School based mental health intervention for young people: development and feasibility study of a digital information prescription intervention.

Lead Research Organisation: University of Leeds
Department Name: School of Psychology

Abstract

There is overwhelming evidence that the foundation of lifelong mental health begins in childhood and adolescence. Currently, more than half of young people will, by the age of 21, have experienced mental health difficulties [3,4]. This is of concern since mental health difficulties in adolescence typically persist into adulthood [5]. The cost of poor mental health to the young person, their families, and the healthcare system is extensive [6]. In the UK, the need for specialist mental health services far outweighs resources, and only a quarter of those referred to specialist services will be seen [7]. Young people and families are often left to cope with mental health difficulties on their own. This project aligns with strategic shifts in national and international policy [8,9] to promote mental health through public health initiatives and with recommendations for early intervention when mental health difficulties arise [5]. In regional (Leeds) plans for implementing the NHS England and Department of Health's Future in Mind strategy [8], young people say that "We want it to be easy to find information about mental health and well-being so we can help ourselves" and "We want to be able to get help quickly and easily when we ask for it" [10]. This project therefore adopts a public health approach to examine the potential of information prescription to help young people with early signs of mental health difficulties get the information they need to help themselves. Information prescription involves the prescription of evidence-based, personalised information and guidance, at the right time, to help people understand their experiences, and equip them with knowledge, strategies and motivation to improve their well-being. Studies with adults show high levels of user satisfaction with self-help information interventions for physical and mental health conditions [11, 12], but the potential of self-help information prescription to help the mental health of young people is unexplored. There is currently no information prescription intervention for young people's mental health that can be delivered in schools. We will develop and feasibility test a digital information prescription intervention suitable for delivery by trained staff in schools to 14-18 year olds who are experiencing mild-moderate (but non-clinical) mental health difficulties and who are in the help-seeking stage [13]. A sister intervention for parents/carers will be developed as they currently report feeling insufficiently equipped to help. The primary aim of the intervention is to halt the progression of early mental health difficulties and to help the young person resume a productive and enjoyable life by developing their knowledge, understanding and resources to improve their mental health. Our project adopts a recovery approach, stressing the first person view of the service user, including personal views of what recovery and good mental health means [14].Our early phase study will work closely with YP with mental health difficulties, parents of YP with difficulties, school staff and mental health professionals to identify their support and information needs, before building an information repository relevant to the six most common mental health difficulties experienced by young people in local schools, and which would be suitable for early intervention via information prescription in school. We will convert this repository into a secure, interactive, multi-media platform, suitable for web and app based access, with monitoring potential, delivered via trained school staff. The project will also co-design school based implementation and training materials as well as safety and evaluation protocols to ensure that any young person whose need escalates will receive help quickly. We will use the study outcomes to co-design a trial comparing the effectiveness of the intervention with other early intervention approaches for young peoples' mental health.

Technical Summary

YP aged 12-18y have the highest incidence and prevalence of mental illness across the lifespan [3,4]. Public health approaches to mental ill health are strongly advocated nationally and internationally [16, 17]. Indicated prevention interventions can reduce the incidence of new cases of mental disorder; these target individuals showing early signs of poor mental health and they aim to avoid progression to a fully-fledged disorder [15]. Although UK schools have responsibility for supporting YPs mental health, they are without a well-evidenced, sustainable early intervention programme. We will develop and feasibility test a digital information prescription intervention for delivery in secondary schools to indicated YP aged 14-18y, along with a sister intervention for parents. Information prescription encourages people to act on accurate, personalised information and guidance about their difficulties, and covers the affective, cognitive and behavioural determinants of good mental health [18,19]. An early phase study is required as existing information prescription interventions for adult mental health [e.g.11,12] are unsuitable and unworkable for delivery in schools to YP. Adopting a comprehensively co-design process with YP, parents, schools and other stakeholders, we will generate intervention content and the technical and software delivery platform, along with training materials and key design features including theoretical frameworks, implementation model, recruitment criteria, user defined outcomes, prototype journey, risk management protocol, referral pathways, change measurement and feasibility and acceptability benchmarks. We will assess information standards and communication power of intervention content before a feasibility and acceptability study in four pilot sites, where we will also test candidate outcome measures for the main study, alongside an exploratory health economics assessment. Outcomes will inform the design of an RCT.

