Promoting mental health and wellbeing in schools: examining Youth Aware of Mental Health (YAM) and the Mental Health & High School Curriculum Guide (The Guide) in English secondary schools

ISRCTN	ISRCTN17631228
DOI	https://doi.org/10.1186/ISRCTN17631228
Protocol serial number	EOR/SBU/2017/015
Sponsor	University College London
Funder	Department for Education

Submission date: 30/08/2018
Registration date: 05/09/2018
Last edited: 02/10/2023

Recruitment status: No longer recruiting
Overall study status: Completed
Condition category: Mental and Behavioural Disorders

Prospectively registered

Protocol

Statistical analysis plan

Results

Individual participant data

Record updated in last year

Plain English summary of protocol

Background and study aims
The majority of mental health difficulties start before adulthood, and there is evidence to suggest these difficulties may be increasing. Schools are ideally situated to provide support; most young people attend school and there are opportunities for support without attending specialist mental health services. Recent programmes aimed at either improving mental health literacy, or raising awareness of and promotion of mental health, have been trialled abroad, but their effects are currently unknown in the UK population. The Department for Education has commissioned the Evidence Based Practice Unit and partners (University of Manchester, the University of Dundee, and London School of Economics) to evaluate the effectiveness of two programmes, YAM and the Guide, on mental health and wellbeing outcomes in schools.

Who can participate?
Secondary schools in one of four hubs: London and the South East; Manchester and the North West; Durham and the North East; Bath, Bristol and the South West. Schools will need to deliver interventions to at least 60 year nine students across three delivery groups.

What does this study involve?
This study involves pupils being randomly allocated to one of two interventions (YAM or the Guide) or continuing with usual provision. Youth Aware of Mental Health (YAM) is a universal, evidence-based and culturally sensitive intervention programme aimed at young people aged 14-17 with a focus on increasing awareness about mental health. Through group-based interactive lectures, dialogue and role-play, YAM seeks to enhance young people’s knowledge on mental health issues such as depression, suicidal thoughts, and stress, while providing them with important skills on how to seek help and advice, and help others. YAM consists of five sessions and it is designed to be implemented in the classroom by YAM instructors who have been trained in its application. The Mental Health and High School Curriculum Guide (The Guide) aims at enhancing the mental health literacy of students. Through classroom-ready lesson plans and activities, within a supportive, familiar environment, The Guide enhances pupils' knowledge on mental health and illness. It also helps them understand how to optimize and maintain good mental health, combat stigma, and enhances help-seeking efficacy in order to help themselves and/or others. The Guide is delivered during school hours by teachers who have been trained in its application (1-day training). It consists of six modules that are taught as in consecutive weeks and are each designed to fit into around 60 minutes of classroom time. The usual provision schools continue with their usual practice without being allocated to one of the two interventions mentioned above.

What are the possible benefits and risks of participating?
This will help the government and researchers understand what interventions may help improve mental health and wellbeing in secondary schools. Pupils may experience a decrease in mental health difficulties or increase in wellbeing, but this is not guaranteed. Young people may become aware of their own mental health and wellbeing which could cause discomfort or distress.

Where is the study run from?
This study is being run by the Evidence Based Practice Unit, University of Manchester, the University of Dundee, and London School of Economics (UK)

When is the study starting and how long is it expected to run for?
September 2017 to March 2024

Who is funding the study?
Department for Education (UK)

Who is the main contact?
1. Dr Jessica Deighton
2. Tjasa Velikonja (Tjasa.Velikonja@annafreud.org)

Contact information

Dr Jessica Deighton
Scientific

Evidence Based Practice Unit
University College London and Anna Freud National Centre for Children and Families
London
N1 9JH
United Kingdom

