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Risk factors and trajectories for self-harm, neurodevelopmental disorders and mental health conditions in pupils in alternative education provision in Wales: population-based electronic cohort study

Olivier Rouquette, Marcos del Pozo Banos Orcid Logo, Sze Chim Lee Orcid Logo, Ann John Orcid Logo

BJPsych Open, Volume: 11, Issue: 5, Start page: e205

Swansea University Authors: Olivier Rouquette, Marcos del Pozo Banos Orcid Logo, Sze Chim Lee Orcid Logo, Ann John Orcid Logo

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DOI (Published version): 10.1192/bjo.2025.10827

Abstract

Background: Pupils in alternative education provision, known as ‘Educated in Other Than At School’ (EOTAS) in Wales, UK, are among the most vulnerable learners and who, for reasons such as mental health or behavioural challenges, do not attend a mainstream or special school. Aims: We compared self-h...

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Published in: BJPsych Open
ISSN: 2056-4724
Published: Cambridge University Press (CUP) 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa71089
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Aims: We compared self-harm, neurodevelopmental disorders and mental health conditions between EOTAS pupils and controls with similar characteristics, before and after being in EOTAS provision. Method: This population-based electronic cohort study included pupils in Wales aged 7&#x2013;18 years, from the academic years 2010&#x2013;11 to 2018&#x2013;19. We linked data from Education Wales to primary and secondary healthcare records within the Secure Anonymised Information Linkage (SAIL) Databank. Individuals included in the EOTAS data-set were identified as cases. Controls were pseudo-randomly selected based on equivalent age and academic year distribution. Results: This study included 8056 pupils in EOTAS and 224 247 controls. Higher levels of deprivation, childhood maltreatment, self-harm, neurodevelopmental disorders and mental health conditions before EOTAS entry were linked to higher odds of being in EOTAS. Pupils in EOTAS provision had increased incidence of self-harm, neurodevelopmental disorders and mental health conditions, from 1 year after entering EOTAS provision up to 24 years of age, than pupils with similar characteristics not in EOTAS provision. Conclusion:While EOTAS provision plays an important role, our findings indicate that it is not sufficient on its own to meet pupils&#x2019; social, emotional, behavioural and mental health needs. 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spelling 2025-12-04T15:37:43.5865401 v2 71089 2025-12-04 Risk factors and trajectories for self-harm, neurodevelopmental disorders and mental health conditions in pupils in alternative education provision in Wales: population-based electronic cohort study 0e502db88ea48ce6b053ed0eef9a54ce Olivier Rouquette Olivier Rouquette true false f141785b1c0ab9efe45665d35c081b84 0000-0003-1502-389X Marcos del Pozo Banos Marcos del Pozo Banos true false 10628af4988d624b49c4de7bd78b4694 0000-0001-5822-6633 Sze Chim Lee Sze Chim Lee true false ed8a9c37bd7b7235b762d941ef18ee55 0000-0002-5657-6995 Ann John Ann John true false 2025-12-04 Background: Pupils in alternative education provision, known as ‘Educated in Other Than At School’ (EOTAS) in Wales, UK, are among the most vulnerable learners and who, for reasons such as mental health or behavioural challenges, do not attend a mainstream or special school. Aims: We compared self-harm, neurodevelopmental disorders and mental health conditions between EOTAS pupils and controls with similar characteristics, before and after being in EOTAS provision. Method: This population-based electronic cohort study included pupils in Wales aged 7–18 years, from the academic years 2010–11 to 2018–19. We linked data from Education Wales to primary and secondary healthcare records within the Secure Anonymised Information Linkage (SAIL) Databank. Individuals included in the EOTAS data-set were identified as cases. Controls were pseudo-randomly selected based on equivalent age and academic year distribution. Results: This study included 8056 pupils in EOTAS and 224 247 controls. Higher levels of deprivation, childhood maltreatment, self-harm, neurodevelopmental disorders and mental health conditions before EOTAS entry were linked to higher odds of being in EOTAS. Pupils in EOTAS provision had increased incidence of self-harm, neurodevelopmental disorders and mental health conditions, from 1 year after entering EOTAS provision up to 24 years of age, than pupils with similar characteristics not in EOTAS provision. Conclusion:While EOTAS provision plays an important role, our findings indicate that it is not sufficient on its own to meet pupils’ social, emotional, behavioural and mental health needs. Additional support and better integration with health and social services are required. Journal Article BJPsych Open 11 5 e205 Cambridge University Press (CUP) 2056-4724 Childhood experiences, self-harm, mental health disorders, education and training, electronic records 11 9 2025 2025-09-11 10.1192/bjo.2025.10827 COLLEGE NANME COLLEGE CODE Swansea University Other This project was funded by UK Research and Innovation – Medical Research Council through the DATAMIND HDR UK Mental Health Data Hub (MRC ref. MR/W014386). 