Overview
Poor mental health can affect anyone at any stage of life, and recent years have highlighted a growing and urgent need to better understand its causes, consequences, and trends in incidence and management. Referrals to child and adolescent mental health services in Wales have risen significantly, underlining the importance of timely, evidence-based research to inform policy, improve services and support early intervention.
The ADR Wales Mental Health research programme, led by Professor Ann John, focuses on anxiety, depression, suicide and self-harm prevention. The programme aligns with the Welsh Government’s two strategies and commitment to strengthen mental health and crisis support by redesigning services to improve prevention, tackle stigma and promote a “no-wrong-door” approach, ensuring people can access the help they need wherever they first seek support.
The research team is working to better understand the factors affecting children and young people’s mental health, building on previous studies that explored links between school absence, exclusion and later mental health diagnosis. By analysing large-scale, population-level data, the programme aims to identify early warning signs and risk factors, helping professionals intervene as early as possible and reduce the likelihood of problems reaching crisis point.
The programme has strong partnerships with leading mental health organisations and research networks. Professor John is Principal Investigator and Co-Director of DATAMIND, the Health Data Research Hub for Mental Health, and leads the National Centre for Suicide Prevention and Self-harm Research, which hosts the Suicide Information Database-Cymru. She leads the informatics workstream in the National Centre for Mental Health.
Suicide remains a major global public health concern and one of the leading causes of death among young people. Many face complex challenges that increase their risk of self-harm and suicidal behaviour. Through collaboration between researchers, clinicians, policymakers and communities, the ADR Wales programme aims to improve prevention, treatment and support for those most at risk.
Priorities
The Programme for Government recognises the importance of providing effective, high quality and sustainable mental health services. This research theme will seek to provide evidence to inform, reform and prioritise investment.
Our work around mental health will cover five areas: school absence and exclusion rates of individuals with a mental health diagnosis; the effectiveness of various mental health transformation services (data permitting); a look at those educated other than at school; the mental health of socio-economic, ethnic minority and underserved groups; and prisoners and self-harm.
We will investigate the impact of Covid-19 on rates of school absence and exclusion of children and adolescents with primary and secondary care mental health diagnosis. We will build on previous work looking at the mental health of pupils absent or excluded at school, now looking at those educated other than at school (EOTAS).
We will link prison data across Wales to identify the prior histories and trajectories of prisoners who self-harm to assess need and risk factors.
We will explore how data linking research can help evaluate, inform and refine mental health transformation services. We will also characterise the mental health of socio-economic, ethnic minority and underserved groups, assess their equity of access to services for mental health and outcomes for those where mental health problems intersect.
Projects
Impact of antidepressant prescribing guidance
This project aims to examine recent trends of depression and antidepressant prescribing over time.
Mental health and self-harming behaviours in University students in Wales
This project will look at the trajectories of students’ mental health in Wales. It will look at both before and during university, and in comparison to non-students in Wales.
Mental health and self-harm in prisoners in Wales
This project aims to understand the risk factors for self-harming behaviour of male prisoners in Wales. It aims to investigate mental health and behaviours before imprisonment and in a control group of men of matching age from the general population.
It will also investigate the relationship between mental health and behaviours- and the occurrence and severity of self-harm events recorded in prison.
Risk of Suicide following School Absenteeism and Exclusion
This project seeks to understand the association between school absences and exclusions and suicide among young people in Wales.
Mental health and self-harming behaviours in pupils Educated in Other Than at School (EOTAS) in Wales
This project sets out to understand the mental health of EOTAS pupils. It will investigate both the diagnoses and symptoms of mental health and self-harm before and after being EOTAS and in comparison to a control group with comparable age, sex, and socioeconomic characteristics in Wales.
The mental health of socio-economic, ethnic minority and underserved groups
This project will investigate disparities in access to services and mental health trajectories of socio-economic, ethnic minority and underserved groups.
Publictaions
Journal Article: Risk of suicide following school persistent absence and exclusion: an electronic cohort study in Wales, UK 2012–2019
Data Insight: Effects of the Covid-19 pandemic on the mental health of children that are clinically extremely vulnerable or living with clinically extremely vulnerable people in Wales
This Data Insight examines the impact of the Covid-19 pandemic on the mental health of clinically extremely vulnerable children and children living with clinically extremely vulnerable people in Wales, using data linkage methods.
Understanding the mental health of pupils educated other than at school
In late 2019, ADR Wales mental health researchers investigated school absence and exclusion amongst pupils with mental health disorders. Welsh Government then requested the analysis be extended to look at diagnoses and symptoms of mental health and self-harm in pupils educated other than at school (EOTAS). EOTAS is education provision to meet the needs of pupils who, for whatever reason (i.e., illnesses, exclusions, mental health, behavioural difficulties) cannot attend a mainstream or special school.
Last year, the research team set out to investigate mental health (diagnoses and symptoms) and self-harm before and after being in EOTAS provision from 2010/11 to 2018/19. They compared the findings in EOTAS children to a group of children with similar age, sex and socioeconomic circumstances in Wales but educated in mainstream school. The team found that:
- 65% of EOTAS pupils were male.
- 40% of EOTAS pupils were from the most deprived 20% of areas in Wales.
- Females first enter EOTAS at a later age than males.
- Pupils experience a range of mental health issues before and after being in EOTAS provision, but the type and rate of mental health problems differs between males and females.
This research is identified as high priority by the Welsh Government, and was initiated as a commitment in the Welsh Government’s loneliness strategy as well as in the Minister for Education’s response to the Children, Young People and Education Committee’s 2019-2020 EOTAS Inquiry.
The researchers presented the provisional findings to key education and health policy colleagues in Welsh Government as well as the EOTAS Advisory Group and headteachers from Pupil Referral Units.
The work provides valuable evidence on the rates of neurodiversity, mental health conditions and self-harm in pupils before and after they enter EOTAS provision; how these differ by age and sex; and how they compare with those of pupils in mainstream education. The Welsh Government has issued guidance to schools and local authorities on supporting emotional and mental wellbeing. This ADR Wales research has the potential to provide further insights specifically on the experience of EOTAS pupils, to complement the Welsh Government guidance.