Mental Health of Children and Young People Survey (MHCYP)

Aim and purpose of data collection:

The Children’s Commissioner for England is a statutory position created by the Children’s Act 2004. Her remit is to promote and protect children’s rights in accordance with the United Nations Convention on the Rights of the Child, with special responsibility towards children in care and other vulnerable groups.

The Children’s Commissioner is requesting the complete 2017 Mental Health Children and Young People survey.

This data collection is necessary to deliver projects on the Children’s Commissioner’s annual Business Plan, hence it is necessary for the Commissioner to deliver her statutory functions.

The 2019/20 Business Plan set out clear priorities for the Children’s Commissioner to address the issues of ‘invisible’ children, children whose needs are not being met by services and who are falling through the gaps as a result. Addressing understanding of the Mental Health needs of children is key to the Commissioner and whilst the statistics published by NHS Digital from the MHCYP data provide some useful indication of where issues lie, the analysis published did not explore relationships between Mental Health and complex social or economic factors and outcomes. For example, the survey collected rich data on engagement with the internet and social media, another issue which the Commissioner has set out to shine a light on, but there are currently no published figures from these data. The survey also collected information on risky behaviour, but exploration of the relationship between these behaviours and mental health has not been published.

There are key research questions which could be addressed using this data where there is currently a dearth of information available. The projects set out below will address these research questions, and others, using the MHCYP 2017.

The MHCYP Dataset:

The MHCYP 2017 survey was designed to provide national data on the prevalence of child mental health. The survey included rapid diagnostic tools for a range of common mental health disorders such as anxiety, depression and obsessive-compulsive disorder, as well as other mental health illnesses such as post-traumatic stress disorder. All cases were reviewed by clinically trained raters who confirm the diagnosis of ill-health.

The 2017 survey collected information about mental health and wellbeing from a stratified probability sample of children and young people living in England and registered with a GP. Information was collected on 9,117 children aged 2 to 19 between January and October 2017. The survey combines reports from children, their parents and teachers (depending on the age of the selected child).

The survey was funded by the Department of Health and Social Care and commissioned by NHS Digital. The survey was carried out by NatCen, Office for National Statistics and Youth in Mind.

What data is required?

For the purposes of these projects the CCO requires access to the full ‘standard extract’ of the 2017 MHCYP survey.

The projects proposed will require access to the full dataset to complete fully. Much of the data in the MHCYP is useful contextual information which will aid the analysis. Relevant contextual data includes parent’s demographic, income and General Health Questionnaire-12 (GHQ-12) scores. The GHQ-12 is a 12-question survey module used to indicate the presence of common mental health disorders and has been used extensively as a measure for evaluating the general health of the survey population. As many of the projects propose analysis which has not been done before, access to all variables will ensure nuanced analysis can be conducted which takes potential moderating or confounding data into account.

The CCO does not require any personally identifiable information.

The CCO are not requesting name, address or date of birth.

The MHCYP is a unique data source, no other survey establishes the underlying population prevalence of mental health and emotional wellbeing of children. The CCO has explored other datasets including previous requests to NHS for aggregate extracts from the MHSDS. However, these administrative data do not include children who have never accessed NHS services, which is a key group currently missing from analysis.

Projects using MHCYP records:

1. Vulnerability

The CCO launched its Vulnerability Framework in July 2017. The framework defines and quantifies a comprehensive list of the different types of childhood vulnerability. The first stage of the project was to quantify the numbers of children in different vulnerable groups and different combinations of vulnerable groups. Beyond quantifying the numbers of children, CCO is engaged with a program of work to use different data sources to identify the interoperability between categories of vulnerable and explore both protective and risk factors for vulnerability. Mental health is a key factor for exploration as it is both a category of vulnerability on its own, but it has a complicated causal relationship with other categories of vulnerability if left untreated. The MHCYP data will further the CCO 2020 report on vulnerability.

The vulnerability report provides a comprehensive data resource for ministers and policy makers to consider cross-department issues and inform their decisions. The Children’s Commissioner uses the data to work with officials across government to design intelligent policy which addresses wider issues. Examples of projects which will inform the vulnerability programme are detailed below.

1.1 Understanding the role of Mental Health in school absence and exclusions.

The CCO has a strong interest in gathering and producing evidence on the outcomes of key vulnerable groups, as part of its broader programme of work on Vulnerability. Children who experience persistent absence or are excluded from school are a vulnerable group as they are missing out on education and are more at risk of other negative outcomes, such as involvement with gangs or risky behaviour.

