| Summary: | <p><strong>Objectives:</strong> 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.</p> <p><strong>Design:</strong> Analysis of spend data by Clinical Commissioning Groups (CCG), including other publicly available data to control for variation in need.</p> <p><strong>Setting:</strong> Local commissioning decisions in the NHS.</p> <p><strong>Participants:</strong> Commissioning of health services across 209 CCGs.</p> <p><strong>Main outcome measures:</strong> Association between the rate of child and adolescent mental health spend and demand for CAMHS, adult mental health services and physical health services after adjusting for confounding factors.</p> <p><strong>Results:</strong> An additional percentage point in the proportion of children in care is associated with 4% higher CYP MH spend per person aged 0-18 (ratio of means: 1.04; 95%CI: 1.00, 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, 0.99).</p> <p><strong>Conclusions:</strong> 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.</p>
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