Bright children from poorer backgrounds twice as likely to receive hospital mental health treatment than affluent high-achievers

Bright children from poorer backgrounds are twice as likely to be admitted to hospital with mental health problems than high-achievers with affluent upbringings. 

That’s according to a new study of tens of thousands of secondary school pupils in England, published today in the peer-reviewed journal Oxford Review of Education, which also demonstrates poorer teens are more likely to be treated for alcohol and drug use and self-harm. 

The paper, funded by the Nuffield Foundation, shows too they are more likely to become pregnant. 

The study’s author, Professor John Jerrim, from UCL (University College London), said his findings could help explain why high-achieving youngsters from disadvantaged backgrounds tend to fall behind their more advantaged peers as they get older.   

A renowned expert in the study of mental health and wellbeing within education, Professor Jerrim is calling for education, healthcare and social services to come together to help these youngsters fulfil their potential. 

“The findings show high achieving children from disadvantaged backgrounds are hospitalised due to mental health and behaviour related issues at a rate of around 80 per 1,000 children between the ages of 11 and 20.  

“This is significantly above the rate of around 40 per 1,000 children for their equally able but more socio-economically advantaged peers,” he adds.  

“The results point to a need for services to develop their responses to the complex needs of young people. This includes ensuring that there is the right environment for early intervention, which is crucial in addressing the diverse challenges faced by young people from different socioeconomic and achievement backgrounds.  
 
“By fostering supportive and inclusive environments, these services can better cater to the unique needs of individuals, promoting equitable opportunities for success.” 

This new research is part of a wider Nuffield Foundation-funded study ‘Long-term outcomes of high-achieving disadvantaged children’.  Professor Jerrim used information from the ECHILD database, which contains anonymised information from hospitals and schools, to look at how hospital admissions for a range of conditions differed between high-achievers from different socio-economic groups between the ages of 11 and 20. 

The conditions included in the analysis were: mental health issues such as anxiety and depression; personality disorders such as bipolar disorder; alcohol or drug misuse; self-harm; and eating disorders. 

The results of SATs, the national exams taken at the end of primary school, were used to measure academic achievement, with those in the top 25% classified as high-achievers. 

Socio-economic status was based on a child’s eligibility for free school meals and the area in which they lived. 

Among results, the analysis of data on more than 42,000 high-achievers, found:  

• Pupils from the most disadvantaged backgrounds were about twice as likely as those from the most advantaged groups to be admitted to hospital for any of the conditions studied (8.6% were admitted between ages of 11 and 20 versus 4.2%). 

• A similar pattern was seen when zeroing in on treatment for alcohol and drug use. 3.1% of the high-achievers from the poorest backgrounds were treated for drug or alcohol use.  This compares with 1.3% of children with similarly good SATs scores from affluent backgrounds. 

• Self-harm hospital treatments exhibited an even sharper alignment between socio-economic background, regardless of achievement levels – with the rate amongst more advantaged children being lower. The increase between Year 7 and Year 10 is almost identical across low socio-economic status students, regardless of whether their academic achievements. 

• The results for pregnancy were particularly striking, with high-achieving girls from disadvantaged backgrounds ten times more likely to receive pregnancy care than their richer peers (3.5% vs 0.3%).  

This is, however, still far lower than the rate for low-achievers from disadvantaged backgrounds.  In a separate part of the study, Professor Jerrim showed that 12.9% of low-achieving girls from disadvantaged backgrounds received pregnancy care by the age of 20. 

Only eating disorders bucked the trend, with similar rates of hospital admissions between high-achievers from different socio-economic backgrounds. 

Finally, there was a sharp increase in hospitalisations of youngsters from disadvantaged backgrounds during Year 9 and Year 10. This tallies with other research that has found that high-achievers tend to start falling behind between the ages of 11 and 14. 

Professor Jerrim acknowledges that the measures of achievement and socio-economic status were not perfect.  In addition, less serious health problems that are typically seen by a GP were not included in the analysis. 

Nevertheless, he believes his findings clearly show that bright youngsters from disadvantaged backgrounds need extra support at school – and at home. 

Jerrim, who is a Professor of Education and Social Statistics at the Institute of Education at UCL, explains: “Socioeconomically disadvantaged children with high levels of early achievement are perhaps the lowest hanging fruit for promoting social mobility. Despite their impoverished upbringing, these children have managed to overcome poverty to outperform many of their peers from more advantaged backgrounds. 

“They have potential to flourish at a top university and obtain high-flying jobs.  Yet, many of them fail to live up to their early promise.  

“This research provides clues as to why.   

“If we are to help them fulfil their potential, we must support this group academically at school, and this needs to be accompanied by arrangements to help them to manage broader issues in their lives. This requires a joined-up approach across education, social care and health services.  

“Until this happens, the full potential of this group is likely to continue to go unfulfilled.”