Currently the CCO understands the number of children who experience absence/exclusions, and their educational outcomes from Department for Education’s (DfE’s) school census records. However, this does not provide any information on the child’s mental health, or involvement with other behaviour or support systems prior or following the exclusion. The MHCYP records will fill this gap, allowing interrogation of the mental health and social context surrounding exclusion/absence. The Children’s Commissioner is keen to identify the issues which lead to absence/exclusion so that intelligence can be provided back to service providers (DfE, Local Authorities etc) on where interventions are needed and make the case for stronger community-based support for mental health.

1.2 Outcomes for children with SEND and mental health issues

As part of research into vulnerable groups the CCO’s research focuses on assessing the educational outcomes and progression of children who have been classified as having Special Educational Needs or Disability (SEND). The CCO is interested to explore the relationship between SEND, mental health and educational outcomes and other experience. The MHCYP data will allow exploration of the interoperability between SEND diagnoses and mental health/emotional wellbeing as well as other factors of vulnerability.

The analysis will inform the recommendations that the Children’s Commissioner will make to policy colleagues concerns provision for SEND students.

2. Promoting positive emotional wellbeing

Beyond the diagnostic tools used in MHCYP the survey data also captured the emotional wellbeing of children using the Warwick Edinburgh Mental Well-Being Scale (WEMWBS). The design of WEMWBS allows exploration of the distribution of mental wellbeing in the population overall, as well as the comparison of mental wellbeing between groups. Positive mental wellbeing is protective against Common Mental Disorders (CMDs) such as Depression, Anxiety and low-level OCD. The distribution of wellbeing between different sub-groups will allow the CCO to explore the risk of mental health illness and what protective or risk factors are present for mental wellbeing.

The data will support the Children’s Commissioner to promote activity which protects children’s mental wellbeing across government. The analysis will feed into policy recommendations made to DfE about provision of counselling in schools and making the case for more community support outside of the NHS Children and Adolescent Mental Health System (CAMHS).

3. Evaluating services

The CCO has collected data from NHS England on Clinical Commissioning Group (CCG) and national spend on providing mental health services to produce the mental health briefing for the past three years. This data collection has shown the disparity in service provision locally however the CCO has not been able to collect data on the engagement of children with services from the child’s perspective. The MHCYP collected data on the types of services that children and families have engaged with as well as useful information on why they chose one service over another or chose not to use services.

The information from this analysis will enable the CCO to improve future Mental Health briefings by understanding where the issues are in the system and what is discouraging children and their families from using services provided. This analysis can be fed back to Local Authorities and their providers, to help them to understand what they need to do to increase engagement and ensure that their services are reaching the intended audience. There are plans to increase spending on service provision for children and young people’s mental health, the Children’s Commissioner will use this analysis to inform these plans and encourage spending to be allocated to services which provide the most benefit.

4. Supplementing CCO Gang and Serious Youth Violence research

The Children’s Commissioner has committed to maintaining research into serious youth violence and gang involvement. One issue which consultation with stakeholders has shown to be an important risk factor for becoming involved with gangs is drug use. Gangs are using drugs such as cannabis to establish a debt model with children and young people, which draws them in to gang activity. The CCO are conducting research with data from Public Health England National Drug Monitoring System to understand treatment for drugs at a local level and combining this with the Local Authority approach to gangs and serious youth violence.

The MHCYP collected data useful to this project on the use of and treatment for drugs amongst the young people in the survey. The CCO will use the MHCYP data to establish estimates of the relationship between mental health and drug use. This will inform recommendations made to Local Authorities on how to provide intervention and treatment services aimed at reducing youth violence and drug use.

5. Digital

The Children’s Commissioners ‘Growing Up Digital’ programme of work has looked at how digital technology including social media is influencing children and young people in England. Previous reports include ‘Life in Likes’ and ‘gaming the system’ which looked at how children interact with social media and online gaming platforms respectively. The MHCYP captured data relevant to the CCO continuing research into children’s relationships with digital platforms, including use of social media and other web platforms. The CCO is interested in exploring the relationships between children’s reported experiences and use of online/digital technology and their emotional wellbeing and mental health.

The survey also captures the phenomena of ‘user generated content’ and whether children have been perpetrators or victims of online or ‘cyber’ bullying. The intention with this analysis is to provide further evidence of the relationship between the use of digital platforms and wellbeing of children. Though analysts cannot establish causal relationships using this data, it is possible to identify associations which can inform the recommendations made to government on regulation of social media and other web services.

Legal basis:

This collection is being conducted under CCO’s statutory powers – section 2F of the Children’s Act 2004. This states:

(1) Any person exercising functions of a public nature must supply the Children’s Commissioner with such information in that person’s possession relating to those functions as the Commissioner may reasonably request for the purposes of the primary function or the function under section 2D.

