The Bradford Mental Health Collaboratory: an efficient platform for evaluating interventions to improve adolescent mental health

Adolescent mental health problems are a major public health concern, and epidemiological evidence suggests that prevalence is increasing in the UK. However, there is limited good quality evidence on the effectiveness of preventative interventions, and evaluations are mostly small with high risk of bias. The Bradford Mental Health Collaboratory aims to establish a programme of interventional research to address this gap. The programme will build on the substantial research infrastructure in Bradford, allowing more efficient evaluations. This infrastructure includes the Born In Bradford birth cohort study; the new Age of Wonder study collecting longitudinal measures of mental health for all 30,000 secondary school pupils in Bradford; and Connected Bradford, a research database of administrative records from the NHS, education, and social care. The programme will be comprised of seven work packages. WP1 (coproduction and adaptation of interventions) will set up processes for involving young people and professionals in the research, including a Citizens' Jury to generate recommendations. WP2 (data resources) will invest in data linkage between local cohort studies and mental health and educational administrative data. This will support the programme s analysis plans, and external researchers who are investigating adolescent mental health. WP3 (natural experiments) will evaluate five existing interventions using quasi-experimental designs. Proposed methods include difference-in-differences, multiple-baseline interrupted time series, and cohort studies with propensity score matching. The five interventions are (1) Mental Health Support Teams, a school-based service supporting pupils with less severe problems; (2) a social prescribing service for socially-isolated young people; (3) Creating Active Schools , a school-based approach to increasing physical activity; (4) the City of Culture 2025, which could improve mental wellbeing via cultural engagement and civic pride; and (5) the Bradford Clean Air Zone, which could increase mental wellbeing through neurological pathways and physical activity. The work will include equity-focused analyses, for example by estimating the association between ethnicity/deprivation and access to interventions. WP4 (trials) will deliver a feasibility cluster-randomised trial of an intervention that improves the school climate. The intervention includes workshops about risk-taking behaviours and emotional skills; and engages staff, pupils, and parents in school policies. It is based on the World Health Organisation Health Promoting Schools framework and builds on trials in Australia and India. The feasibility trial will randomise six schools with a primary outcome of school absences. Depending on the results and funding for a full trial, it will be scaled-up to a fully-powered trial within the duration of the programme grant. WP5 (health economics) will use microsimulation to estimate the economic and distributional impacts of preventing mental health problems in adolescence, and the contribution of the interventions evaluated in WP3 and WP4. WP6 (implementation and theory development) will study the context and mechanisms of interventions in Bradford. This will include an implementation science-based approach to the feasibility trial, and qualitative research with young people who have experience of mental health services. WP7 (dissemination) will involve dissemination of findings, including traditional academic channels; policy briefings; engagement and strategy development with local partners; and mainstream media and social media.