This blog has been published as part of the NIHR SPHR Public mental health newsletter
A blog by Lucy Oakey, Programme Manager for PHRESH
We truly are in the midst of a mental health crisis – especially for young people. Tragically, these young people are often not able to get the help they need. This is partly because we do not yet fully know what is causing this surge in mental health problems, what treatments work best for them, or how we can prevent more children and young people from suffering in this way.
When it comes to the mental health of young people today, the statistics speak for themselves: roughly 1 in 5 children aged 5–19 are likely to have a mental health problem, with half of all mental health problems emerging by the age of 14. Yet, as many as three quarters of young people living with a mental health problem are not being provided with the care and support that they need.
These statistics are more than just numbers. They convey a story of a whole generation of young people suffering with poor mental health, with ever increasing numbers experiencing symptoms of depression/anxiety or are self-harming. More needs to be done to help prevent these cases, to allow young people to move on to become healthy, stable and secure individuals who are able to thrive in adulthood.
While PHRESH researchers are involved in many of the NIHR SPHR’s Public mental health projects there are also projects taking place more widely across the consortium. In this piece, we will look at three important projects currently being undertaken by PHRESH researchers. Each project looks to improve children’s mental health through evaluation of interventions and co-production of workshops to tackle important mental health issues our young people are facing.
Smart phones
SMART Schools Study: Smartphones, social Media and Adolescent mental wellbeing: the impact of school policies Restricting dayTime use
Dr Victoria Goodyear and Dr Miranda Pallan, from PHRESH (University of Birmingham), secured NIHR Public Health Research programme funding to investigate the use of smart phones during the school day. This research is welcomed by government, parents and schools alike who seek guidance to help understand the relationship between phone use in adolescents and wellbeing.
The research team are currently conducting a natural experimental observational study using mixed methods to compare the impact of school daytime restrictions on smartphone use on mental wellbeing in two secondary school contexts – schools that do not permit phone use (intervention) vs schools that permit phone use (control). The focus is on adolescents aged 12–13 years and 14–15 years (population). The primary outcome will be mental wellbeing, with various secondary outcomes also being measured, such as anxiety, depression and classroom behaviour.
The willingness of schools to be involved in the study, shown through recruitment being completed ahead of target (30 schools in total – 20 intervention and 10 control), is an indication of the need for evidence in this area to help create guidance for schools. Focus group data showed that schools feel ill-equipped to support adolescents with safe use of phones in relation to well-being, highlighting the importance of the work.
During data collection, an emerging finding showed that a high proportion (1 in 4) of adolescents in the study sample reported thoughts of suicide and/or self-harm. In response to this, the study team co-produced a safeguarding protocol for data collection in schools with young people with lived experiences of mental health (University of Birmingham, Institute for Mental Health, Youth Advisory Group), relevant adults (teachers, safeguarding leads, clinicians, researchers) and relevant groups (legal services, ethics committees). This is currently in the process of being submitted as a Communications Article to the BMJ Open.
The study team are continuing to collect data and we cannot wait to hear their results. You can stay up to date with their progress through their blog, twitter (@SMART_SchStudy) and podcast.
Bullying
The Stand Together Trial – KiVa
A unique city partnership between HSBC UK, the University of Birmingham and Birmingham Children’s Hospital was developed to understand the relationship between predictors and incidents of bullying in Birmingham. Through this campaign, the partnership joined with the NIHR funded ‘Stand Together’ anti-bullying trial team to run an anti-bullying intervention called KiVa in local schools. Prof Judy Hutchings, Bangor University, leads the programme with Professor Matthew Broome, from the University of Birmingham, and Dr Chris Chiswell, a Public Health Consultant at the BWC, leading on this exciting work within Birmingham.
“Bullying is a preventable event. It isn’t a right of passage, or an inevitable and character forming experience. Interventions existed, and we knew we could do something about it”
Originally developed in Finland, KiVa, an abbreviation of the phrase ‘against bullying’ in Finnish, delivers a range of classroom and environmental actions that aim to increase children’s awareness of bullying. One thing that students love is the opportunity to act out scenarios in front of their classmates, illustrating different bullying behaviours, talking about how the victim might feel in the scenario and why, and offering up solutions to address the bullying. KiVa also looks to increase emotional literacy, and peer-to-peer empathy towards victims, equip them with strategies and build coping skills for those who are experiencing bullying.
