Background Research suggests that children known to social services experience a higher prevalence of mental ill-health compared to their peers. However, previous studies have been limited based on sample sizes, comparison populations and level of detail around care interventions. Northern Ireland (NI) is unique as it has an integrated health and social care system holding data centrally on all individuals known to social services, allowing for a population wide examination of the mental health of children involved with social services and those never known. The aim of this project was to examine mental ill-health amongst a cohort of all children aged 18 years and under based on care exposure including Looked After Children (LAC) placed in foster/kinship/residential care, Children in Need (CIN) known to social services but not removed from home and those never known.
Methods This data linkage study linked population-wide primary care registration data to children’s social care records, prescribed medication data and hospital records. Data were used to determine the period prevalence of mental ill-health in 2015 defined by receipt of psychotropic medication, psychiatric hospital admission and/or presentation to Emergency Department for self-harm. Logistic regression quantified the likelihood of each mental health outcome with adjustment for factors associated with mental ill-health and self-harm.
Results The cohort consisted of 535,801 children aged 18 years or less in NI during 2015. Over 1 in 6 (17.6%, n=94,232) were previously or currently known to social services. There was a clear stepwise association between level of interaction with social services and mental ill-health. Compared to children never known to social services LAC were nearly 9 times more likely to be in receipt of antidepressants (OR=8.93, 95%CI 7.06, 11.29), 10 times more likely to be in receipt of anxiolytics (OR=10.06 95%CI 7.28, 13.92) and over 40 times more likely to be receipt of antipsychotics (OR=42.59, 95%CI 32.85, 55.23). Likelihood of presenting with self-harm and psychiatric hospital admission were also significantly higher in LAC (OR=24.42, 95%CI 17.16, 34.73 and OR=86.26, 95%CI 42.58, 174.75 respectively).
Conclusion Children known to social services have poorer mental health compared to those not known. The relationship is graded, with prevalence lowest for those never known, higher for children known as CIN, and highest for LAC. Additional analysis is underway exploring variations in mental health based on care pathways and reason known to social services.
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