(2) The information must be information which that person would, apart from subsection (1), lawfully be able to disclose to the Commissioner

This statutory function to collect data to inform the CCO's work relates directly to Articles 6(1)(e) of the GDPR: ‘processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller’.

The Article 6(1)(e) criteria is met by the Children Act 2004 Section 2:

(1) The Children's Commissioner's primary function is promoting and protecting the rights of children in England.

(2) The primary function includes promoting awareness of the views and interests of children in England.

(3) In the discharge of the primary function the Children's Commissioner may, in particular—

(h) investigate any other matter relating to the rights or interests of children;

(j) publish a report on any matter considered or investigated under this section.

This data collection involves the collection of information on ethnicity (in broad ethnic groups) which is considered to be special category data under GDPR (see ICO guidance on special category data here). In order to process special category data the Office of the Children’s Commissioner must demonstrate that at least one of the specific conditions set out in Article 9 of the GDPR have been met

Article 9(2)(g):

“(g) processing is necessary for reasons of substantial public interest, on the basis of Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject;”

This request meets the substantial public interest condition set out in the Data Protection Act 2018, Schedule 1, Part 2(6) ‘statutory and government purposes’.

Schedule 1 Part 2,6(1) sets out that:

6 (1) This condition is met if the processing—

a) is necessary for a purpose listed in sub-paragraph (2), and

b) is necessary for reasons of substantial public interest.

(2) Those purposes are—

a) the exercise of a function conferred on a person by an enactment or rule of law;

b) the exercise of a function of the Crown, a Minister of the Crown or a government department.

The Children’s Commissioner is a statutory position, the primary function of which is to promote the rights and interests of children in England (as above). The CCO can thus process special category data under GDPR Article 9(2)(g) as allowed by the DPA Schedule 1 Part 2(6)(2)(a) ‘the exercise of a function conferred on a person by an enactment or rule of law’.

There are no ethical issues raised by the proposed dissemination as de-identified data is requested.

All organisations party to this agreement comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by personnel (as defined within the Data Sharing Framework Contract i.e.: employees, agents and contractors of the Data Recipient who may have access to that data).

The 2017 MHCYP dataset is held on behalf of NHS Digital by the UK Data Service (UKDS, www.ukdataservice.ac.uk ) and UKDS are responsible for dissemination under direction by NHS Digital.

The CCO will receive the whole standard dataset. The CCO will be able to download the dataset from UKDS for the period specific within the DSA and they must securely destroy all local copies of the dataset when the DSA expires and notify DARS in line with standard procedures.

As the CCO download the data securely from the UK Data Service archive, there are no flows of data from NHS Digital or to NHS Digital. The CCO will store these data securely for the agreed period and not share it with any third parties. There are no further data flows. The UKDS securely transfers the MHCYP dataset to the CCO. The data file contains no identifiers and the dataset is not linked and will not be further linked.

Data will only be accessed by individuals within the CCO who have authorisation to access the data for the purposes described, all of whom are substantive employees of the CCO.

What will be done with the data:

• The data will not be linked with any other data.

• There will be no requirement nor attempt to reidentify individuals from the data.

• The data will not be made available to any third parties except in the form of aggregated outputs with small numbers suppressed in line with the HES Analysis Guide.

The full dataset is required in order to cover all England (national analyses) and to be able to control for a range of factors in the analyses. A range of conditions will be examined in the analyses.

Data management and variable derivation will be done in R (software environment for statistical computing ). Analyses will be conducted using standard statistical software, using survey weights and controlling for complex survey design. All patterns reported on will be tested for statistical significance.

Simple descriptive analyses will be used to generate prevalence rates and produce cross-tabulations. These will be presented in tabulations (using percentages and means, and showing base sizes), bar charts, and line graphs. Trend data (from comparisons with earlier surveys in the series) will be based on consistently defined age-ranges and geography for comparability across years. Multiple regression analyses will be carried out to examine association between risk factors and mental health outcomes or service and treatment access when other factors are controlled for, and to identify the role of different potential mediators or explanatory factors. Population attributable fractions may be calculated to compare risk factors with variable extent and variable strength of association. The CCO will examine different options for testing what risk factors may be driving any changes in rate or distribution of mental illness or treatment and service use access. Latent class analyses may be conducted to profile how different and multiple adversities across mental health and other life circumstances cluster together.

While the focus of the study is the mental health and service and treatment use of children and young people, these patterns will be considered in relation to family, neighbourhood and school context. Where available, analyses will be conducted on the MHCYP data from children, parents and teachers (The MHCYP collected data from parents and teachers in separate interviews - all MHCYP data relating to the child - just the questions were answered by their parents or teachers), so that comparisons can be made.

