Long-Term Evaluation and Modelling of the Effectiveness and Cost-Effectiveness of Whole-School Public Mental Health Interventions

Mental health problems are increasing among children and young people (CYP) in England, with surveys showing that rates of probable mental disorders in 6-16 years olds have increased from 1 in 9 children in 2017 to 1 in 6 children in 2020. Schools and colleges can play an important role in helping to improve children and young people’s mental health and many now provide more support. For example, there have been 287 new Mental Health Support Teams covering over 4,700 schools. These teams have been introduced to help deliver mental health interventions in schools.

While we are beginning to understand what works in schools, most previous research has considered short-term outcomes. There is a strong possibility that the full benefits of interventions in schools may only emerge in the longer term, for instance by increasing educational opportunities, employment prospects and improved health among CYP. Unless we know about these longer-term outcomes, we can’t assess the true cost-effectiveness of interventions in schools. Finally, we don’t yet know how far the benefits of different school-based approaches to improving mental health among CYP vary (in the long-term) between people or places.

The proposed research project will help us understand more about how whole school approaches affect long-term outcomes. It will also help us understand how and where these approaches work best, and what the benefits of these approaches are in the long-term.

To do this we will:
(1) Use a specialist computer programme (called a simulation model) to predict the long-term outcomes of whole school approaches for improving mental health among CYP. This computer programme, LifeSim, was developed using data collected from over 10,000 children born in the year 2000. We will add new data from three studies of whole-school approaches to improving mental health to predict how they may benefit people over much longer periods of time.
As part of this objective, we will use the Born in Bradford and Age of Wonder data to examine the impact of Mental Health support teams in primary schools by looking at the difference in mental health and education outcomes in schools that do and don’t have mental health support teams.

(2) Undertake a thorough review of previous studies of effective whole-school approaches to improving mental health among CYP to identify ‘active ingredients’, and to understand how these work and the local conditions that are needed for success.

(3) Run several workshops with young people, parents, teachers and people who provide mental health support, to get their views on the most important parts of approaches to mental health in schools and where these approaches work best. This will help us to develop ‘logic models’ which will capture the important elements of the effective school-based approaches to improving mental health among CYP, to guide future adaptation and implementation.

We will work closely with a wide range of experts by experience, including young people, to review evidence from the study as it emerges, to select the whole-school interventions considered to be the most effective and cost-effective in the long-term and to refine our understanding of how specific school-based approaches work, where and for whom. This work will be supported by the McPin Foundation, and by a network of young people, teachers and others that has been recruited in Bradford, as part of the NIHR ACT-funded Adolescent Mental Health Collaboratory.