Understanding the relationship between mental healthcare provision

Understanding the relationship between mental healthcare provision and outcomes for children with mental health problems in the context of chronic illness

Background:
Young people with physical illness are at a significantly greater risk of developing mental health disorders than the general population (Blackman, Gurka, Gurka, & Oliver, 2011). These difficulties not only impact the child and family and can impair friendships and school attendance but can also negatively impact the management and course of the physical illness and incur significant costs to health services. For example, between 12% and 18% of all National Health Service (NHS) expenditure on long-term conditions is linked to poor mental health – most commonly in the form depression and anxiety disorders (Naylor, 2012). In the USA, population studies have shown a trend of increased number, duration and cost of admission to children’s hospitals, if the patient has an additional psychiatric disorder (Zima et al., 2016). Mental health provision for children who also have a chronic illness varies according to the physical health condition. For example, there may be integrated provision from within paediatric clinics, referrals to internal paediatric psychology services, or referral to external child and adolescent mental health services (CAMHS). However, there is little data to demonstrate the most effective model for the treatment of mental health problems in the context of childhood illness.

Aims/Objectives:
This study will examine the extent to which different models of mental health provision are associated with mental and physical health outcomes for children with chronic illness. The overall objective is to inform UK mental health policy for children and young people with chronic physical illnesses.

Methods:
Working with advice and guidance from colleagues at the Royal College of Paediatrics and Child Health, the student will investigate the perceived importance, advantages and disadvantages of different models of mental health provision through surveys and focus groups of children and young people, parents and carers and mental and physical healthcare professionals.  They will then analyse longitudinal datasets of national audits including Epilepsy 12 (https://www.rcpch.ac.uk/work-we-do/quality-improvement-patient-safety/epilepsy12-audit) and the National Paediatric Diabetes Audit (NPDA; https://www.rcpch.ac.uk/work-we-do/quality-improvement-patient-safety/national-paediatric-diabetes-audit). This will be followed by a significant dissemination/policy component informed by implementation science.

Timeline:
Year 1: training in statistical analysis; development of Statistical Analysis Plan; ethics
Year 2: focus groups and analysis; data cleaning and database preparation
Year 3: analysis; dissemination

References:
1.  Blackman, J. A., Gurka, M. J., Gurka, K. K., & Oliver, M. N. (2011). Emotional, developmental and behavioural co‐morbidities of children with chronic health conditions. Journal of Paediatrics and Child Health, 47(10), 742-747.
2.  Naylor, C., Parsonage, M., McDaid, D., Knapp, M., Fossey, M., & Galea, A. (2012). Long-term conditions and mental health: the cost of co-morbidities.
3.  Zima, B. T., Rodean, J., Hall, M., Bardach, N. S., Coker, T. R., & Berry, J. G. (2016). Psychiatric disorders and trends in resource use in pediatric hospitals. Pediatrics, 138(5), e20160909.