The MHCYP 2017 dataset available via DARS has been redacted on Disclosure Control Procedure advice to minimise the likelihood of individuals being able to identify anyone taking part in the survey.

The scope of the analyses has been conceived by and will be entirely conducted by the CCO. All analyses and processing of the data will be carried out by the CCO. The CCO will be both Data Controller and Data Processor for this request.

The next iteration of the Vulnerability Framework will be published in Summer 2020. This will produce national and local estimates where possible for the issues identified in the projects above. Aggregate tables and data visualisations are published through the Vulnerability Framework as well as a report which draws together the findings and the policy implications of them.

The Vulnerability Framework report and database is designed to inform a range of stakeholders of the number of vulnerable children in England by mapping the full range of difficulties a child might be living with. The CCO’s stakeholders range from government officials, who will need to know the figures for their specific policy area, such as health or education to children’s rights groups who need to know where children are most vulnerable, to Local Authorities who use the local level findings to improve local planning. Locally, the CCO estimates are used to inform Joint Strategic Needs Assessments and to inform funding priorities. Nationally, the vulnerability figures are used by the CCO to target specific policy areas where the data shows the greatest need for change.

The vulnerability database is published in plain English with simple visualisations of data such as tables, line charts and maps to enable members of the public to find out more about vulnerability in their area.

In addition to the Vulnerability Framework the data will be used to inform reviews and reports on the topics listed in the projects throughout 2020. The findings from reviews may be communicated through published reports, press briefings and conferences. All reports from the Children’s Commissioner are published on the CCO website: https://www.childrenscommissioner.gov.uk/. Reports from the CCO are sent to relevant policy leads across government and the Commissioner will use the evidence collected to inform senior officials of where the greatest change is needed. This may contribute to updating legislation (such as the ‘Online Harms’ bill), changing education policy (such as guidance on school behaviour policies) or health policy (such as increasing access to and funding for CAMHS which the Commissioner has long fought for).

Reports from the Children’s Commissioner are often reported in national news where the findings are nationally relevant. Additionally, the Commissioner will use findings from this report in conferences, key note addresses and in interviews/press appearances.

The Children’s Commissioner has a unique mandate to act without fear of favour from government. This independence allows the Commissioner to report on the issues most important to children across England and represent their needs across government. The findings from this research will support the Commissioner in this work.

All published aggregate figures will be subject to disclosure control and suppression of small cell counts in line with the HES Analysis Guide.

The role of the Children’s Commissioner for England is to promote and protect the rights of children in England. This includes promoting awareness of the views and interests of children in England. In order to fulfil this role the Children’s Commissioner requires access to evidence on issues which are affecting children in England. Mental Health has been continually raised with the Commissioner through interviews with children and their families. In a recent survey of 2,000 children in England commissioned by the CCO, children were asked to select their top 3 worries from a list. 33% reported feeling stressed and/or sad as one of their top worries and 43% said that the lives of children would be improved if they had someone to talk to at school if they felt worries or stressed to help them look after their mental health.

Children are repeatedly asking for more support for mental health from both NHS and community services and are increasingly aware of the need to look after their emotional wellbeing as part of growing up. Yet, as the latest Mental Health briefing shows, there remains a chasm between what is required and what is available to children through Children and Young People Mental Health Services.

All the projects that this data will inform will provide the Commissioner with the evidence to inform government and Local Authorities of where additional support is needed and where the system is failing to meet the needs of children. It is crucial that children have someone to speak up for them across government and the analysis carried out by the CCO using the MHCYP and other data ensures that the Commissioner is capturing the experience of the most vulnerable children in society.

By publishing findings openly through the Children’s Commissioner’s website, the CCO is building a body of evidence which can be used by other groups to improve their understanding, identify issues and campaign for their own change locally and nationally.

The CCO will work to achieve the maximum benefit possible from each report and research programme. The form that this takes will differ depending on the project and the findings. Some work will be used to inform decision makers across government of the issues relevant to their area to improve the evidence base for policy decisions. Impact may also be achieved by raising the public awareness of issues which affect their children and communities. The Commissioner engages with senior civil servants, elected representatives, local government and charities to ensure that people have access to the information that they need to make informed decisions.

There has been a local and national push for services to be more integrated and take a more holistic view of health and wellbeing. The new multi-agency safeguarding arrangements within Local Authorities, for example, require Clinical Commissioning Groups, the police and the Local Authority to take equal responsibility for safeguarding and protecting the welfare of children in the area. The inclusion of MHCYP analysis alongside other data across different project areas promotes the mental health of children being considered as part of their wider experience. The CCO will demonstrate the value of this approach by producing reports with novel insights into the experience of children and recommendations for change.

Yielded Benefits is not a requirement for new applications.