2025-12-04T15:37:43.5865401 2025-12-04T15:28:28.3794966 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Olivier Rouquette 1 Marcos del Pozo Banos 0000-0003-1502-389X 2 Sze Chim Lee 0000-0001-5822-6633 3 Ann John 0000-0002-5657-6995 4 71089__35770__02b94f1884614528a7f6bd299507eeb1.pdf 71089.VOR.pdf 2025-12-04T15:34:46.9983950 Output 489137 application/pdf Version of Record true © The Author(s), 2025. Published by Cambridge University Press on behalf of Royal College of Psychiatrists. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence. true eng https://creativecommons.org/licenses/by/4.0/
title Risk factors and trajectories for self-harm, neurodevelopmental disorders and mental health conditions in pupils in alternative education provision in Wales: population-based electronic cohort study
spellingShingle Risk factors and trajectories for self-harm, neurodevelopmental disorders and mental health conditions in pupils in alternative education provision in Wales: population-based electronic cohort study
Olivier Rouquette
Marcos del Pozo Banos
Sze Chim Lee
Ann John
title_short Risk factors and trajectories for self-harm, neurodevelopmental disorders and mental health conditions in pupils in alternative education provision in Wales: population-based electronic cohort study
title_full Risk factors and trajectories for self-harm, neurodevelopmental disorders and mental health conditions in pupils in alternative education provision in Wales: population-based electronic cohort study
title_fullStr Risk factors and trajectories for self-harm, neurodevelopmental disorders and mental health conditions in pupils in alternative education provision in Wales: population-based electronic cohort study
title_full_unstemmed Risk factors and trajectories for self-harm, neurodevelopmental disorders and mental health conditions in pupils in alternative education provision in Wales: population-based electronic cohort study
title_sort Risk factors and trajectories for self-harm, neurodevelopmental disorders and mental health conditions in pupils in alternative education provision in Wales: population-based electronic cohort study
author_id_str_mv 0e502db88ea48ce6b053ed0eef9a54ce
f141785b1c0ab9efe45665d35c081b84
10628af4988d624b49c4de7bd78b4694
ed8a9c37bd7b7235b762d941ef18ee55
author_id_fullname_str_mv 0e502db88ea48ce6b053ed0eef9a54ce_***_Olivier Rouquette
f141785b1c0ab9efe45665d35c081b84_***_Marcos del Pozo Banos
10628af4988d624b49c4de7bd78b4694_***_Sze Chim Lee
ed8a9c37bd7b7235b762d941ef18ee55_***_Ann John
author Olivier Rouquette
Marcos del Pozo Banos
Sze Chim Lee
Ann John
author2 Olivier Rouquette
Marcos del Pozo Banos
Sze Chim Lee
Ann John
format Journal article
container_title BJPsych Open
container_volume 11
container_issue 5
container_start_page e205
publishDate 2025
institution Swansea University
issn 2056-4724
doi_str_mv 10.1192/bjo.2025.10827
publisher Cambridge University Press (CUP)
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description Background: Pupils in alternative education provision, known as ‘Educated in Other Than At School’ (EOTAS) in Wales, UK, are among the most vulnerable learners and who, for reasons such as mental health or behavioural challenges, do not attend a mainstream or special school. Aims: We compared self-harm, neurodevelopmental disorders and mental health conditions between EOTAS pupils and controls with similar characteristics, before and after being in EOTAS provision. Method: This population-based electronic cohort study included pupils in Wales aged 7–18 years, from the academic years 2010–11 to 2018–19. We linked data from Education Wales to primary and secondary healthcare records within the Secure Anonymised Information Linkage (SAIL) Databank. Individuals included in the EOTAS data-set were identified as cases. Controls were pseudo-randomly selected based on equivalent age and academic year distribution. Results: This study included 8056 pupils in EOTAS and 224 247 controls. Higher levels of deprivation, childhood maltreatment, self-harm, neurodevelopmental disorders and mental health conditions before EOTAS entry were linked to higher odds of being in EOTAS. Pupils in EOTAS provision had increased incidence of self-harm, neurodevelopmental disorders and mental health conditions, from 1 year after entering EOTAS provision up to 24 years of age, than pupils with similar characteristics not in EOTAS provision. Conclusion:While EOTAS provision plays an important role, our findings indicate that it is not sufficient on its own to meet pupils’ social, emotional, behavioural and mental health needs. Additional support and better integration with health and social services are required.
published_date 2025-09-11T05:31:28Z
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