Since 2019, with some interruptions due to partial school closures related to the COVID-19 pandemic, over 11,000 primary school children, aged 7–11 years old, from 57 schools in England and Wales have participated in the KiVa anti-bullying programme. Schools were randomly assigned into intervention and control groups, meaning that roughly half of all schools ran the KiVa anti-bullying programme in their schools during the first year of the project, with the other schools waiting until the following year to run the KiVa programme. Several surveys were completed by children and teachers from both groups of schools, helping us to answer the following research questions:
- Over the period of one academic year, were there any reductions in bullying among school children aged 7–11 years old when comparing KiVa and usual practice?
- Were there any improvements to children’s mental health, school attendance and academic attainment, or sense of wellbeing and connectedness for those schools who participated in KiVa?
- Does the effectiveness of the KiVa programme vary by socio-economic status and do effects vary by gender?
The NIHR funded ‘Stand Together’ project is drawing to a close at the end of the 2022–23 academic year, after which the final data on prevalence of bullying in these regions and the effectiveness of the intervention on bullying will be fully explored. Readers keen to find out the outcome of this ambitious study will have to wait for the data to be published, hopefully later this year.
Excitingly, the HSBC funded component of this project is ongoing, funding both control and intervention schools to continue running the KiVa programme and supporting further research to enable a better understanding of the lived experiences of bullying among children in this age group, which will continue until the end of 2024. For this research, Andrew Maile, a Research Fellow in the IMH, will be conducting qualitative interviews using a mosaic method with children, parents, and teachers and we look forward to hearing the outcome of the work.
With thanks to Andrew Maile, Carolyn Chew-Graham, and Victoria Goodyear for providing input into the article.
Eating disorders and self-harm
CHOOSE Study: Children and young people psychiatric diagnoses before and during the Covid-19 pandemic
Professor Carolyn Chew-Graham from Keele University, along with colleagues from The University of Manchester and University of Exeter, were successful in securing funding from the NIHR School for Primary Care Research (SPCR) to conduct the CHOOSE study.
Researchers across the three institutions, supported by the mental health research charity The McPin Foundation, used a database of anonymised primary care electronic health records to track the number of eating disorder diagnoses and self-harm incidents recorded monthly by GPs from January 2010 through March 2022.
The findings showed that there was a fall in people accessing primary care for eating disorders and self-harm in April 2020, following the introduction of the first UK national lockdown. From July 2020, eating disorders were 42% higher than would be expected based on previous trends for females aged 13–16, and 32% higher for those aged 17–19.
The increase in incidence of self-harm was also greatest among females aged 13–16, with the number of episodes being 38% greater than expected. The findings are reported in a pre-print and will soon be published in the Lancet Child and Adolescent Health.
The research team held meetings with young people, carers, family advisory groups (supported by the McPin Foundation) and a clinical advisory group to discuss and seek explanations for the findings. It was suggested by the group that the initial drop in primary care records was reflective of the reluctance to use the health service during the pandemic, rather than due to a reduced need. However, it was also suggested by the group that perhaps a trigger for some people’s symptoms may be the school environment and with this reduced due to home-schooling some children and young people may have seen their mental health improve. Another possibility raised was the idea of people turning to non-medical approaches in an attempt to avoid using the NHS and seek support via different avenues.
The reasons suggested for the pandemic having less of an effect on males was that they may be even less likely to seek help given the circumstances. Some even suggested that less school gave young boys more time to game and therefore more chance to connect and talk to friends, reducing mental health problems.
Finally, some members of the young people’s advisory group felt that the rise in eating disorders documented might be due to the need to have come control in one aspect of their lives.
This strong link with people with lived experience was further cemented through a webinar held within Mental Health awareness week, which was co-chaired by one of the young people involved in the research.
The research team and the McPin Foundation are reflecting on the success of their work together and are planning a paper reporting how to involve people with lived experience in database studies.
We hope this blog has provided an insight into some of the work being conducted by researchers within PHRESH around Public mental health.
If you would like to engage with any of the researchers mentioned in this article or have any ideas for collaboration that you would like to explore please get in touch, we would love to hear from you.
Email us at Phresh.sphr@contacts.bham.ac.uk
Follow us on twitter @PHRESH_midlands
About PHRESH
The PHRESH Consortium includes researchers from three leading universities in the West Midlands; Universities of Birmingham, Warwick and Keele. It will address important public health challenges to improve the health and wellbeing of all people in this diverse region and beyond.
