Youth mental health service effectiveness, mental health and educational outcomes

University of Cambridge requires access to NHS England data for the purpose of the following research project: Youth mental health service effectiveness, mental health and educational outcomes.

The following is a summary of the aims of the research project provided by University of Cambridge:

1. To examine associations over time between mental health and functioning and educational variables in children and young people

2. To understand effectiveness of self-reported mental health service use on these outcomes, using causal inference (e.g. propensity-based methods), to robustly clarify what services may or may not be effective across a range of outcomes.

3. To elucidate the mechanisms behind these processes (mediation), which individuals might have different responses (moderation), and why (moderated mediation).

4. To use outcomes obtained during the COVID-19 pandemic to understand:

a. ways in which the pandemic may have been harmful to young people’s mental health, functioning, and educational outcomes

b. how pre-pandemic mental health service use may have protected at-risk young people during this population-wide stressor.

The University of Cambridge wishes to use pupil attainment and characteristics from 2002/03 to 2023/24 from the National Pupil Database matched to 9,117 individuals from the Mental Health of Children and Young People 2017 Survey (MHCYP).

With this data, they will examine associations over time between mental health and functioning and educational variables, and effectiveness of mental health service use on these outcomes, to understand what works, for whom, and why. The aim is to understand the mechanisms behind these processes, which individuals might have different responses, and why. Outcomes obtained during the COVID-19 pandemic will inform how the pandemic may have been harmful to young people’s mental health, functioning, and educational outcomes, and how pre-pandemic mental health service use may have protected at-risk young people during this population-wide stressor.

The following NHS England Data will be accessed:

• Mental Health of Children and Young People 2017 Survey (MHCYP) and all follow-up waves – necessary to link with Department of Education (DfE) data to understand how mental health affects the education of young people.

The level of the Data will be identifiable – the data sent from NHS England will be identifiable to Department of Education (DfE) but pseudonymised for University of Cambridge. Once DfE links NHS England Data with the DfE datasets, the identifiable data will be destroyed.

The Data will be minimised as follows:

• Limited to participants who consented to linkage with NHS England data and DfE data only.

• All participants that have withdrawn from the study at any time will be omitted from having their data shared with DfE.

• Participants who were enrolled in the study on the basis of parental consent and who have since reached adulthood, and who have subsequently declined further contact, will be deemed to have withdrawn consent with effect from 2017. Accordingly, their data will be excluded from any data sharing with the Department for Education (DfE).

University of Cambridge is the controller as the organisation responsible for ensuring that the Data will only be processed for the purpose described above.

The lawful basis for processing personal data under the UK GDPR is:

Article 6(1)(e) - 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 lawful basis for processing special category data under the UK GDPR is:

Article 9(2)(j) - processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on 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 processing is in the public interest because results aim to inform interventions to improve mental health outcomes in the most disadvantaged and vulnerable children and young people. The study will also assess the impact of mental health service use, teacher support, and educational support on mental health outcomes such as well-being, emotional problems, self-harm, conduct problems, and substance use.

Moderation analyses will be performed to test which services were effective in what ways in disadvantaged and vulnerable children and young people, such as those from lower socio-economic households (e.g. in receipt of Free School Meals), students with SEND, and Looked-After Children.

The funding is provided by The Wellcome Trust. The funding is specifically for the study described. Funding is in place until at least February 2028.

The funders will have no ability to suppress or otherwise limit the publication of findings.

DfE and NHS England are processors acting under the instructions of University of Cambridge. DfE’s role is limited to linking NHS England data with DfE datasets.

NHE England’s role is providing identifiable MHCYP datasets to DfE for data linkage purposes.

When designing the study, two groups of UK adolescents (aged 16–22) with lived experience of mental health problems and mental health service use were consulted. Participants expressed difficulties keeping up with school demands when struggling with their mental health, including how it is hard to get to mental health appointments if they have to miss school. They (for example) observed a bidirectional relationship with self-harm and education: that academic pressure could lead to self-harm, but self-harm could hinder school performance (e.g. urges distract from learning) and adapting to school life (e.g. potential for bullying). They identified key contributors (e.g., family dynamics, peer relationships, lack of counselling) and potential moderators (e.g., gender, ethnicity, disadvantaged background, pubertal timing). They noted that treatment early, long-term, and outside school may be particularly beneficial. These perspectives underscored the importance of the research questions, including the need for awareness, support, and services for young people with mental health problems. PPI input shaped the proposed assessment of bidirectional effects, mediators, moderators, and choice of datasets.

No data will flow to NHS England for the purposes of this Data Sharing Agreement (DSA).

NHS England will provide the relevant records from the MHCYP datasets to DfE. The Data will only contain identifiers including: First and Last Names, Date of Birth, Postcode and Study ID, which are required to link the identifiers with the data already held by DfE at record level.

