title: How do child and adolescent mental health problems influence public sector costs? Interindividual variations in a nationally representative British sample.
abstract: BACKGROUND
  Policy and practice guidelines emphasize that responses to children and young people with poor mental health should be tailored to needs, but little is known about the impact on costs. We investigated variations in service-related public sector costs for a nationally representative sample of children in Britain, focusing on the impact of mental health problems.
  
  
  METHODS
  Analysis of service uses data and associated costs for 2461 children aged 5-15 from the British Child and Adolescent Mental Health Surveys. Multivariate statistical analyses, including two-part models, examined factors potentially associated with interindividual differences in service use related to emotional or behavioural problems and cost. We categorized service use into primary care, specialist mental health services, frontline education, special education and social care.
  
  
  RESULTS
  Marked interindividual variations in utilization and costs were observed. Impairment, reading attainment, child age, gender and ethnicity, maternal age, parental anxiety and depression, social class, family size and functioning were significantly associated with utilization and/or costs.
  
  
  CONCLUSIONS
  Unexplained variation in costs could indicate poor targeting, inequality and inefficiency in the way that mental health, education and social care systems respond to emotional and behavioural problems.
authors.affiliation: Personal Social Services Research Unit, London School of Economics and Political Science, London, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Knapp
authors.affiliation: Personal Social Services Research Unit, London School of Economics and Political Science, London, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Snell
authors.affiliation: Centre for the Economics of Physical and Mental Health, Institute of Psychiatry, King's College London, London, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Healey
authors.affiliation: Croydon Adolescent Mental Health Team, London, UK.
authors.forename: Sacha
authors.initials: S
authors.lastname: Guglani
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK.
authors.forename: Sara
authors.initials: S
authors.lastname: Evans-Lacko
authors.affiliation: Personal Social Services Research Unit, London School of Economics and Political Science, London, UK.
authors.forename: Jose-Luis
authors.initials: JL
authors.lastname: Fernandez
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Howard
authors.initials: H
authors.lastname: Meltzer
authors.affiliation: Institute of Health Research, University of Exeter Medical School, Exeter, UK.
authors.forename: Tamsin
authors.initials: T
authors.lastname: Ford
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D008605:Mental Health Services / Q000191:economics / Q000706:statistics & numerical data; D017150:Public Sector / Q000191:economics / Q000706:statistics & numerical data; D006113:United Kingdom
keywords: Psychiatric practice; economic evaluation; education; social work