Brief Educational workshops in Secondary Schools Trial (BESST)
Poor mental health in young people is increasing, with clear evidence of mounting psychiatric problems. However, less than a quarter of young people with mental health problems can access services, meaning there is an urgent need for easily accessible and effective mental health resources. Common barriers include the limited provision of services, reluctance of adolescents to seek professional help as well as a fear of stigmatisation.
Young people’s mental health is a major government priority, with current policy advocating the development of effective education based mental health care to prevent the escalation of mental health problems, improve access and reduce service waiting times. However, existing school-delivered programmes for depression and anxiety only have modest effects. These programmes are also mainly focused on younger children.
BESST is an exciting clinical trial designed to understand whether a group workshop programme, called DISCOVER, can positively impact the mental health of 16-18-year-old sixth-form students.
Find the full study protocol online.
What is DISCOVER?
The DISCOVER workshop programme is an award-winning, school-based programme for sixth-form students who experience stress, anxiety, or low mood. This workshop programme was developed with a Teenage Advisory Group of 16–18-year-olds to reach young people more easily via a self-referral route.
The DISCOVER programme is aimed at equipping young people with practical skills to manage stress, worry, and other challenges they may face in their academic and personal lives.
How the trial works
BESST seeks to understand how effective the DISCOVER workshop programme is in reducing symptoms of depression (and other outcomes) in students attending the workshop compared to those who receive their usual school care but no workshop. Responses of the two groups were then compared to understand whether the workshop effectively reduced the severity of symptoms on the various questionnaires at three and six month follow-up.
Progress to date
900 students from 57 sixth-forms across England were successfully enrolled into BESST, with 70 clinicians from 15 Mental Health Support Teams trained to deliver the intervention. Data collection commenced in October 2021 and the final six-month follow-up data was collected in June 2023. We have now completed analysis of the outcome data and are eagerly awaiting the publication of our findings. Check out the BESST Trial website for the full findings.
Trial Impact
The results of this trial will tell us whether DISCOVER is a suitable programme to take forward as a school-based mental health provision. It is very possible that DISCOVER could be a highly effective and popular component in frontline education-based mental health care as advocated by government health and education policy.
We see DISCOVER fitting in very well with the current education-based mental health care aims of the government. Therefore, this trial is essential to inform the Department of Health about the effectiveness of this potentially very important intervention for 16-18-year-olds.
Study Team
Chief Investigator
- Dr June Brown: Site Lead for London, King's College London
Co-Investigators
- Professor Paul Stallard: Site Lead for Southwest England, University of Bath
- Dr Jessica Deighton: Site Lead for Northwest England, University of Manchester
- Miss Jynna Yarrum: Site Lead for Midlands, University of Northampton
- Dr Ben Carter: Lead Trial Methodologist and Statistician, King's College London
- Ms Kirsty James: Trial Statistician, King's College London
- Dr Crispin Day: Fidelity Lead, CAMHS Research Unit, South London and Maudsley NHS Foundation Trust
- Dr Irene Sclare: Clinical Lead, Michael Rutter Centre, South London and Maudsley NHS Foundation Trust
- Professor Peter Fonagy: Policy Lead, Anna Freud Centre and University College London
- Professor Sarah Byford: Senior Health Economist, King's College London
- Dr James Shearer: Health Economist, King's College London
- Dr Tim Weaver: Process Evaluation, Middlesex University
- Dr Stephen Lisk: Trial Manager, King's College London
Summary of Findings
We’re delighted to share the results from the BESST trial. Scroll down the page to learn more about our findings and the insights garnered from this study.
You can also read the full open-access research report in the Lancet Psychiatry journal.
Key findings
- The DISCOVER workshop programme was found to be effective in reducing symptoms of depression. Overall, the participants receiving the workshop programme showed significantly greater reduction in depressive symptoms on the MFQ measure of depression than those not receiving the workshop programme.
- In students showing elevated symptoms of depression at the start of the trial (above 27 on the MFQ measure), the workshop showed an even larger effect of significantly reducing depressive symptoms.
- Our results indicate the workshop program was probably cost-effective for all students, and very likely to be cost-effective for those with elevated depressive symptoms at the start of the trial.
Further results
Other questionnaire measures allowed us to further understand the effect of the workshop on study participants. They answered questions regarding anxiety (RCADS), general wellbeing (WEMWBS) resilience (CYRM-12), and sleep (SCI).
We found that participants in the group receiving the DISCOVER workshop programme showed, on average, a greater reduction in their self-reported levels of anxiety than those receiving their usual school care without the workshop programme.
Students who received the workshop also showed a signifcantly greater improvement in levels of general wellbeing and resilience.
Recruitment and Representation
BESST employed a self-referral approach, allowing students to participate in the trial if they felt it was suitable for them.
We were able to reach many young people who had not previously sought help through more formal routes: 80 per cent of our sample had not previously sought help from their GP for their mental health.
We also had a diverse sample of students participating in the trial: 46 per cent of our sample came from ethnic minority groups. 71 per cent of our sample were female and 25 per cent were male.
Impact
BESST has garnered significant engagement and collaboration from 6th forms, students, and NHS services across England. Here are four key snapshots from the trial results.
- DISCOVER has demonstrated potential to be a scalable intervention to improve mental health in 16-18 year students throughout England.
- This workshop programme was shown to be effective when delivered by NHS Mental Health Support Teams based in Sixth Forms.
- DISCOVER is likely to be cost-effective and may save the NHS money through early intervention.
- Further work will help understand whether these positive effects continue to help adolescents as they transition to adulthood.
Principal Investigator
Reader/Associate Professor in Clinical Psychology
Affiliations
Project websites
Contact us
Dr Stephen Lisk
Trial Manager
stephen.lisk@kcl.ac.uk
Dr June Brown
Chief Investigator
june.brown@kcl.ac.uk