Evaluation report
An audit looking at the impact of poverty on referrals to child and adolescent mental health services
Nourbakhsh A, Joshi K, Yorston B ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This audit examined how poverty affects referrals to child and adolescent mental health services in Scotland. Researchers analyzed 15 months of referral data from NHS Grampian CAMHS using deprivation indices to identify disparities. Young people from the most deprived areas were referred more often but had higher rejection rates, were three times more likely to need tier 4 (intensive) care, and had higher rates of medication use. The findings suggest that health inequalities in deprived communities affect both access to and type of mental health care received.
Key points
- Young people from the most deprived areas (decile one) had higher referral rates (3.19%) compared to least deprived areas (decile ten: 1.74%)
- Referrals from most deprived areas were rejected at higher rates (33% in decile one versus 21% in decile ten)
- Young people from most deprived areas were 3 times more likely to require tier 4 (high intensity) care compared to their proportion of the population
- Medication intervention rates were significantly higher for young people from the most deprived areas
- Health inequalities in deprived communities appear to impact both acceptance of referrals and type of service provision
Limitations
The audit is descriptive and analyzes routinely collected service data without a control group or experimental design; it cannot determine causation or the underlying reasons for the observed disparities in referrals and service provision.
Abstract
Aims Recently, there has been a greater focus on how mental health in young people (YP) can be improved. Up to 10% of YP in Scotland have a diagnosable mental health condition1 and half of all adults with mental ill-health have had symptoms from their mid-teens2. Poverty is an important factor associated with poorer mental well-being from an early age which worsens if left untreated3. The aim of this audit was to answer the question: Are more YP referred from the least deprived areas, and are they more likely to require medication intervention or high intensity (tier 4) care? The results of which could help identify possible avenues for intervention to help improve retention of those most at risk of negative outcomes. Method NHS Grampian CAMHS provides service to Aberdeen City, Aberdeenshire, and Moray. Pre-collected data over 15 months from these areas were analysed using the Scottish Index of Multiple Deprivation (SIMD) deciles to distinguish any differences between referrals made. In addition, this audit evaluated the data to define any trends of deprivation linking YP to medication intervention or tier 4 care. Result Results showed that more referrals were made for YP in low-ranking areas (3.19% of decile one compared to 1.74% of decile ten). The referrals were also more likely to be rejected based on the referral criteria, 33% in decile one versus 21% in decile ten. The increased rejection of referrals is most likely a reflection of the health inequalities faced by communities in more deprived areas. In terms of service provision, the patients from the most deprived areas are 3 times more like to require tier 4 care while the least deprived are 1.5 times more likely as compared to percentage of population. With regards to medication intervention patients from deciles one, five, six and seven have significantly higher numbers. Conclusion This project set out to look at the current service provided by CAMHS and found that despite best efforts deprivation has had an impact on the acceptance of referrals. Going forward this data will be shared with multiagency stakeholders to develop service provisions, in particular the issues identified with the rejection of referrals in more deprived areas. Higher level of medication use in more deprived population is not unexpected but highlights the need to share the findings with a multiagency network.