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)
A brief cognitive behavioural therapy workshop programme for 16-18 year olds is being tested in 60 schools across England to see if it can cut depression rates within six months. More than half of all mental health problems emerge by age 15, yet fewer than one in four young people with these conditions get help. Existing school programmes focus on younger children, leaving older teenagers with no proven options. The DISCOVER workshops—run by Child Wellbeing Practitioners for groups of up to 16 students—aim to close that gap by offering accessible treatment inside schools, where stigma and limited services often block access. If the trial shows DISCOVER is clinically and cost-effective, the programme could be rolled out nationally through the government’s plan to put mental health professionals into schools. That would give 16-18 year olds a practical, evidence-based route to treatment without requiring them to seek help from overstretched NHS services. The research also tests whether the workshops reach students from ethnic minority backgrounds and those who avoid traditional counselling, which could reshape how mental health support is delivered in secondary education.
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RESEARCH QUESTION Is DISCOVER a clinically effective and cost-effective intervention that reduces depression in 16-18 year olds at 6 months? BACKGROUND TO THE RESEARCH 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. 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. 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. 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. 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). AIMS AND OBJECTIVES To investigate the clinical effectiveness and cost-effectiveness of DISCOVER to reduce depression in 16-18 year olds. PRIMARY OBJECTIVES: 1. To investigate the clinical effectiveness of DISCOVER on depression at 6 months Secondary objectives: 1. To assess the clinical effectiveness of DISCOVER on anxiety and wellbeing 2. To assess the cost-effectiveness of DISCOVER 3. To qualitatively identify school/contextual actors that optimise clinical effectiveness 4. To assess the accessibility of the workshops for hard-to-reach populations (e.g. BME students, non-users of CAMHS or school counselling) 5. To assess the acceptability of the intervention when workshops are run by CWPs 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. 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. 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. DISCOVER could improve the mental health of students and reduce the “service-gap” in CAMHS. 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
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