group. Within region of residence, rates were highest in the North-East (61.9, CI 61.5, 62.4) and lowest in London (39.5, 39.3, 39.7).Conclusion We present the first national estimates of referrals to mental health services within a school cohort, finding that almost one fifth of pupils were referred. We find stark variation in referral rates to mental health services by social strata. To explore the extent of inequities in access, we will triangulate evidence with the Born in Bradford cohort. We will describe mental health-related contacts across multiple services and estimate contact rates after adjustment for baseline assessments of emotional and behavioural difficulties.",
  "authors": [
    {
      "affiliations": [
        "Great Ormond Street Institute of Child Health, University College London, London, UK"
      ],
      "name": "Kate Lewis"
    },
    {
      "affiliations": [
        "Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK"
      ],
      "name": "Helen Dale"
    },
    {
      "affiliations": [
        "Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK"
      ],
      "name": "Dan Lewer"
    },
    {
      "affiliations": [
        "Great Ormond Street Institute of Child Health, University College London, London, UK"
      ],
      "name": "Ruth Blackburn"
    }
  ],
  "title": "OP11 Referrals to mental health services among adolescents in England by social strata: secondary school cohort study, 2012 to 2021",
  "uid": "40d8bfe8-415c-525e-926b-283650aa2083"
}