Linking data on women in public family law court proceedings concerning their children to mental health service records in South London

Pearson, Rachel and Jewell, Amelia and Wijlaars, Linda and Bedston, Stuart and Finch, Emily and Broadhurst, Karen and Downs, Johnny and Gilbert, Ruth (2021) Linking data on women in public family law court proceedings concerning their children to mental health service records in South London. International Journal of Population Data Science, 6 (1): 6.

Abstract

Introduction Maternal mental health problems and substance misuse are key risk factors for child neglect or abuse and court-mandated placement into care. Linkage between mental health records and family court data could raise awareness about parent mental health needs and inform approaches to address them. Objectives To evaluate data linkage between administrative family court data and electronic mental health records for a population-based mental health service for 1.3 million people in South London. Methods We deterministically linked administrative family court data for women (n=5463) involved in care proceedings in South London with service user records from the South London and Maudsley NHS Mental Health Trust (SLaM). We restricted the cohort to women involved in proceedings between 2007 and 2019, in local authorities where SLaM solely provides secondary/tertiary mental health services and the Improving Access to Psychological Therapies (IAPT) (n=3226). We analysed the associations between match status and sociodemographic/case characteristics using multivariable logistic regression. Results Two-thirds (2317/3226; 66%) of women linked to a SLaM service user record at some point; most (91%) who linked accessed secondary/tertiary mental health services, indicating serious mental illness. Accounting for possible missed matches, we estimated that 70-83% of women accessed SLaM services at some point. Older women at index proceedings (>35yrs OR: 0.69, 95%CI: 0.54-0.88vs<25yrs) and Black women or women from other ethnic groups (Black ethnic groups 0.65, 0.50-0.83; other ethnicity 0.59, 0.43-0.81 vs White ethnic groups) had lower odds of linking. Odds of linking were higher for women with an infant in proceedings (1.42, 1.18-1.71), or with curtailed/terminated parental responsibility (1.44, 1.20-1.73). Conclusions Our linkage supports growing evidence of a high burden of mental health problems and substance misuse among women whose children enter care in England, compared to the general population. Research using this linkage should inform strategies to address the considerable mental health needs of vulnerable women and their children. Key messages Two-thirds of women whose children were subject to care proceedings in four South London local authorities had linked mental health records at some point during a 12-year period: 91% of these women had contact with secondary or tertiary services indicating serious mental illness. These findings may underestimate need due to poor identifier quality (e.g. missing date of birth) and ascertainment biases relating to unequal access to healthcare. Sensitivity analyses estimated that 70-83% of women may have used mental health and substance misuse services over the study period. Our linkage demonstrates the feasibility of establishing cross-sectoral linkages using administrative data sets and electronic patient records in England. Use of these linked data is encouraged and interested researchers should contact the CRIS administrator at cris.administrator@slam.nhs.uk.