Planned Impact

A clear and meaningful pathway to impact in this project is facilitated by the centrality of user perspectives, its attention to the complexities of schools as implementation contexts, and in the comprehensive co-design and testing of resources with users and stakeholders. We will realise project impacts through our co-design process, our communication strategy, targeted impact events and by applying for a Knowledge Exchange Fellowship (University of Leeds Social Sciences Impact Acceleration Fund) early in the life of the project. We anticipate both short- and long-term impacts for the following beneficiaries:

(i) YP, parents and schools: YP will benefit from involvement in our co-design process (e.g. new experiences and skills, mental health information, value in contributing to research) and by participation in the intervention, where we anticipate improvements to quality of life. Parents will benefit from contributing to co-design (e.g. meeting other parents, influencing action) and also from intervention participation (e.g. accessing new resources). Schools will benefit from shaping the intervention for suitable delivery in schools and by access to new resources to support YP's wellbeing.

(ii) Mental Health Stakeholders: Public health commissioners need cost-effective, sustainable, evidence-base interventions that can operate as both preventive and early intervention for mental health. This project will deliver important early indicators of the potential of information prescription as a public health initiative with young people. We will inform local commissioners of the project and will share final outcomes with them. The project is supported by Leeds South and East CCG and, through RG, we have direct input to the Future in Mind: Leeds Local Transformation Plan (Programme Board) which the CCG lead. We will use the project outcomes to influence the agenda there for public mental heath interventions with young people (e.g. the value in testing low intensity, resilience building, early interventions; and the creative deployment of co-designed digital technologies). There may be additional longer-term impacts through the sharing of good practice with other UK regional transformation plans.

(iii) Digital Technologies and Information Prescription: The innovative use of information prescription through interactive, multi-media for young people will have national interest. We will host a one day national conference targeting non-academic stakeholders to showcase the new resource and to raise awareness of the potential of information prescription for recovery of good mental health.
(iv) Public Mental Health Practice & Policy: Current UK policy highlights schools' responsibilities for the health and wellbeing of children and young people, yet there is a significant absence of support for schools to deliver public mental health work, and more broadly, there are tensions and challenges facing the nature and ownership of public mental health initiatives. We will contribute to and extend these discussions via a multi-stakeholder event examining key issues facing public mental health for YP and the changing landscape for schools as key sites for public mental health work. A post-event report will published online with email shots to key stakeholders.

Across these domains and with the third sector, we will aim to establish new relationships likely to be important for a future definitive trial and to create a step-change in way information prescription may be used and deployed for mental health. Success in our Pathways to Impact will be indicated by: number of users reached through the project; feedback from the steering group and participants; website hits; number and kind of attendees at impact events; number of new collaborative partnerships established; the number of new organisations /stakeholders to whom we communicate the work; and the number of successful publications in both academic and non-academic outlets.

Publications

10 25 50
 
Description Presentation to Clinical Commissioning Group
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Participation in a advisory committee
 
Description Leeds Clinical Commissioning Group
Amount £3,000 (GBP)
Funding ID 115508 
Organisation NHS Leeds South and East CCG 
Sector Public
Country United Kingdom
Start 03/2018 
End 03/2019
 
Description MRC Proximity to Discovery
Amount £12,599 (GBP)
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 09/2019 
End 12/2020
 
Description Leeds Clinical Commissiong Groups 
Organisation NHS Leeds CCG
Country United Kingdom 
Sector Hospitals 
PI Contribution Sharing up-to-date research evidence on mindfulness for young people. Contribution to an online portal for mental health support to young people in Leeds.
Collaborator Contribution Leading the mindfulness elements of an online portal for mental health support to young people.
Impact MindMate has been launched and mindfulness for young people is included.
Start Year 2015
 
Description National Institute of Mental Health and Neuroscience 
Organisation National Institute of Mental Health and Neurosciences
Country India 
Sector Hospitals 
PI Contribution A new research collaboration to develop school based mental health interventions in India
Collaborator Contribution University of Leeds funded a grant writing visit for two academics from the National Institute of Mental Health and Neurosciences. We are currently writing that grant application.
Impact No outcomes yet - we are writing a grant application which we hope to submit by end of 2020. Disciplines involved: psychiatry, psychology, arts and media, healthcare, social policy
Start Year 2019
 
Description Thompson Brand Partners 
Organisation Thompson Brand Partners
Country United Kingdom 
Sector Private 
PI Contribution Thomson Brand Partners were chosen at the grant application stage to support the development of the digital aspect of the intervention. They were pursued as they had already created, with Clinical Commission Groups, the current digital provision for mental health services in Leeds.
Collaborator Contribution TBP will be creating the software to deliver our intervention. This process has begun.
Impact We are still currently in the intervention design stage.
Start Year 2017
 
Description mHabitat 
Organisation mHabitat
Country United Kingdom 
Sector Private 
PI Contribution mHabitat were a chosen partner at the grant application stage, This is the first time we have collaborated. I pursued this partnership via a Clinical Commissioning Group contact.
Collaborator Contribution mHabitat are responsible for guiding the co-design process of our digital intervention. To date, they have been associated with a number of our workshops.
Impact Outputs to date are workshops co-design outputs that are informing our intervention development.
Start Year 2017
 
