I have always had a longstanding interest is how we reach people who do not or can not access services for depression and anxiety, especially as evidence suggests only about 30% of people with mental health problems actually receive help and 70% never get the support they need.
To try and rectify this number at a grass roots level I started running workshops for adults in Southwark, in everyday settings such as leisure or community centres. These workshops covered stress, depression/self-confidence, insomnia, and anger. They aimed to be effective as well accessible to the general public who would normally not access help from clinical services.
Key to their accessibility was the use of a self-referral system, so those who felt they needed this help could simply come along to the workshop. We found this approach attracted large numbers of minoritised groups and also those who had not previously sought help from their GPs.
From small beginnings to a national clinical trial
Dr Irene Sclare, a clinical psychologist at South London and Maudsley who works with adolescents, shared my thinking about this need for accessible interventions, especially for young people who encounter significant barriers to help from the NHS because of long waiting lists, inconvenient appointment times and locations (often during school hours and in clinics), and the prioritisation of care for those with very severe problems.
Irene started developing stress workshops for adolescents and, in 2014, we first ran a very small pilot study of the workshops (known as DISCOVER) in schools in South London. We subsequently ran a slightly larger study in 2019 which showed the DISCOVER workshops were accessible and likely to be effective. However, a larger study was needed to rigorously investigate the effectiveness of the workshops.
In July 2019 we received a grant from the NIHR Heath Technology Assessment (HTA) for just under £1.7m to run this clinical trial which covers four regions of England: London, Midlands, Southwest, and Northwest. Our target was to recruit 900 students in 60 schools across these 4 regions – half of which would receive the workshop.
BESST – the trial
When we started the trial in January 2020, we had to pause for a year as lockdown was put in place on 26th March 2020, a week after our trial manager began work! A year later we re-started the trial and recruited our research workers in anticipation of a start in September 2021, despite various scares about schools not letting us in (and maybe even having to change to an online intervention!)
Once we re-started the trial in April 2021 and decided that we would stick to face-to-face workshops, we recruited 19 schools and 6 services to deliver the workshops. We did succeed in recruiting 379 students in September 2021 and then had to work extremely hard the following year to make up the difference. In year 2, we recruited 11 services and 38 schools, enrolling 521 students into the trial.
Now we have reached our target of 900 students across 57 schools and are getting over 90 per cent follow-up rates, which we’re very happy about. A really interesting (and important) finding is that just under half of the students are from diverse backgrounds and that 80 per cent have not previously received help. This demonstrates the key element of accessibility that we hoped to build into these workshops and the research.
What has led to this success? So many things ...
The workshop delivery teams have been very enthusiastic about getting trained in our approach. The school staff have also been really keen for the workshops to be offered to their students.
We think we have reached so many students because they believed that they needed the workshops even though they knew there was a 50 per cent chance they wouldn’t receive them. As in those first workshops I ran in Southwark in 2004 I think the self-referral system has really helped in reaching so many students. It has allowed them to feel an element of control about enrolling where they did have the choice, and weren’t required to go through a formalised diagnostic process.