A systems approach to improving young people’s mental health and transitions into adulthood

In England and Wales, the proportion of young people experiencing high levels of anxiety, depression, self-harm and eating disorders by the end of their teenage years, has increased in recent years.

Early experience of poor mental health is associated with difficult transitions into adulthood and serious long term implications for adult life, including long term unemployment, morbidity and premature mortality. Such problems cost the UK economy £117.9 billion annually.

Mental health is a source of great inequality, with young people from impoverished backgrounds, with experiences of parental mental disorder or substance misuse, and who are in minoritised groups at much higher risk of problems. These inequalities persist into future generations. Child and Adolescent Mental Health Services are only able to provide treatment for the most serious conditions.

We need to identify more effective ways to support young people at risk of poor mental health, and to provide early, non-clinical intervention.

This research will work within two Integrated Care Systems (ICSs) to take a systems approach to preventing or reducing mental health problems among at-risk young people, and supporting more resilient transitions into adulthood.

It will be made up of five work packages: WP1: An umbrella literature review and synthesis of evidence for effective and cost effective non-clinical interventions that prevent or reduce mental health problems among adolescents WP2: A participatory action research study with young people who have had difficult transitions into the late teenage years to design local policy and system changes.

Young people and their nominated parent or adult (n=20 at each site) will engage in creative storytelling methods to reflect on their experiences, and will attend workshops to identify priorities for change. They will remain involved in data collection in WP4, and will form a public advisory group throughout the research.

WP3: Co-production of areas for change across two ICS, that will improve support for at-risk young people's mental health, and create resilient transitions.

Commissioners, service providers and young people (n=30 at each site) will attend workshops to identify areas for change, create logic models, and operationalise the changes.

WP4 Evaluate the effectiveness and cost effectiveness of systems-wide change/interventions aiming to improve adolescent mental health and resilient transitions into adulthood.

Methods will include: repeated cross-sectional before and after measures of mental health and associated outcomes (n=300 at each time point at each site), interviews with young people and service providers (n=30 at each site at two time points), ripple effects mapping workshops to explore implementation and pathways to impact (20 participants at each site at two time points) and cost utility analyses, estimating costs and benefits to all health, education, social and community services.

Early findings will be fed back to enable further systems change. WP5: Share findings with policy makers and consider implications for policy change.

Policy briefings, bespoke webinars and discussions with local and national policy makers will be delivered at multiple points to identify opportunities to influence policy and guidance.