Kailo - A systemic approach to improving adolescent mental health

The mental health and well-being of adolescents is vitally important, not only for their own well-being and development, but also as a contributor to the health, social and economic prosperity of our society. Yet evidence suggests poor mental health is on the rise: fuelled by an erosion of meaningful social connections, discrimination, environmental concerns and uncertainty about economic and employment prospects (to name a few). These influences are not felt equally - the most vulnerable in society are those hardest hit, compounded by recent shocks such as COVID-19.

Typical approaches to promoting the mental health of vulnerable young people often fall far short of providing the help that young people need. The mental health system as it stands is largely designed to react to problems once they have taken hold, and as the system is so stretched, help that is made available is often too late, nor is necessarily what young people need.

Our work will take a radically different approach. As a partnership of leading scientists, designers, practitioners and community activists, we have designed an approach called 'Kailo' - which means 'connected' or 'whole'. Kailo is an evidence-informed framework that will support local partnerships to co-design strategies that address the underlying drivers of mental health. The strategies and activities will be informed by the latest scientific evidence about promoting adolescent mental health, yet will be flexed and tailored to suit local needs and contexts. These strategies will result in activities that foster social connections, enhance mental health literacy, create better connected systems of support, and inform changes to local environments and infrastructure, all of which will contribute to promoting adolescent mental health. These strategies and activities will be co-designed by young people, community members, local authority / health system practitioners and leadership (guided by the structured Kailo framework and research team).

The first two areas implementing Kailo are intentionally very different locations. One is Newham, in East London: a diverse, densely populated inner-city area. The other is North Devon: a large, rural area. Both areas have rich assets and strengths, alongside heightened levels of mental health needs and locally specific challenges. We are working in these two contrasting areas as it will allow us to explore and help refine the approach so that it can work across many different contexts as possible.

Running alongside implementation of Kailo in these two areas will be a team of experienced researchers and evaluators, who test what works well, and identify where the challenges lie. This will inform a version 2.0 of the framework, which will then be implemented in new areas, accompanied by a further evaluation exploring the impact and difference it makes to adolescent mental health, and the associated drivers of this. These evaluation activities will include state-of-the-art methodological approaches and system modelling techniques allowing us to meaningfully explore the nuances and complexity inherent in the work.

Finally, a common challenge in this sort of work is ensuring that strategies and activities are sustainable in the long-run, and don't fizzle out. Similarly, we also want to make sure that as many places around the UK and beyond can adopt the Kailo framework so that the maximum amount of young people can benefit. As such, we will be working with leading entrepreneurs and business-minded partners to ensure that our approaches can be widely adopted and sustained, yet still reflect the local nuance and needs of specific communities.

Adolescent mental health is a non-communicable disease of great policy, practice and economic concern. Levels of unmet need have long been recognised. Inequalities in poor mental health for marginalised and disadvantaged young people have been highlighted and exacerbated by the current COVID-19 pandemic.

There is increasing acknowledgement that existing mental health systems and services play an important but fundamentally limited and stretched role in responding to and treating difficulties. Adolescent mental health is a systemic issue, and to demonstrably turn the tide of deteriorating mental health in society we must address the wider and systemic determinants. Such efforts may be informed by the latest scientific advances in our understanding of the aetiology of poor mental health and the systemic moderators, mediators that exert an influence. Yet a 'one-size fits all' approach will have limited impact, as the wider determinants of mental health are expressed differently in varying contexts. It follows that evidence-informed preventative and health-promotive activities must be tailored to local context.

To this end our partnership has developed and will test an evidence-informed preventative framework called Kailo across a number of communities in the UK. The design and implementation of the framework will be led by leading social design and research teams, supporting equitable and inclusive co-design methodologies, informed by the latest evidence and targeting the wider determinants of adolescent mental health. The framework will be iteratively tested and optimised through a range of innovative developmental and systemic evaluation methods, including realistic feasibility testing, system mapping and system dynamic simulation modelling and contributory impact evaluation. This will inform ongoing refinement of the approach into a sustainable, replicable model, disseminated through extensive policy, practice and research knowledge mobilisation channels.