King's College London

Receiving psychological support during adolescence can prevent the development of long-term and serious mental health problems. However, despite the sharp increase in poor mental health in adolescents, it is estimated that 60% of young people who need help are not receiving any care from NHS services. Barriers to accessing mental health support, such as fear of stigmatisation and limited capacity of healthcare systems, prevents young people from accessing early support at this critical juncture. There is, therefore, a pressing need to overcome these barriers and increase access to effective mental health support for adolescents.

The DISCOVER workshop is a one-day programme for 16-18 year olds to learn practical tools for managing stress, anxiety and low mood based on cognitive behavioural techniques.

The BESST trial showed that the DISCOVER workshop intervention was clinically and cost-effective when delivered by NHS Mental Health Support Teams (MHSTs) in schools and colleges. BESST also found that DISCOVER was able to engage underserved groups, particularly young people from diverse ethnic backgrounds, possibly due to the self-referral nature of the programme and by being offered at school or college.

The DISCOVER Implementation (DI) study, funded by the National Institute for Health and Care Research, now builds on this success, examining what is needed to fully integrate the DISCOVER workshop programme into existing NHS services to reach more young people across England.

Understanding the barriers to implementation and how to overcome them is essential as evidence-based interventions often struggle to be incorporated into real-world environments outside of research projects. This exciting study aims to understand how to implement DISCOVER into routine MHST services available at schools and colleges so adolescents can easily access the mental health support they need at this critical age.

Research question: What are the factors that help or hinder the implementation of the DISCOVER intervention in a sustainable, affordable way outside of a trial environment in the NHS, whilst achieving the clinical outcomes observed within the trial environment?

Aims

1. To provide a theoretically informed assessment of the factors influencing successful and sustained implementation of DISCOVER in routine practice in secondary schools.
2. To publish evidence-based recommendations, guidance and toolkits to support future implementation of DISCOVER across the secondary education sector.

Five work packages (WPs) guide the study:

1. Develop an Outcomes Measurement Framework to assess clinical and economic outcomes.
2. Support MHST-led delivery of DISCOVER in 24 schools, tracking fidelity and adaptation.
3. Identify implementation facilitators and barriers using CFIR.
4. Evaluate the implementation costs of DISCOVER
5. Create a national DISCOVER implementation guide and toolkit.

How does the DI study work?

The DI study is running from 2025-2028 across six regions in England. The study involves both sites that previously took part in the BESST trial (known as Sustain sites) and new areas implementing DISCOVER for the first time (Scale sites). In all regions, MHSTs will be trained to deliver the workshops in schools. The study explores whether the clinical and cost-effectiveness of the workshops can be sustained in the sites previously involved in BESST, and if similar outcomes can be achieved in the new regions.

To answer these questions, participating students will independently complete online questionnaires measuring their wellbeing scores, including depression and anxiety, before the workshop takes place and after the workshop at 3 and 6 months. These scores will then be compared to the findings from the BESST trial to determine whether the outcomes are comparable. Cost-effectiveness will also be compared with BESST. Additionally, insights from students, MHST staff and other stakeholders will be gathered via interviews and surveys to learn what helps or hinders the implementation of DISCOVER.

This study is guided by the Consolidated Framework for Implementation Research (CFIR), which aids the understanding of how programmes are implemented in real-world settings, and PPIE involvement is strongly incorporated into the study.

The study investigates how DISCOVER might be implemented and aims to produce a clear, evidence-based guide and practical tools to help DISCOVER be sustainably scaled-up across England.

This study is funded by the National Institute for Health and Care Research (NIHR Health & Social Care Delivery Research).

Full results from the DI study will be available in March 2028.