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OBJECTIVES: To investigate whether the rate of spend on child and adolescent mental health is influenced by demand for other competing services in local commissioning decisions. DESIGN: Analysis of spend data by Clinical Commissioning Groups (CCG), including other publicly available data to control for variation in need. SETTING: Local commissioning decisions in the National Health Service. PARTICIPANTS: Commissioning of health services across 209 CCGs. MAIN OUTCOME MEASURES: Association between the rate of child and adolescent mental health spend and demand for child and adolescent mental health services (CAMHS), adult mental health services and physical health services after adjusting for confounding factors. RESULTS: An additional percentage point in the proportion of children in care is associated with 4% higher child and young person mental health (CYP MH) spend per person aged 0-18 (ratio of means: 1.04; 95% CI 1.00 to 1.07). Spending £100 more on physical health services was associated with 9% lower spend in CYP MH per person aged 0-18 (ratio of means: 0.91; 95% CI 0.84 to 0.99). CONCLUSIONS: Healthcare commissioners in England face a challenge in balancing competing needs. This paper contributes to our understanding of this by quantifying the possible extent of the trade-off between physical health and CYP MH when allocating budgets. Any attempt to explain the variation in CAMHS spend must also take account of demand for other services.

Original publication




Journal article


BMJ Open

Publication Date





child and adolescent psychiatry, health economics, mental health, organisation of health services, Adolescent, Adolescent Health, Adolescent Health Services, Child, Child Health, Child Health Services, Costs and Cost Analysis, England, Female, Health Care Rationing, Health Services Needs and Demand, Humans, Male, Mental Health Services, State Medicine