Adolescent Mental Health and Development in the Digital World

VISION: Our vision is to harness the potential of digital technology to transform adolescent mental health and wellbeing and provide a safe, and supportive, digital environment to tackle the growing humanitarian crisis of unmet need arising from mental health disorders in young people (covering the definition of adolescence from age 10 up to the age of 25).

THE PROBLEM: There is a youth mental health crisis; in the UK, 1.25 million (25%) of 17-19-year-olds experience significant levels of depression or anxiety; yet less than a third of these young people receive any treatment. Academic-led digital interventions exist but few, if any, have been implemented in real-world settings. Meanwhile, there are thousands of mental health and wellbeing apps, but the vast majority have no evidence-base and some may be harmful. This crisis coincides with a new 'digital environment', where being online and using social media has become integral to young people's lives. However, social media platforms are not designed to meet the mental health needs of young people. Pressing societal, public policy and research questions concern how the 'digital environment' affects young people's mental health; whether it increases the risk for mental health problems and how vulnerable young people with mental health difficulties engage with the digital environment.

THE SOLUTION: Our research vision addresses two key challenges:
i) RESEARCH THEME 1: DIGITAL INTERVENTIONS: How to harness digital technologies and platforms to identify those at risk and target personalised digital interventions that bridge the adolescent mental health treatment gap. This includes developing the infrastructure to collect, share, discover and analyse sensitive personal data that matches the speed of digital innovation
ii) RESEARCH THEME 2: DIGITAL RISK & RESILIENCE: How engagement with the digital environment influences, and is influenced by, adolescent mental health problems, brain and cognitive development and what factors promote resilience. We aim to generate evidence-based advice to safeguard youth from harmful digital environments and design tools to promote resilience.

ENGAGEMENT STRATEGY: We will bring together, through workshops, knowledge exchange events and pilot studies, an interdisciplinary community of researchers (psychiatry, psychology, neuroimaging, computer science, arts & design, humanities, education) to work with young people, parents/caregivers, clinicians, digital technology developers and policy-makers to offer vital co-ordination and research leadership in this nascent field. The collaboration builds on an outstanding track record of digital mental health research at the University of Nottingham (UoN) (NIHR MindTech Medtech Co-operative, NIHR Nottingham Biomedical Research Centre Mental Health & Technology Theme and Horizon Digital Economy Research Institute). We will engage with industry and charity partners (BBC, Xenzone, Samaritans), leading UK academic centres (Oxford, UCL, KCL, LSE) and UKRI Mental Health Networks (eNurture, Emerging Minds).

YOUTH ENGAGEMENT: Young People's Advisory Group (YPAG): working in collaboration with McPin Foundation we will ensure that immersive patient and public involvement (PPI) and co-production with young people and their parents/caregivers cuts across all of our activities. Our Partners Board will facilitate knowledge exchange with healthcare, social care, education, policy-makers and industry to deliver evidence-based policy and practice solutions that can be readily implemented.

OUTPUTS & IMPACT: Our proposed Engagement Award will be at the vanguard of these developments through building and sustaining new interdisciplinary research collaborations, knowledge exchange, developing early career researchers (ECRs), engaging new partners and laying out a road map for future research.

OBJECTIVES

By engaging new partners and academic disciplines, the Engagement Award will lay out a research road map for future activity, ensuring a high probability of delivering significant impact, within the MRC/AHRC/ESRC Adolescence, Mental Health and the Developing Mind programme.

METHODOLOGY

A wide range of methods will be used in pilot projects and engagement activities in order to capture the complexity and dynamics of this fast-moving field: some exemplar methods for pilot studies are described here:

1. PP1.1: Feasibility and acceptability of the SPARX CBT programme for UK adolescents. This will lay the foundations for a future large randomised controlled trial comparing supported versus unsupported version of SPARX in UK adolescents.
2. PP1.2: HABITs digital platform: we will i) establish a shared source code repository accessible to NZ and UK developer teams. ii) use the shared code repository to deploy a running instance of the HABITs digital platform in the UK with support of the NZ team in configuring the service. iii) apply the UK instance of the platform to enable demonstration trials of an existing digital mental health app (SPARX app) already configured to interoperate with the HABITs platform, and proof-of-concept operation with novel tools as provided by UK researchers.
3. PP2.1: Developmental epidemiological methods will be used to interrogate existing data from the MILLENNIUM COHORT STUDY to investigate adolescent risk and resilience in digital environments.
4. PP2.2: To facilitate examination of brain resilience we will create an open-source framework capable of extracting a collection of quantitative and interpretable multivariate imaging-derived features per individual (imaging-derived phenotypes).
5. PP2.3: A qualitative interview study will examine the benefit and risks of digital skills in adolescents experiencing internet-related mental health difficulties - the benefits and risks of digital skills.

Our long-term vision is to deliver benefits to young people, industry, health, education and social care practitioners, policy-makers, and the wider research community. Through the pilot projects and workshop activity, the Engagement Award will provide an important stepping-stone in progressing towards this goal.

YOUNG PEOPLE: Through our pioneering Café Connect work will engage with young people in relaxed, non-threatening environments in the community to ensure they have meaningful involvement in shaping and prioritising future research. Young people have helped shape the work planned here and will be involved throughout the research process from beginning to end.

INDUSTRY, PRACTITIONERS & CHARITIES: can potentially benefit from the identification of unmet needs in the field and have a say in prioritizing future research questions. We have excellent relationships with some partners already (e.g. Samaritans, Xenzone, BBC) but the engagement award will permit us to extend our networks significantly.

POLICY MAKERS: Through our PARTNERS BOARD and engagement events, we will work with policy-makers in health, education, social care and Government. This includes organisations such as the UK Department of Health and Social Care, Department for Culture, Media and Sport (CSA Professor Tom Rodden) and the National Institute for Health and Care Excellence (NICE) to inform public health policies, regulation of digital technologies and guidance on new digital interventions. We will leverage the excellent contacts and networks afforded by the University of Nottingham Institute of Policy and Engagement led by Stephen Meek (ex Cabinet Office).

SCHOOLS & COLLEGES: our work will be important to the work of schools who possess unrivalled access to young people - especially new mental health practitioners. Our partnership with the Anna Freud Centre National Schools in Mind Network (>11,000 schools and colleges) will ensure that we engage with a wide range of professionals.

HEALTH & SOCIAL CARE: we will engage with NHS England, Public Health England, NHSX and Local Authorities who will be important partners to ensure that future interventions and tools are deliverable within the NHS and social care. It is vital to reduce the gap between the production of research and the application of findings within clinical practice. The Mental Elf Blog currently estimates the gap between research and delivery in mental health services to be 17 years.

Ultimately, the pilot and engagement work described here will provide vital information regarding the development of digital interventions for young people with mental health conditions and evidence-based policy to make the safest place in the world for young people to be online. These benefits could have huge potential to translate across the world, to help reduce global mental health inequalities, particularly in low and middle-income countries.