Dr Tjasa Velikonja
Public

Anna Freud Centre
4-8 Rodney Street
London
N1 9JH
United Kingdom

Phone	+44 (0)20 7794 2313
Email	Tjasa.Velikonja@annafreud.org

Study information

Primary study design	Interventional
Study design	Interventional multicentre cluster randomised trial
Secondary study design	Cluster randomised trial
Study type	Participant information sheet
Scientific title	Approaches for Wellbeing and Mental Health literAcy: Research in Education (AWARE)
Study acronym	AWARE
Study objectives	Current hypothesis as of 29/07/2019: Aims: 1. To examine whether YAM is more effective than the usual school-based provision in reducing emotional difficulties in young people 2. To examine whether The Guide is more effective than the usual school-based provision in increasing help seeking of young people around mental health Hypothesis: H1: Young people receiving YAM will report a greater reduction in emotional difficulties at between 3–6 and 9-12 months follow-up than those who receive the usual school curriculum H2: Young people receiving The Guide will report a greater increase in help seeking at between 3–6 and 9-12 months follow-up relative to those who receive the usual school curriculum Previous hypothesis: Aims: 1. To examine whether YAM is more effective than the usual school-based provision in reducing emotional difficulties in young people 2. To examine whether The Guide is more effective than the usual school-based provision in increasing help seeking of young people around mental health Hypothesis: H1: Young people receiving YAM will report a greater reduction in emotional difficulties from baseline to 6 and 12 months follow up than those who receive the usual school curriculum H2: Young people receiving The Guide will report a greater increase in help seeking from baseline to 6 and 12 months follow up relative to those who receive the usual school curriculum
Ethics approval(s)	University College London ethics committee, 20/02/2018, ref: 6735/009
Health condition(s) or problem(s) studied	Mental health and wellbeing
Intervention	Current intervention as of 29/07/2019: This study involves pupils being allocated to one of two interventions (YAM or the Guide) or continuing with usual provision. The method of randomisation is minimisation. 1. Youth Aware of Mental Health (YAM): a universal, evidence-based and culturally sensitive intervention programme aimed at young people aged 14-17 with a focus on increasing awareness about mental health. Through group-based interactive lectures, dialogue and role-play, YAM seeks to enhance young people’s knowledge on mental health issues such as depression, suicidal thoughts, and stress, while providing them with important skills on how to seek help and advice, and help others. YAM consists of five sessions and it is designed to be implemented in the classroom by YAM instructors who have been trained in its application. 2. The Mental Health and High School Curriculum Guide (The Guide), aims at enhancing the mental health literacy of students. Through classroom-ready lesson plans and activities, within a supportive, familiar environment, The Guide enhances pupils' knowledge on mental health and illness. It also helps them to understand how to optimize and maintain good mental health, combat stigma, and enhance help-seeking efficacy in order to help themselves and/or others. The Guide is delivered during school hours by teachers who have been trained in its application (1-day training). It consists of six modules that are taught as a block and are designed to each fit into 60 minutes of classroom time 3. Usual Provision (Control) Schools will continue with usual practice without partaking in one of the above interventions. Interventions will be for 5 weeks (YAM) and 6 weeks (the Guide). Follow up will happen approximately 3-6 and 9-12 months after intervention start. The statistician undertaking analysis will be blind to the study conditions. Previous intervention: This study involves pupils being allocated to one of two interventions (YAM or the Guide) or continuing with usual provision. The method of randomisation is minimisation. 