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Health

Brief Educational workshops in Secondary Schools Trial (BESST)

Poor mental health in young people is increasing, with clear evidence of mounting psychiatric problems. However, less than a quarter of young people with mental health problems can access services, meaning there is an urgent need for easily accessible and effective mental health resources. Common barriers include the limited provision of services, reluctance of adolescents to seek professional help as well as a fear of stigmatisation.

Young people’s mental health is a major government priority, with current policy advocating the development of effective education based mental health care to prevent the escalation of mental health problems, improve access and reduce service waiting times. However, existing school-delivered programmes for depression and anxiety only have modest effects. These programmes are also mainly focused on younger children.

With these factors in mind, we have developed an accessible and non-stigmatising workshop program for older students. This award-winning programme, named DISCOVER, is a brief group workshop programme for 16 - 18-year-olds that was developed in collaboration with a Teenage Advisory Group (TAG) of 16 - 18-year-olds. DISCOVER aims to improve engagement, offer effective treatment, and maintain participants’ motivation and improvement to reduce relapse. The DISCOVER workshop is delivered in a group setting, to around 12 - 15 young people, over one school day. The workshop includes videos, discussions, and the chance to learn and practice techniques designed to improve and maintain mental wellbeing. The workshop material is organised into eight short (20 minute) sections and particular attention is paid to personal, relationship and academic worries typical for 16 - 18-year-olds. Specific methods taught include (i) Behavioural methods e.g. time management, sleep hygiene and maintaining motivation (ii) Cognitive methods e.g. learning to challenge negative thoughts and (iii) mindfulness e.g. meditation exercises. Following the workshop, to maintain progress and adherence, participants receive a DISCOVER workbook and access to a workshop-specific DISCOVER app to remind them of the methods. Participants also receive three 'follow-up' phone calls from the workshop leader to discuss how they are progressing with their personal goals.

We would like to understand whether this workshop is more effective at improving students’ mental health than the normal care they receive at school. Specifically, this clinical trial aims to answer the research question of whether the DISCOVER workshop is a clinically effective and cost-effective intervention in schools that reduces symptoms of depression in 16-18-year-olds at 3 and 6 months after the intervention.

The results of this trial will tell us whether DISCOVER is a suitable programme to take forward as a school-based mental health provision. It is very possible that DISCOVER could be a highly effective and popular component in frontline education-based mental health care as advocated by government health and education policy. We see DISCOVER fitting in very well with the current education-based mental health care aims of the government. Therefore, this trial is essential to inform the Department of Health about the effectiveness of this potentially very important intervention for 16 - 18-year-olds.

Publications

Sclare I, Michelson D, Malpass L, Coster F, Brown JS: Innovations in practice: DISCOVER CBT workshops for 16-18 year olds: development of an open-access intervention for anxiety and depression in inner-city youth. Child and Adolescent Mental Health 2014, 20(2):102-106.

Brown JSL, Blackshaw E, Stahl D, Fennelly L, McKeague L, Sclare I, Michelson D: School-based early intervention for anxiety and depression in older adolescents: A feasibility randomised controlled trial of a self-referral stress management workshop programme (“DISCOVER”). Journal of Adolescence. In press.

ISCRTN page

Study Team

Chief Investigator

Dr June Brown

Co-Investigators

Professor Paul Stallard
University of Bath

Dr Jessica Deighton
University of Manchester

Miss Jynna Yarrum
University of Northampton

Dr Ben Carter
Institute of Psychiatry, Psychology & Neuroscience

Dr Crispin Day
CAMHS Research Unit, Maudsley Hospital

Dr Irene Sclare
Michael Rutter Centre, Maudsley Hospital

Professor Peter Fonagy
University College

Dr James Shearer
Institute of Psychiatry, Psychology & Neuroscience

Professor Sarah Byford
Institute of Psychiatry, Psychology & Neuroscience

Dr Tim Weaver
Middlesex University

Project status: Ongoing

Contact

Dr Stephen Lisk
Trial Manager
stephen.lisk@kcl.ac.uk

Dr June Brown
Chief Investigator
june.brown@kcl.ac.uk