Growing financial strain on the NHS due to longer stays in hospital
Eating disorders and self-harm most common reasons for emergency admissions
The total cost of emergency admissions for mental health among children and young people in England rose from £22.5 million in 2012/13 to £87.3 million in 2021/22, finds research published online in the journal BMJ Open.
The retrospective observational study concludes that costs were driven by increases in both admission rates and lengths of stay.
There is growing concern about the rise in mental health disorders among children and young people. In England, one in five children and young people aged 8 to 25 years had a probable mental disorder in 2023, an increase from one in nine in 2017, according to figures from NHS Digital.
In England, between 2012 and 2022, there was a 65% increase in children and young people needing emergency admission to acute medical wards due to mental health concerns, the researchers had previously reported. However, until now, the economic implications of this rise in admissions was poorly understood.
To systematically break down the costs to the NHS, the researchers analysed Hospital Episode Statistics data covering all emergency admissions for young people aged 5-18 years in England between 1 April 2012 and 31 March 2022. They then calculated the costs associated with each admission according to the diagnosis, interventions needed, and length of stay.
While the cost of paediatric emergency admissions for any reason increased by 100% over the decade, the cost of paediatric emergency mental health admissions rose more rapidly, by just below 300%.
There was a spike in mental health admission costs after 2019/20, followed by a flattening after 2020/21, coinciding with the Covid-19 pandemic. Following the pandemic, total admission numbers declined, but overall costs remained high due to an increase in long stay admissions.
The study shows that in 2021/2022, over 80% of the total mental health cost was attributed to females, and more than 50% to children and young people aged 11-15 years.
Eating disorders and self-harm were the two most costly conditions in 2021/2022, the analysis found, despite eating disorders representing a relatively small proportion of overall admissions. This is because eating disorders tend to require intensive and prolonged care, the researchers suggest.
The study also found that admissions from more socioeconomically deprived areas tended to be associated with long hospital stays and higher costs per admission.
A strength of the study was the comprehensive dataset used, which covered the whole of England, but the researchers acknowledged that a limitation of their research was that conditions or diagnoses that are not the primary reason for a hospital admission may be under-reported. There could also have been inconsistencies in coding and cost reporting across NHS trusts.
Additionally, specific groups such as individuals who use private services or those who tend to avoid hospital care may be under-represented in the analysis. And as the study primarily focuses on direct hospital costs, it does not account for long term costs such as increased primary care use following emergency admissions.
The researchers say that although investment in child and adolescent mental health services (CAMHS) has increased in recent years, it has not matched the growth in demand. This has contributed to more children and young people presenting in crisis to emergency departments and being admitted to acute medical wards.
They call for urgent action to address what is behind the rise in poor mental health among children and young people, adding that policies should prioritise early intervention, reduce regional and socioeconomic disparities and ensure that mental health resources are allocated where they are most needed.
"Policymakers must consider targeted interventions and strategic investments to better support children and young people with mental health needs while alleviating pressure on already strained acute care services," they write.