1. Youth Aware of Mental Health (YAM): a universal, evidence-based and culturally sensitive intervention programme aimed at young people aged 14-17 with a focus on increasing awareness about mental health. Through group-based interactive lectures, dialogue and role-play, YAM seeks to enhance young people’s knowledge on mental health issues such as depression, suicidal thoughts, and stress, while providing them with important skills on how to seek help and advice, and help others. YAM consists of five sessions and it is designed to be implemented in the classroom by YAM instructors who have been trained in its application. 2. The Mental Health and High School Curriculum Guide (The Guide), aims at enhancing the mental health literacy of students. Through classroom-ready lesson plans and activities, within a supportive, familiar environment, The Guide enhances pupils' knowledge on mental health and illness. It also helps them to understand how to optimize and maintain good mental health, combat stigma, and enhance help-seeking efficacy in order to help themselves and/or others. The Guide is delivered during school hours by teachers who have been trained in its application (1-day training). It consists of six modules that are taught as a block and are designed to each fit into 60 minutes of classroom time 3. Usual Provision (Control) Schools will continue with usual practice without partaking in one of the above interventions. Interventions will be for 5 weeks (YAM) and 6 weeks (the Guide). Follow up will happen approximately 6 and 12 months after interventions start. The statistician undertaking analysis will be blind to the study conditions.
Intervention type	Behavioural
Primary outcome measure(s)	Current primary outcome measure as of 29/07/2019: For YAM: Emotional difficulties on the Short Mood and Feelings questionnaire (SMFQ) (Angold, 1995) collected online and measured at baseline, 3-6 months and 9-12 months post intervention For The Guide: Help seeking (Wilson et al., 2011) collected online and measured at baseline, 3-6 months and 9-12 months post intervention Previous primary outcome measure: For YAM: Emotional difficulties on the Short Mood and Feelings questionnaire (SMFQ) (Angold, 1995) collected online and measured at baseline, 6 months and 12 months post intervention For The Guide: Help seeking (Wilson et al., 2011) collected online and measured at baseline, 6 months, and 12 months post intervention
Key secondary outcome measure(s)	Current secondary outcome measures as of 29/07/2019: All measures will be collected online and measured at baseline, 3-6 months and 9-12 months post intervention: Pupils: 1. Positive wellbeing (Hueber, 1991) 2. Behavioural problems (Deighton, 2013) 3. Support from School Staff (Sun and Stewart, 2007) 4. Attitudes Toward Mental Illness Questionnaire (Milin et al. 2016) 5. Pediatric Quality of Life (Stevens, 2009) 6. Service Use (Client Service Receipt Inventory) 7. Knowledge based stigma (Evans-Lacko et al., 2011) 8. Sigma related behaviour (Evans-Lacko et al., 2011) 9. Mental health first aid (Hart et al, 2015) 10. The Guide questions* 11. Emotional difficulties* : Short Mood and Feelings questionnaire (SMFQ)) (Angold, 1995) 12. Intended help seeking^ : General Help-Seeking Questionnaire (Wilson et al., 2011) Teachers: 1. Mental health literacy (Fortier et al., 2017) 2. Mental health literacy (Jorm 1997) 3. Mental health literacy (Kutcher et al., 2015) 4. The Guide questions* For the Guide only ^ For YAM only Previous secondary outcome measures: All measures will be collected online and measured at baseline, 6 months and 12 months post intervention: Pupils: 1. Positive wellbeing (Hueber, 1991) 2. Behavioural problems (Deighton, 2013) 3. Support from School Staff (Sun and Stewart, 2007) 4. Attitudes Toward Mental Illness Questionnaire (Milin et al. 2016) 5. Pediatric Quality of Life (Stevens, 2009) 6. Service Use (Client Service Receipt Inventory) 7. Knowledge based stigma (Evans-Lacko et al., 2011) 8. Sigma related behaviour (Evans-Lacko et al., 2011) 9. Mental health first aid (Hart et al, 2015) 10. The Guide questions 11. Emotional difficulties* : Short Mood and Feelings questionnaire (SMFQ)) (Angold, 1995) 12. Intended help seeking^ : General Help-Seeking Questionnaire (Wilson et al., 2011) Teachers: 1. Mental health literacy (Fortier et al., 2017) 2. Mental health literacy (Jorm 1997) 3. Mental health literacy (Kutcher et al., 2015) 4. The Guide questions* *For the Guide only ^ For YAM only
Completion date	31/03/2024