The identifiers provided by NHS England will be stored on servers at DfE until the data is linked with National Pupil Database (NPD). Once linked, the identifiers will be destroyed and the pseudonymised linked NPD data will be stored at the Office for National Statistics (ONS) Secure Research Service (SRS).

DfE stores Data on the Cloud provided by Microsoft Ltd. Microsoft Ltd servers are located in Republic of Ireland and The Netherlands. ONS stores Data on the Cloud provided by UK Cloud Services UK Cloud Services servers are located in the UK.

The University of Cambridge must confirm and provide evidence upon audit by NHS England that access via any remote device complies with the data security obligations within this DSA and the Data Sharing Framework Contract.

For remote access:

- Remote access will only be from secure locations situated within the territory of use (as further restricted elsewhere within the DSA if so done) stated within this DSA;

- Access controls granting users the minimum level of access required are in place;

- Remote access is only via secure connections (e.g., VPNs or secure protocols) to protect data;

- Multifactor authentication (MFA) is required for remote access;

- Device security, including up-to-date software and operating systems, antivirus software, and enabled firewalls are utilised for the remote access;

- All remote access is undertaken within the scope of the organisation’s DSPT (or other security arrangements as per this DSA) and complies with the organisation’s remote access policy.

The above applies in addition to any condition set out elsewhere within the DSA (e.g. who may carry out processing, and for what purpose).

Remote processing will be from secure locations within England/Wales. The data will not leave EEA at any time.

Access to pseudonymised Data is restricted to employees of University of Cambridge who have authorisation from Chief Investigator.

Access to confidential patient identifiable data is restricted to employees of DfE.

ONS and Microsoft Limited is not permitted to access the Data.

All personnel accessing the Data have been appropriately trained in data protection and confidentiality.

The Data will be linked at person record level with Early Years Census, Termly School Census, Alternative Provision Census, EYFSP, Phonics, KS1 attainment, KS2 attainment, KS4 attainment, KS5 attainment, Absence and Exclusions datasets obtained from National Pupil Database (NPD) at DfE.

The identifying details will be destroyed by DfE once data is linked. All analyses will use the pseudonymised dataset. There will be no requirement and no attempt to reidentify individuals when using the pseudonymised dataset.

Analysts from the University of Cambridge will analyse the Data for the purposes described above.

The expected outputs of the processing will be:

• A PhD thesis

• Submissions to peer reviewed journals on an annual basis

• A report of findings to the funder, The Wellcome Institute.

• A report of findings to primarily for use by the media: Work with the University of Cambridge Head of Research Communications at the School of Clinical Medicine to write press releases prior to publication of manuscripts.

• Presentations at conferences such as IEPA Early Intervention in Mental Health, MQ, European Psychiatric Association

• Presentations to the public

• briefing on recommendations for regional and national policymakers and commissioners

• provide written evidence to UK parliament

The outputs will not contain NHS England Data and will only contain aggregated information with small numbers suppressed as appropriate in line with the relevant disclosure rules for the dataset(s) from which the information was derived.

The outputs will be communicated to relevant recipients through the following dissemination channels:

• Journals

• Generate news pieces or blogs to communicate the findings to the public.

• Oral presentations and posters displayed at conferences

• Press/media engagement

• Briefings and written evidence to policymakers / government

Conference presentations will occur annually, when relevant conferences occur. Journal article manuscripts based on these analyses will be prepared annually, with press releases written after acceptance to the journal and before publication, so press release can be timed with publication date. Blogs and other public dissemination will come shortly after manuscript publication. Briefings and written evidence to policymakers / government will be by the end of the project.

The public benefit of this work will be informing prevention interventions, improving mental health services, and contributing to the broader understanding of the complex

relationship between mental health, functioning, and academic outcomes.

Increased understanding of how much community mental health services improve mental health and educational outcomes, why, and under what circumstances, will facilitate better targeting of resources and drive service improvement. This will lead to better access to services and improved effectiveness, as well as more personalised services and improvements in treatment to benefit children and young people with mental health problems.

The pathway to improvements from the work will be through the researchers making recommendations to regional and national policymakers and commissioners, as well as by providing written evidence to UK parliament. Scientific dissemination in peer-reviewed journals will demonstrate the robustness of findings, building confidence in policy and public stakeholders of the need for and ways to employ change. Public dissemination will help with advocacy for change.

The research team has extensive links with charities, patient and public involvement groups, youth voice networks, and clinical research networks that can support widespread dissemination. Some examples of charities are: MQ (https://www.mqmentalhealth.org) Black Minds Matter: (https://www.blackmindsmatteruk.com), Platform for Life: (https://www.platformforlife.org.uk). Findings can also be disseminated to the many groups we have reached out to for PPI and qualitative work for this project (ie. schools, youth clubs, Job Centre Plus, University groups, organisations which offer mental health support).

Yielded Benefits is not a requirement for new applications.