Selective and indicated UK school-based mental health interventions: a systematic review and narrative synthesis

BACKGROUND

Mental health disorders amongst children and young people pose a significant burden, with a growing emphasis on early intervention. A notable gap exists between the prevalence of these disorders and sufficiently early treatment, emphasising the need for effective preventive measures.

AIMS

This review aims to comprehensively assess and narratively synthesise both quantitative and qualitative literature on secondary preventative (indicated and selective) school-based mental health interventions in the UK.

METHOD

All empirical studies published since 2010, which reported on UK secondary preventative school-based interventions were eligible. Eligible studies were identified by searching the following electronic databases: PsycINFO (Ovid), MEDLINE (Ovid), Scopus (Elsevier), EMBASE (Elsevier), ERIC (EBSCO), and Web of Science (Clarivate). Database searches yielded 3269 results, with 26 articles meeting inclusion criteria. These articles covered 22 unique studies encompassing various study designs. The Mixed Method Appraisal Tool (MMAT) was used to assess study quality, and study findings were synthesised using a single narrative synthesis ('storytelling') approach.

RESULTS

Three central themes emerged: (1) Outcomes for children and young people; (2) acceptability and preferences; and (3) practical considerations. The majority of included studies demonstrated high quality. Studies revealed diverse perspectives on the strengths, limitations, barriers, and facilitators of school-based interventions.

CONCLUSIONS

School-based interventions hold promise in promoting positive mental health amongst young people, emphasising the pivotal role of educational settings in addressing these challenges. Despite encouraging outcomes, this review highlights the need for further research to better understand intervention effectiveness, implementation barriers, and cost-effectiveness; to facilitate the development of tailored and impactful strategies for supporting young people's mental health.

PRISMA/PROSPERO STATEMENT

This systematic review was conducted following Cochrane methodology PRISMA guidelines. The review was registered with PROSPERO in June 2023 (CRD42023431966).

Humanistic Therapy for Young People: Client-Perceived Helpful Aspects, Hindering Aspects, and Processes of Change

This qualitative study aimed to establish aspects of humanistic therapy that young people (13-16 years old) perceived as helpful and hindering, and to test a novel method for identifying perceived processes of change. A "medium q" thematic analysis was conducted followed by a coding-based "process of change analysis." Participants were 50 young people in London schools who experienced moderate or severe emotional symptoms and had participated in up to 10 sessions of a school-based humanistic intervention. Participants were predominantly female and ethnically heterogeneous. Therapist qualities most often perceived as helpful were affiliative in nature. Unhelpful therapist activities were silences and a lack of input. Young people described feeling free to talk and open up. Helpful outcomes included feeling unburdened, gaining insight, and improving relationships. "Getting things off their chest," "Advice and guidance," "Modeling relationships," and "insights to behavior change" were identified as specific processes of change in over 50% of young people. Approximately one-third felt hindered by a lack of therapist input, silences, or not feeling able to open up or trust. These findings indicate the potential value of an active, "process guiding" stance in humanistic therapy. Our process of change analysis has potential for identifying perceived change mechanisms in therapy. This work was supported by the Economic and Social Research Council [grant reference ES/M011933/1]. Anonymized qualitative interview transcripts are available on request to the First Author/Chief Investigator. Quantitative, participant-level data for the ETHOS study (with data dictionary), and related documents (e.g., parental consent form), are available via the ReShare UK Data Service (reshare.ukdataservice.ac.uk/853764/). Access requires ReShare registration.

Are the concerns destroying mental health of college students?: A qualitative analysis portraying experiences amidst COVID-19 ambiguities

Coronavirus presenting an unforeseeable chain of events has exaggerated misery for students in India as they attracted the most detrimental experiences associated with lockdown restrictions leading to a shutdown of colleges as a preventive measure. The research endeavors to furnish a review of the overall hardships and psychological state of mind of college students and improvement in the implementation of policy decisions. Researchers conceptualize the newly discovered phenomenon by adopting grounded theory. Data from 256 newspaper articles, online articles and magazines have been gathered and converted into 256 separate files. To broaden the justification of research, social media analysis employing tweets, Facebook posts and Whatsapp messages are considered adding to the contributory prospects of the study. Compiled data is then refined through data mining technique. Triangulation approach amalgamating content analysis and thematic analysis has been deployed, thereby exploring the qualitative aspect of data gathering. Reviews from 31 students through telephonic conversation and 8 academic experts extended more accuracy to the research process. Findings administered academic disruptions with career concern, emotional suffering, financial concern, online learning, overseas injustice and psychological effects as the final themes representing various concerns experienced by college students. Hence, this work concludes with some constructive suggestions to deteriorate the amplified concerns.

The 4Ds of Dealing With Distress - Distract, Dilute, Develop, and Discover: An Ultra-Brief Intervention for Occupational and Academic Stress

The Covid-19 crisis has clarified the demand for an ultra-brief single-session, online, theory-led, empirically supported, psychological intervention for managing stress and improving well-being, especially for people within organizational settings. We designed and delivered "4Ds for Dealing with Distress" during the crisis to address this need. 4Ds unifies a spectrum of familiar emotion regulation strategies, resilience exercises, and problem-solving approaches using perceptual control theory and distils them into a simple four-component rubric (Distract-Dilute-Develop-Discover). In essence, the aim is to reduce distress and restore wellbeing, both in the present moment through current actions (distract or dilute), and through expressing longer-term goal conflicts (e.g., through talking, writing, and drawing) to discover new perspectives that arise spontaneously after sufficient time and consideration. The intervention is user-led in that it draws on users' own idiosyncratic and pre-existing experiences, knowledge, skills and resources to help them apply an approach, or combination of approaches, that are proportionate and timed to the nature and context of the stress they are experiencing. In this article we review the empirical basis of the approach within experimental, social, biological and clinical psychology, illustrate the novel and time-efficient delivery format, describe its relevance to sports and exercise, summarise feedback from the recipients of the intervention to date, and describe the directions for future evaluation.

A qualitative exploration of 14 to 17-year old adolescents' views of early and preventative mental health support in schools

BACKGROUND

Preventative interventions may be effective in reducing and preventing symptoms of mental ill health in children and young people. However, there is a paucity of research in this area that explores the views of young people. This paper reports on a qualitative study to inform the future development of attractive and appropriate early and preventative school-based mental health interventions.

METHODS

Semi-structured interviews were conducted with a purposive sample of 12 young people aged 14-17 in North East England. Interviews were audio-recorded, transcribed, anonymised and analysed following a thematic approach.

RESULTS

Four key themes were identified, relevant to those providing, designing and commissioning early and preventative mental health interventions in schools: 'mental health literacy', 'risk factors for wellbeing decline', 'experience of school-based support' and 'recommendations for future support'.

CONCLUSIONS

Young people have varying levels of mental health literacy, but are able to identify academic stress, bullying and the transition from primary to secondary school as leading causes of worry. Young people want more regular and in-depth mental health education, tailored levels of support in school and improved training for teachers.

The development of a parent–child activity based on the principles of perceptual control theory

Problems most frequently reported by young people in school counselling relate to family difficulties. During adolescence, conflict between parents and young people increases as young people move towards independence whilst still being reliant on parents. The quality of communication during this period has implications for young people’s well-being. The current study explored how the principles of perceptual control theory (PCT) could be used to develop a structured activity aimed at helping young people to talk to their parents about their goals and goal conflicts.

PCT proposes that individuals function well when they are able to control things that are important to them. Every individual has numerous goals/wants and if two or more are incompatible, conflict arises. The current study focused on supporting young people to explore conflict that might arise due to incompatible goals held by them and their parent. Six families (child and parent/carer) were recruited to try a goal-setting and monitoring activity. The activity was facilitated by a Method of Levels researcher over a 10-week period. There were two follow-up appointments at 2 and 4 months. Two families were retained for the entire study. On completion, four families provided qualitative feedback. On the basis of participants’ feedback, the activity was modified to incorporate discussions on incompatible goals. Two families piloted the modified activity and provided feedback. Both families completed the study. Results suggest that a parent–child activity using the principles of PCT is feasible and acceptable among parents and young people.

Key learning aims

(1)