First a mental ill health epidemic, then a pandemic affecting access to mental health services – how have mental health referrals been impacted?

Project overview

Mental health issues are prevalent within the Bradford District, with a mental ill health epidemic affecting children and young people.Before the COVID-19 pandemic stakeholders report a range of issues, including problems with accessibility to support, fragmented and poorly coordinated services, and insufficient resources. COVID-19 mitigation measures affect the mental health of many, and at the same time accessing mental health support services is more challenging. This project investigates the effect of COVID-19 on mental health referrals of children and young people in Bradford.

Data and methods

Mental health referral data is controlled by the Healthy Minds Youth in Mind Service. Nearly 5,000 records of mental health referrals of children and young people are available at the individual client level (deidentified), with details on mental health referral reason and source as well as the client’s age and postcode district. Mental health referral reasons especially prominent in Bradford include self-care issues, anxiety, post-traumatic stress disorder, depression, and in crisis (Figure 1).

Figure 1. Word cloud of Bradford’s mental health referral reasons and sources

An interrupted time series analysis (pre-COVID- 19 and COVID-19 phase) with Poisson regression on weekly counts from the first week of January 2019 to the first week of February 2021 has been used. The week commencing 23 March 2020, where the first lockdown was announced and enforced, marks the start of the COVID-19 phase. As part of a sensitivity analysis the COVID-19 phase is also defined as the week of 16 March 2020, when the Prime Minister asked everyone to stop non-essential contact and travel, and the week of 11 March 2020, when COVID-19 was declared a pandemic by the WHO. We are looking at all mental health referrals and those particularly relevant in the context of non- pharmaceutical interventions such as social distancing: anxiety and depression. We also investigated how the COVID-19 pandemic affected mental health referral reasons especially prominent in Bradford’s BD4 postcode district (including Holme Wood). 7 out of 10 referrals were for self-care issues and 1 out of 10 referrals for post-traumatic stress disorder.

Key findings

Holme Wood’s postcode district (BD4) has the second- highest mental health referral rates in children and young people in Bradford (8%; see Figure 2).

Figure 2. Mental health referrals of children and young people in Bradford 2019 to 2021

In the 110 weeks between January 2019 and the beginning of February 2021, on average 43.12 children and young people have been referred to mental health support services weekly (SD = 21.02). As seen in Figure 3, the recorded mental health referrals and estimated regression line dropped in the week of the first UK lockdown. Poisson regression analysis of weekly mental health referrals pre-COVID-19 and during COVID-19 characterises this drop in mental health referrals as highly significant (b= -0.697, SE= 0.170, t=-4.087, p < 0.001). However, the overall number of weekly mental health referrals has increased significantly since 2019 (b= 0.011, SE= 0.003, t= 3.679, p< 0.001).

Figure 3. Weekly count of mental health referrals and estimated regression lines for before and after the first national lockdown

All selected mental health referral reasons – exempt post-traumatic stress disorders, which experienced a highly significant increase after the first lockdown – experienced a significant decrease in weekly referrals compared to the pre-lockdown phase. The largest reductions are linked to depression, followed by anxiety and self-care issues.

Value of the research

Understanding the effects of the COVID-19 pandemic on mental health referrals will benefit local stakeholders in informed decision making and resource allocation.

Based on this initial analysis, further research on mapping mental health support in Holme Wood will be conducted. For example, focus groups are planned to explore access and barriers to various health services (including mental health) for Holme Wood residents and service providers. Further, a system map of mental health services in Bradford will be created with the help of partners to identify gaps and where connections can be made to strengthen the system.


  • BD 4, Holme Wood’s postcode district, has one of the highest mental health referral rates.
  • Bradford’s weekly mental health referrals have significantly decreased immediately after the first national lockdown but are generally increasing since 2019.
  • Not all children and young people with mental health issues will be represented in the data sample.

Research theme

Children and Young People’s Mental Health


Prof Mark Mon-Williams
Professor of Psychology, University of Leeds

Dr Ning Lu
Senior Research Fellow, Bradford Teaching Hospitals NHS

Mallory Morehead
ActEarly Project Manager, Bradford Teaching Hospitals NHS


MYMUP, an online mental health service and database which contains a professional section and a self-help site for people to access mental health services.

OutLOUD Ltd, a Holme Wood-based creative education company working with hard to reach young people and vulnerable groups in Bradford, is leading the community engagement piece of ActEarly.


This work was supported by Wave 1 of The UKRI Strategic Priorities Fund under the EPSRC Grant EP/T001569/1, particularly the “Digital Twins: Urban Analytics” theme within that grant & The Alan Turing Institute.