Eligibility

Participant type(s)	Other
Age group	Child
Lower age limit	13 Years
Upper age limit	14 Years
Sex	All
Target sample size at registration	8640
Key inclusion criteria	Current inclusion criteria as of 29/07/2019: Schools: 1. Be willing to deliver/have an intervention delivered to around 60 year 9 pupils in three delivery classes 2. Are able to allocate 1 hour per week to deliver in the intervention for 6 weeks in the spring term of 2018 or 2019 3. Fall under one of the four hubs: London and the South East; Manchester and the North West; Durham and the North East; Bath, Bristol and the South West 4. For The Guide only, be able to send teachers of delivery groups to training after October half term 2018/2019 5. Sign a Memorandum of Understanding, data sharing agreement and provide pupil lists to the research team Pupils: 1. Be in Year 9 2. Parental consent and young person assent Previous inclusion criteria: Schools: 1. Be willing to deliver/have an intervention delivered to around 60 year 9 pupils in three delivery classes 2. Are able to allocate one hour per week to deliver in the intervention for 6 weeks in the spring term of 2018 or 2019 3. Fall under one of the five hubs: 1) London, 2) Birmingham and the Midlands, 3) Bristol, Bath and Somerset, 4) Durham and the North East, 5) Manchester 4. For The Guide only, be able to send teachers of delivery groups to training after October half term 2018/2019 5. Sign a Memorandum of Understanding, data sharing agreement and provide pupil lists to the research team Pupils: 1. Be in Year 9 2. Parental consent and young person assent
Key exclusion criteria	Current exclusion criteria as of 29/07/2019: Schools: 1. Not able to deliver/have an intervention delivered to around 60 year 9 pupils in three delivery classes 2. Unable to allocate one hour per week to deliver in the intervention for six weeks in the spring term of 2018 or 2019 3. Fall outside one of the four hubs: London and the South East; Manchester and the North West; Durham and the North East; Bath, Bristol and the South West 4. For the Guide only, unable to send teachers of delivery groups to training after October half term 2018/2019 5. Unable to sign a MOU, data sharing agreement or provide pupil lists to the research team 6. Be a primary school or alternative provision (e.g. pupil referral unit) Pupils: 1. Not in Year 9 2. Parental consent and young person assent not provided Previous exclusion criteria: Schools: 1. Not able to deliver/have an intervention delivered to around 60 year 9 pupils in three delivery classes 2. Unable to allocate one hour per week to deliver in the intervention for six weeks in the spring term of 2018 or 2019 3. Fall outside one of the five hubs: 1) London, 2) Birmingham and the Midlands, 3) Bristol, Bath and Somerset, 4) Durham and the North East, 5) Manchester 4. For the Guide only, unable to send teachers of delivery groups to training after October half term 2018/2019 5. Unable to sign a MOU, data sharing agreement or provide pupil lists to the research team 6. Be a primary school or alternative provision (e.g. pupil referral unit) Pupils: 1. Not in Year 9 2. Parental consent and young person assent not provided
Date of first enrolment	01/03/2018
Date of final enrolment	31/07/2022

Locations

Countries of recruitment

United Kingdom
England
Scotland

Study participating centres

Evidence Based Practice Unit (EBPU). University College London and Anna Freud National Centre for Children and Families.

4-8 Rodney Street
London
N1 9JH
United Kingdom

Manchester Institute for Education

Ellen Wilkinson Building
Oxford Road
Manchester
M13 9PL
United Kingdom

London School of Economics

Houghton St
London
WC2A 2AE
United Kingdom

University of Dundee

Nethergate
Dundee
DD1 4HN
United Kingdom

Results and Publications

Individual participant data (IPD) Intention to share	Yes
IPD sharing plan summary	Available on request
IPD sharing plan	The trialists will provide an anonymised dataset with some variables removed if they would cause an individual to be identifiable (such as a looked after child with special educational needs). This will be undertaken with advice from the Department for Education.

Study outputs

Output type	Details	Date created	Date added	Peer reviewed?	Patient-facing?
Protocol article	protocol	03/09/2019		Yes	No
Participant information sheet	Participant information sheet	11/11/2025	11/11/2025	No	Yes
Study website	Study website	11/11/2025	11/11/2025	No	Yes

Editorial Notes

02/10/2023: The following changes have been made:
1. The overall study end date has been changed from 30/06/2023 to 31/03/2024 and the plain English summary updated accordingly.
2. The intention to publish date has been changed from 30/09/2023 to 30/09/2024.
18/03/2021: The following changes were made to the trial record:
1. Contact details updated.
2. The recruitment end date was changed from 14/09/2019 to 31/07/2022.
3. The overall trial end date was changed from 31/07/2021 to 30/06/2023.
4. The intention to publish date was changed from 31/07/2021 to 30/09/2023.
05/09/2019: Publication reference added.
29/07/2019: The following changes have been made:
1. The intervention has been changed.
2. The primary outcome measure has been changed.
3. The secondary outcome measures have been changed.
4. The participant inclusion criteria have been changed.
5, The participant exclusion criteria have been changed.
6. The study hypothesis has been changed.
7. The plain English summary has been changed to reflect the above changes.