The Identification and Adaptation of an Effective Mental Health and Wellbeing Intervention for Implementation with Welsh Secondary School Students aged 11-18

Aim:

To understand what is needed to address adolescent mental health in schools in Wales, select an effective intervention which fits these needs, and make recommendations on how to adapt it to Wales.

Background:

In Wales, 19% of adolescents report elevated mental health symptoms, with anxiety and depression increasing since the COVID pandemic. Secondary school students also face problems accessing specialist mental health care and they are ‘bounced’ between services when seeking help. The Welsh Government recognises these problems and made it statutory for schools to embed a Whole-School Approach (WSA) to mental wellbeing in 2021. Schools must offer a range of support including programmes to increase all students’ mental health knowledge and targeted programmes for those at risk of more severe problems.

Meeting these requirements is difficult for schools because there is no clear evidence that UK programmes make a long-term difference to mental health. Also, whilst the WSA implicates teachers as key agents, their own high levels of anxiety and depression, their limited time and mental health expertise, and adolescents not wanting teachers to deliver sensitive health information makes this difficult. Globally, interventions do exist which decrease secondary school students’ mental health problems, and these could be adapted to Wales. They have potential as they: target symptoms for both anxiety and depression, and many adolescents experience both; use lay individuals to deliver programmes, decreasing the load on teachers; and use a model which meets the WSA’s focus of supporting all students’ mental health, as well as targeting those showing symptoms.

Design:

The study has two phases. In phase 1, there are three methods. First, a case study analysing relevant Welsh policy and research, and including focus groups with students and school staff, and interviews with health practitioners and government personnel will be undertaken. This will show what could make a difference to adolescent anxiety and depression in schools. Secondly, using this information as criteria, a rapid review will produce a list of interventions which will be scored (based on the strength of their evidence), with the final intervention selected depending on negotiations with developers about the possibility for adaptation. Lastly, a case study of relevant documents, observations in the original context, and interviews with those that developed and delivered the intervention will provide a model of it, and how it is delivered.

Phase 2 involves two methods. First, a comparison of the two case studies will produce a draft of how the intervention could work in Wales and any potential issues which need addressing. Subsequently, a participatory process of consultations with the same stakeholders as in phase 1 will be conducted. Participants will be informed about the draft intervention and potential issues, and their ideas on the changes needed to fit to Wales will be incorporated.

This will result in recommendations of the adaptations needed to deliver the intervention in Wales, and a comprehensive intervention model.

Public involvement:

Four sessions each with two youth advisory groups (one for mental health service users and a general population group) are positioned at important decision-making points.

Dissemination:

Three academic articles, a professional and a young person’s report, a blog, webinar and conference presentations will be produced.