Title MindMate2U 
Description MindMate2U is a tool for early intervention for youth mental health. It is a form of self-help and is transdiagnostic. It is developed for hosting within schools as a school resource, but otherwise entirely private and independently navigated by the young person. It contains psychoeducation on 5 risk topics (stress, anxiety, low mood, anger and panic) and wasy to promote 5 resilience factors (sleep, relationships, purpose & direction, self-esteem and dealing with challenges). It is a 6 week program. 
Type Of Technology Webtool/Application 
Year Produced 2018 
Impact Our project has tested the acceptability and feasibility of MindMate2U in four UK secondary schools. Outcomes show both are high, with no identified risks. Schools are keen to host the resource. Our plan is to apply for funds to take this to an effectiveness trial. 
URL http://www.dip.leeds.ac.uk
 
Description Conference Presentation (Belfast) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact A presentation at the European Conference on Mental Health in Belfast (4th October 2019). The purpose was to report the outcomes of the feasibility study. We had requests during and after the event from researchers and third sector organisations to find out how they could engage with the 'app' we had created.
Year(s) Of Engagement Activity 2019
URL https://www.ecmh.eu/wp-content/uploads/2019/09/ECMH-oral-presentations-30092019.pdf
 
Description Mental Health Professionals Design Workshops 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact We engaged 15 mental health professionals from clinical practice and the third sector to help co-design intervention content. Many of the contributors remained engaged with the project and were final reviewers for intervention content. Three have registered to attend our end of project scientific meeting.
Year(s) Of Engagement Activity 2018
URL http://www.dip.leeds.ac.uk
 
Description Parent Co-Design Workshop (Autumn 2017) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Patients, carers and/or patient groups
Results and Impact This was a co-design workshop with parents or carers of young people who had experienced mental health difficulties. They helped us to start sharing the parental component of the intervention.
Year(s) Of Engagement Activity 2017
 
Description Presentation at the International Association for Youth Mental Health 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Patients, carers and/or patient groups
Results and Impact Presentation on the study outcomes at the 5th International Conference on Youth Mental Health in Brisbane, Australia (26-28th Australia). The conference is relatively unique is having a significant focus on youth and third sector engagement.
Year(s) Of Engagement Activity 2019
URL https://www.iaymh2019.com/
 
Description Presentation to Special Interest Group - Clinical Child Psychology 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Presentation to disseminate and discuss the planned intervention with a Special Interest Group focused on child and adolescent mental health. A number of people approached me afterwards to show interest in the project and, via this, we recruited an additional secondary school teacher for our steering group. That teacher is supporting the piloting of the planned intervention in their school and is supporting recruitment to an upcoming teacher co-design workshop.
Year(s) Of Engagement Activity 2018
 
Description Professional Approval Panel (MindMate) 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact A three hour workshop with an existing panel of experts responsible for approving digital mental health support for young people in Leeds. The purpose was to consult with them on our evolving intervention and to ensure clinical safety.
Year(s) Of Engagement Activity 2018
 
Description School Mental Health Fair 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Schools
Results and Impact Hosting a mental health stall at a school Health Fair, explaining the MRC funded project and engaging young people in dialogue about looking after our mental health. Allowed young people to see how digital tools are being designed for them, for use within schools.
Year(s) Of Engagement Activity 2019
 
Description Scientific Meeting:The digital space and young people's mental health 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other audiences
Results and Impact A scientific meeting (University of Leeds) to share our study outcomes and to open debate and dialogue about the evidence, ethics and future of e-interventions for youth mental health. We engaged diverse groups, from local library services to schools to expert researchers.
Year(s) Of Engagement Activity 2019
 
Description University Open Days 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Hosted demonstrations of the newly designed digital tool from the project. Allowed general public to see MRC funded research on mental health and the possibility of digitally delivered mental health support.
Year(s) Of Engagement Activity 2019
 
Description Young People Co-Design Workshops 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact 17 young people aged between 14-18, and who had different experiences of mental health difficulties attended between 4 and 7 workshops. The purpose of these workshops was to co-design the planned intervention, from recruitment through to content, implementation and evaluation. Workshop outputs have directly informed the intervention design. We have been, and will be, sharing these outputs with parents and schools in upcoming co-design workshops with those stakeholders.
Year(s) Of Engagement Activity 2017,2018
 
Description Young People's User Workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Patients, carers and/or patient groups
Results and Impact Young people engaged with a beta version of the newly developed digital tool and gave their views on it, We discussed a range of aspects of implementation in schools as well as security and privacy issues. This led to another round of refinements prior to full testing.
Year(s) Of Engagement Activity 2019