Title: Early intervention for depression and anxiety in 16-18 year olds : a multi-centre trial of self-referral psychological Stress workshop programmes in schools (BESST study - Brief Educational workshops in Secondary Schools Trial)
Funder: Department of Health and Social Care

Abstract: AIMS OF THE RESEARCH_x000D_ We have developed a workshop programme for 16-18 year olds, called ‘DISCOVER’. The 3 key aims of the programme are to _x000D_ i. be accessible to students _x000D_ ii. offer a programme that is helpful and helps students maintain their progress_x000D_ iii. offer good reach so that this low-cost intervention is widely offered _x000D_ _x000D_ This group programme (each for up to 16 students) is a day-long programme with up to 3 phone calls with the workshop leader after the workshop to discuss how students are progressing with their personal goals. _x000D_ _x000D_ We originally tested this programme with a small group of 31 students and found that they reported lower depression and anxiety. We also found that black and ethnic minority students were happy to come. We then ran a larger second study of 155 students and found that students were happy to take part – and stay in the study. We also found that the programme was acceptable to students and seemed to help students. We therefore concluded we should run this larger 3rd study in different sites. _x000D_ _x000D_ BACKGROUND TO THE RESEARCH_x000D_ Studies show that the mental health of young people is getting worse. However, specialist mental health services are not large enough and young people are not always keen to seek help from professionals. Further, there are no effective programmes for 16-18 year olds._x000D_ _x000D_ The Government is aware of the problem and is discussing what can be done. It is proposing to introduce new school-based mental health professionals who would run programmes that have been shown to be helpful. We hope that if this study is successful, DISCOVER could be run by these new school-based professionals._x000D_ _x000D_ DESIGN AND METHODS USED_x000D_ We want to test the effects of the new programme, DISCOVER, in 4 different areas of the UK (London, Bath, Manchester, Northampton). This 3 year study will involve 60 schools and 900 students. We want to compare the DISCOVER programme with help normally offered in schools. We want to see if the DISCOVER programme will be shown to reduce depression and anxiety compared to a control intervention (normal provision in schools). We also want to test more complex effects like economic costs as well as factors which might affect how well the programme is run (e.g. which school, workshop materials) as this could affect how the programme is normally run in schools._x000D_ _x000D_ PATIENT AND PUBLIC INVOLVEMENT_x000D_ The DISCOVER programme has been developed from the start with young people. They actually suggested it should be called ‘DISCOVER’ and advised about the programme and how to deliver it. In this third study, we are collaborating with another group of young people with experience of mental health problems (called Common Room) who will help us in several ways. They will work with students at each site and also help design materials for the study as well as help publicise the results. _x000D_ _x000D_ DISSEMINATION_x000D_ We will write reports for managers in the NHS, schools and colleges and the government. We will also write papers and present at conferences so that other people will learn about this study.

Lay abstract: RESEARCH QUESTION _x000D_ Is DISCOVER a clinically effective and cost-effective intervention that reduces depression in 16-18 year olds at 6 months? _x000D_ _x000D_ BACKGROUND TO THE RESEARCH _x000D_ Poor mental health in young people is common and rates are increasing. It has been shown that over 50% of mental health problems develop by age 15. However, less than 25% of young people with these problems access services, indicating a large “need-service” gap. Common barriers include the limited provision of services, a reluctance by adolescents to seek help and a fear of being stigmatised. _x000D_ _x000D_ School-delivered mental health programmes have been developed with some promising results but mainly focus on younger children. There are currently no effective programmes for 16-18 year olds for depression and anxiety._x000D_ _x000D_ We therefore developed DISCOVER which is a brief CBT group workshop programme (each for up to 16 students) which has been specially developed for 16-18 year olds. It aims to be accessible, offer effective treatment and offer good reach as it is a group intervention._x000D_ _x000D_ The pilot evaluation showed promising results for accessibility and effectiveness. A recent NIHR funded feasibility study in 10 London schools showed the viability of research methods (e.g. recruitment and retention), potential clinical impact as well as acceptability to students and staff. DISCOVER now needs testing in a full trial. _x000D_ _x000D_ To reduce the “need-service” gap, the Government is now proposing to introduce more education based mental health care in schools, provided by new professional groups such as Child Wellbeing Practitioners (CWPs). _x000D_ _x000D_ AIMS AND OBJECTIVES To investigate the clinical effectiveness and cost-effectiveness of DISCOVER to reduce depression in 16-18 year olds._x000D_ _x000D_ PRIMARY OBJECTIVES: _x000D_ 1. To investigate the clinical effectiveness of DISCOVER on depression at 6 months_x000D_ _x000D_ Secondary objectives: _x000D_ 1. To assess the clinical effectiveness of DISCOVER on anxiety and wellbeing_x000D_ 2. To assess the cost-effectiveness of DISCOVER_x000D_ 3. To qualitatively identify school/contextual actors that optimise clinical effectiveness _x000D_ 4. To assess the accessibility of the workshops for hard-to-reach populations (e.g. BME students, non-users of CAMHS or school counselling) _x000D_ 5. To assess the acceptability of the intervention when workshops are run by CWPs_x000D_ _x000D_ METHODS A cluster randomised controlled trial, in four UK areas (London, Bath, Manchester, Northampton) compared with a control intervention (normal provision). 60 schools (n=900 students) will be randomised and students and followed up 3 and 6 months following consent. Clinical outcomes, intervention processes and cost-effectiveness will be assessed. _x000D_ _x000D_ TIMELINES FOR DELIVERY The 3 year study will run from January 2020 until December 2022. There will be 2 cohorts. In each year, school recruitment will occur between May and August, followed by student recruitment between September and November with follow-ups until May the following year. Analysis and write-up will take place Jun-Dec2022._x000D_ _x000D_ ANTICIPATED IMPACT: If DISCOVER is shown to be effective, it could be readily implemented in secondary schools across the UK, and CWPs trained to deliver DISCOVER. _x000D_ _x000D_ DISCOVER could improve the mental health of students and reduce the “service-gap” in CAMHS. _x000D_ _x000D_ DISSEMINATION: NHS managers, schools and colleges and policy makers will receive progress/ outcome reports. Academic papers will be published and findings presented at key conferences

Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH