Public health practitioners and academics working together to evaluation a mental health youth awareness programme

Natalie Connor, Michelle Baldwin, Gill O’Neill, Gillian Waller and Dorothy Newbury-Birch

What is the Youth Aware Mental Health Programme (YAM)?

The Saving and Empowering Young Lives in Europe study (SEYLE) was a cluster randomised control trial (RCT) that compared the efficacy of schoolbased preventative interventions of suicidal behaviours (Wasserman et al. 2015). Three interventions and a control group were compared. One of these interventions, the Youth Aware of Mental Health Programme (YAM), was associated with a significant reduction of incident suicide attempts and severe suicidal ideation compared with the control group. YAM has been designed for use in the classroom as a universal evidence-based mental health promotion programme for 14-16-year-olds. The aim of the programme is to help students explore their experiences of mental health using role play, as well as reflect on previous actions and reactions. In addition, pupils are provided with a resource guide of local health resources and different organisations who work with young people in the community.

YAM is a structured programme that is delivered by trained facilitators in the school setting. Facilitators attend a training programme delivered by a team from the National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP) at the Karolinska Institutet and Columbia University. This team were commissioned by Durham County Council to deliver the YAM training to staff in County Durham. The staff trained included a mix of school, resilience and educational psychology nurses. The program typically lasts for five weeks, with an introductory lesson followed by four distinct lessons, each of which lasted an hour and explored various scenarios linked to mental health through role play.

The SEYLE study, carried out in nine countries and across five continents, found YAM to be effective at improving several mental health outcomes, such as reducing depression and reducing suicide attempts (Wasserman et al. 2015). Furthermore, the YAM programme was shown to encourage understanding between pupils, encourage peer support and allow pupils to get to know each other better, helping them to understand that they were not alone with their problems and thus they were more likely to seek help when needed.

YAM also helped adolescents who had existing mental health problems as the programme included facilitations of clinical evaluation and help (Wasserman et al. 2015).

Why is YAM useful?

Approximately 615 million people worldwide, both adults and children, have issues with mental health (Chisholm et al. 2016). At least one in four people will experience a mental health issue at some point in their lives (McManus et al. 2009). More recently, a YouGov online poll revealed that 51% of adults who had felt stressed in 2018 reported feeling depressed, with 61% having feelings of anxiety (Mental Health Foundation; 2018).

Mental health problems were reported to cost the UK economy an estimated £70-100 billion in 2015 (Mental Health Foundation 2016). Yet public spending on mental health is focussed almost entirely on coping with crisis, rather than investing in prevention (Mental Health Foundation 2016). Mental illness and self-injury account for 23% of the UK’s disease burden, compared to 16% for cancer and 16% for cardiovascular disease (WHO (2008) ‘The Global Burden of Disease, 2004 update’).Yet despite this, mental illness received only 13% of NHS health expenditure (Centre for Economic Performance 2012).

The mental health of young people is a global concern (Sawyer et al. 2012). Research indicates that one in ten children aged 5-16 years has a mental health problem, and half of those with lifetime mental health problems first experience symptoms by the age of 14, (Sawyer et al. 2012; Green et al. 2005) and three-quarters before their mid-20s (Kessler and Wang 2007). The Prince’s Trust carried out their annual Macquarie Youth Index in 2017, which showed that the wellbeing of young people under the age of 25 has dropped to its lowest level in their survey since the study was launched in 2009 (The Prince’s Trust Macquarie Youth Index 2017). In total, 48% of the 2215 young people surveyed experienced problems that prevented them focusing on their studies, and nearly half of those who had experienced a problem did not talk to anyone about their situation. Of those who had experienced a problem. 32% did not know who they could talk to. A total of 78% felt that there was stigma attached to mental health issues which was a barrier to them discussing their problems (The Prince’s Trust Macquarie Youth Index 2017). Furthermore, one in 12 children and young people deliberately self-harm, and approximately 40,000 cases of self-harm by children and young people result in hospitalisation each year (Young Minds and The Cello Group 2012). Therefore, early intervention for youth mental health problems is likely to result in long-term health and societal gains (Sawyer et al. 2012; McGorry et al. 2007; Schaffalitzky et al. 2015).

Those who describe themselves as having positive mental health and wellbeing are reported to have a range of better outcomes across all ages and backgrounds. These include improved physical health and life expectancy,

Mental health youth awareness 57 better educational achievement, increased skills, reduced health risk behaviours such as smoking and alcohol misuse, reduced risk of mental health problems and suicide, improved employment rates and productivity, reduced anti-social behaviour and criminality, and higher levels of social interaction and participation.

Why an implementation evaluation?

This evaluation was one of a number of co-production evaluations undertaken between Teesside University and Durham County Council. An implementation evaluation was agreed upon, as the SEYLE RCT had already proven the effectiveness of YAM; however, the feasibility and acceptability of such a programme in County Durham was untested. In order to evaluate the implementation of this programme process data was collated and pupils, school staff and delivery staff were invited to take part in focus groups to discuss barriers and facilitators to the successful implementation of the programme. The primary aim of this evaluation was to determine whether YAM was a feasible delivery model that was sustainable within the school environment in County Durham. Seven schools took part in the year one pilot, and seven schools in year two (two schools from year one, and five new schools). Six of these schools were involved with the evaluation.

YAM is currently being evaluated by the Department of Education in a large-scale randomised control trial, which will span over 200 schools in England. DNB is a member of the steering group for the study. The RCT follows on from a report by the Institute for Public Policy Research, which said all secondary schools needed access to a mental health professional on site, at least one day a week, to combat anxiety and depression. Two other interventions will be evaluated alongside YAM. a Canadian model called ’The Guide' and a lighter-touch preventative programme. However, this data will not be available until at least 2020.

Major learnings from practitioners

This section will describe what the co-ordinators and staff who delivered the YAM programme have learnt within the first two years of the YAM roll-out across County Durham, as well as the key learning points from the academic team using co-production methods.

< Prev   CONTENTS   Source   Next >