{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T13:59:33Z","timestamp":1791295173871,"version":"4.1.0"},"reference-count":41,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"unspecified","delay-in-days":5,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100023699","name":"Health Data Research UK","doi-asserted-by":"publisher","award":["HDRUK2023.0029"],"award-info":[{"award-number":["HDRUK2023.0029"]}],"id":[{"id":"10.13039\/501100023699","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014013","name":"UK Research and Innovation","doi-asserted-by":"publisher","award":["MR\/Y030788\/1"],"award-info":[{"award-number":["MR\/Y030788\/1"]}],"id":[{"id":"10.13039\/100014013","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["NIHR205448"],"award-info":[{"award-number":["NIHR205448"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["NIHR206114"],"award-info":[{"award-number":["NIHR206114"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,9,4]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      Evidence on demographic and socioeconomic differences in adolescent mental health service use\n                      <jats:italic>across multiple healthcare settings<\/jats:italic>\n                      is vital for equitable health policy and service responses. We quantified inequalities in referrals to National Health Service (NHS)-funded mental health services and NHS hospital use for mental health concerns by social strata for secondary school pupils in England.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used linked education-health records (ECHILD) to create a cohort of pupils entering state-funded secondary schools in England (age 11\u2009years\/year 7) from 2012\/13 to 2021\/22. We measured rates of service use by gender, racial-ethnic group, region of residence, free school meal eligibility and area-level deprivation. Contacts were captured in the Mental Health Services Data Set and Hospital Episode Statistics. Pupils were followed up until service contact, age 21 years, death or study end (31 August 2022).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 5\u2009629\u2009720 pupils, 980\u2009648 (17.4%) were referred to NHS-funded mental health services; a rate of 45.2 per 1000 person-years (95% CI 45.1 to 45.2). Referral rates were higher in females (55.5, 95%\u2009CI 55.4 to 55.7) than males (35.7, 95%\u2009CI 35.6 to 35.8) and were highest in the North East (58.2, 95%\u2009CI 57.7 to 58.7). Rates were highest among White Irish travellers (70.8, 95%\u2009CI 66.2 to 75.8)\u2009and lowest among Pakistani (20.8, 95%\u2009CI 20.5 to 21.1) pupils. Pupils eligible for free school meals had particularly high rates (75.3, 95%\u2009CI 75.0 to 75.6), and rates increased with quintiles of area-level deprivation. Sociodemographic patterns were consistent across referrals, emergency department attendances, and hospital admissions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We find marked variation in mental health service use across social strata but consistency across different service types, likely reflecting differences in underlying need, symptom recognition, help-seeking, referral pathways, recording practice and the availability and acceptability of services.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-004281","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T13:20:20Z","timestamp":1791292820000},"page":"e004281","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Disparities in adolescent mental health-related National Health Service presentations in England: a secondary school cohort study"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1148-1017","authenticated-orcid":false,"given":"Kate M","family":"Lewis","sequence":"first","affiliation":[{"name":"Great Ormond Street Institute of Child Health, UCL, London, UK"},{"name":"Population Health Improvement UK (PHI-UK), National Research Network, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Dale","sequence":"additional","affiliation":[{"name":"Bradford Teaching Hospitals NHS Foundation Trust, Bradford Institute for Health Research, Bradford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Lewer","sequence":"additional","affiliation":[{"name":"Bradford Teaching Hospitals NHS Foundation Trust, Bradford Institute for Health Research, Bradford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0745-3358","authenticated-orcid":false,"given":"Roc\u00edo","family":"M\u00e9ndez Pineda","sequence":"additional","affiliation":[{"name":"Great Ormond Street Institute of Child Health, UCL, London, UK"},{"name":"Population Health Improvement UK (PHI-UK), National Research Network, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johnny","family":"Downs","sequence":"additional","affiliation":[{"name":"Population Health Improvement UK (PHI-UK), National Research Network, UK"},{"name":"Department of Child and Adolescent Psychiatry, King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3491-7381","authenticated-orcid":false,"given":"Ruth M","family":"Blackburn","sequence":"additional","affiliation":[{"name":"Great Ormond Street Institute of Child Health, UCL, London, UK"},{"name":"Population Health Improvement UK (PHI-UK), National Research Network, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"2026100606200965000_4.4.e004281.1","doi-asserted-by":"publisher","DOI":"10.1038\/s41380-021-01161-7"},{"key":"2026100606200965000_4.4.e004281.2","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1038\/s41591-024-02846-6","article-title":"Closing the global gap in adolescent mental health","volume":"30","year":"2024","journal-title":"Nat Med"},{"key":"2026100606200965000_4.4.e004281.3","unstructured":"National Audit Office . 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