Examining inequalities in screening and pathways to mental health care for minoritised children and young people in the UK.

Background: In the absence of culturally sensitive assessment, symptoms of stress or distress may be missed or mis-identified and, in turn, impede access to mental health services leading to long-term impact. Primary care services and schools play a crucial role in identifying and addressing mental health difficulties in young people, however, cultural insensitivity or race-based biases have the potential to derail identification efforts and in turn, risks both pathologizing normative behaviours and delaying appropriate referrals. The inaccurate interpretation of presentation amongst minoritised children and young people may lead to a ripple effect whereby missed or mis-identified difficulties perpetuate feelings of stigmatisation, perceived discrimination and distrust within the education and health systems, further deterring help-seeking. Ultimately, improved culturally sensitive identification of need and appropriate intervention has the potential to improve individual, family, and community well-being.

Objectives: To examine inequalities in screening and pathways to mental health care for children and young people, by exploring (1) identification of mental health difficulties, referral pathways and entry to services (2) the perspectives of relevant stakeholders on topics such as identification, pathways to care and their vision for change (3) available community-based supports. The project and specific research questions will be developed in partnership with parents and young people through consultations and workshops.

Research Questions: The project aims to answer the overarching question: Are there systematic biases based on race and ethnicity in screening of and responses to children and young people's mental health difficulties in the UK? Specifically, the project components aim to interrogate:
1. Are there systematic biases in screening for mental health difficulties and pathways to care?
2. What are stakeholders' perspectives on and responses to (1) biases in screening and referral processes (2) their role in facilitating pathways to care?
3. What community-based alternatives to formalised mental health services are available for children and young people living in the UK?

Study Design: Informed by a Patient and Public Involvement and Engagement (PPIE) component, the project will utilise a mixed methods approach, including quantitative, qualitative and review components, for each of the research questions respectively:
1. Quantitative component: Analyse secondary data (incl. education, policing, social care, mental health services and hospital admissions data) to ascertain whether there is consistency in identification based on symptom presentation, and in turn, responses, service involvement and referrals.
2. Qualitative component: Explore stakeholders' (e.g. teachers, CAMHS liaisons, police liaisons, community service providers) perspectives around identification of mental health needs, referrals and service involvement, ways to improve processes and pathways to care.
3. Review component: Compile the available evidence base for culturally-safe alternatives to formalised mental health services available for children and young people in the UK

Policy relevance/Pathways to impact: The findings of the project will be relevant for policy makers, community-based providers, as well as school and clinic-based practitioners and clinicians, by providing insight into potential biases in current screening and pathways to mental health services and provision. The review will also provide an overview of available community-based supports for young people and parents in the UK.