Racial-ethnic and gender inequities in school absences, exclusions and SEND responses to mental health need: population-based cohort study using linked administrative data in England

Objective: To examine whether schools respond equitably to indicators of mental health need - absences and exclusions - across racial-ethnic group and gender, by examining rates, timing and pathways between these indicators and school Special Educational Needs and Disability (SEND) provision for Social, Emotional and Mental Health (SEMH) needs or mental health-related hospital contacts.Design: Population-level longitudinal analysis of linked administrative school and hospital records, developed in partnership with peer researchers with lived experience and community stakeholders.Setting: State-maintained schools in England, 2005-2018.Participants: 1,696,198 children aged 5-16 years born 2000-2002. Main outcome measures: Rates and timing of severe absences and exclusions. Risk ratios for pathways between indicators of need and SEND-for-SEMH and mental health-related hospital contacts.Results: School responses to the same indicators of need differed systematically based on racial-ethnic group and gender, with simultaneous over-punishment and under-recognition. Over-punishment manifested in boys from Mixed White-Black, Mixed Other, Black, Pakistani, Bangladeshi, Romani, Irish Traveller and Other racial-ethnic groups, and girls from Mixed White-Black Caribbean, Black Caribbean, and Romani backgrounds, being significantly more likely to be excluded before SEND-for-SEMH compared to White British boys. Boys from Mixed White-Black, Mixed Other, Black Caribbean, Black Other, Romani and Irish Traveller backgrounds were significantly more likely to be excluded after SEND-for-SEMH. Black Caribbean, Irish Traveller, Mixed White-Black Caribbean, and Romani pupils experienced exclusions younger. Under-recognition manifested in most girls and pupils from Asian, Black African, White Other and Other racial-ethnic groups being significantly less likely to receive SEND-for-SEMH following severe absences or exclusions. Among girls with indicators who accessed hospital services, three quarters had high-need contacts, predominantly inpatient admissions.Conclusions: Differential school responses to indicators of need based on gender and racial-ethnic group constitute intersectional discrimination, breaching the Public Sector Equality Duty. Mandatory equity-oriented frameworks, formal concern pathways and accountability mechanisms are urgently needed.