Investigating inequalities in children and young people’s mental healthcare and outcomes: prospective longitudinal analysis from the STADIA trial

Br J Psychiatry. 2026 Apr 27:1-10. doi: 10.1192/bjp.2026.10617. Online ahead of print.

ABSTRACT

BACKGROUND: Many children and young people (CYP) with significant mental health difficulties face barriers to accessing care from mental health services, impacting their clinical outcomes and recovery. Sociodemographic and socioeconomic factors may contribute to inequalities in access and outcomes.

AIMS: To investigate the roles of sociodemographic, socioeconomic and clinical factors in influencing access to services, receipt of clinical care or diagnoses and clinical outcomes.

METHOD: Using data from a large, nationally representative, randomised controlled trial in England (STADIA), 1225 children aged 5-17 years and with emotional difficulties referred to child and adolescent mental health services (CAMHS) were followed up over 18 months post-referral to investigate predictors of referral acceptance, receipt of care and their clinical outcomes.

RESULTS: Older CYP (for each 1-year increase in age, odds ratio 1.07, 95% CI: 1.02, 1.11) and those living in the least deprived neighbourhoods (deprivation index, least versus most deprived quintile: odds ratio 1.60, 95% CI: 1.05, 2.43) were more likely to have their referral accepted by CAMHS. Clinical severity (i.e. scoring above cut-off for symptoms and/or impact) was not associated with receipt of a clinical diagnosis or treatment/intervention. At 12-month post-referral, 61% met mental health ‘caseness’ criteria (v. 67% at baseline). CYP living in less deprived neighbourhoods had better clinical outcomes at 12-month follow-up (least versus most deprived quintile: odds ratio 0.49, 95% CI: 0.30, 0.81, for meeting caseness criteria, i.e. the presence of clinically significant symptoms and impairment). Females were more likely than males to have clinically significant levels of depression at 12-month follow-up (odds ratio 1.77, 95% CI: 1.28, 2.45).

CONCLUSIONS: There appear to be sociodemographic and socioeconomic inequalities in access to care and outcomes for clinically referred CYP with emotional mental health difficulties, with limited improvements in clinical outcomes 1 year following referral to CAMHS. CYP living in more deprived areas and younger children appear less likely to receive help, hampering earlier intervention efforts even in help-seeking populations.

PMID:42037085 | DOI:10.1192/bjp.2026.10617