One of the world's largest trials ever undertaken in the realm of mental health is now underway in the classrooms of hundreds of schools in England—and WS has learned new details about the curriculum, as outcomes are being evaluated for the first round of data.

Thousands of children and teens are being taught wellness techniques aimed at providing the students with better coping skills and self-awareness of their mental health. The London-based researchers expect their study to show how investing in training and setting aside class time devoted to relaxation, mindfulness, and mental health will pay off for our youth—with less depression and anxiety, and fewer suicidal thoughts.

Organized by the Anna Freud National Centre for Children and Families, this long-range study began in January 2019 and has enrolled 370 schools. In partnership with University College London and funded by the UK's Department for Education, these interventions have been shown in smaller studies to be promising for students in other countries. This much-larger study is expected to make clear that a small investment of time can put young people in the driver's seat of their own inner lives with knowledge and skills they can practice on their own.

"Schools and teachers don't have all the answers, nor could they, but we know they can play a special role, which is why we have launched one of the biggest mental health trials in schools," UK Education Secretary Damian Hinds said in a statement. "These trials are key to improving our understanding of how practical, simple advice can help young people cope with the pressures they face."

The randomized control trials were set up to evaluate two major age groups: one for 9th graders, and another one for students in grades 4, 5, 7, and 8. The schools then were assigned to different groups, with each linked to a specific age-appropriate wellness curriculum, or no curriculum at all—so that effective comparisons could be made.

At least 8,600 ninth-graders participated in the trial. Ninety high schools set aside 45-60 minutes in a class once per week for 6 consecutive weeks, so that a specially-trained instructor could present a lesson from a mental health curriculum.

Dr. Daniel Hayes, the Trials Manager for the Education for Wellbeing project, told WS that one group of teens was assigned to The Mental Health and High Schools Curriculum Guide, developed in Canada by Dr. Stan Kutcher. It was originally a web-based curriculum, but was adapted for the UK study to include more resources from England and less emphasis on PowerPoint presentations in favor of interactive discussions. The lessons contained units on bipolar disorder, panic disorder, schizophrenia, eating disorders, depression, OCD, ADHD, stress, support, and where to get help.

Another high school group participated in the Youth Aware of Mental Health (YAM) curriculum. The primary focus here is reducing symptoms of depression. Statistics show that seeking help at 14 years old can result in a sevenfold decrease in depressive symptoms at 17. In a different randomized controlled trial in Europe using the YAM, the data showed reduced suicidal ideation or attempts at the 12-month follow up.

In the primary and middle school groups, most of the children are involved more experientially, with 5-minute coaching sessions in mindfulness, progressive muscle relaxation, and deep breathing. School staff members complete a half-day face-to-face training course and are provided with manuals appropriate to the grade level, containing many activities, apps, and online games.

The Mindfulness intervention was developed for the trial based on the concept as defined by Jon Kabat-Zinn: "paying attention in a particular way: on purpose, in the present moment, and non-judgmentally". It consists of mindful breathing exercises and other activities focused on self-awareness of sensations, emotions and thoughts, with exercises divided into three types: (1) those focusing on the mind; (2) those focusing on the body; (3) those focusing on the world around us.

Another group was paired with a curriculum designed to bring awareness to aspects of mental health in 8 consecutive weekly lessons:

The curriculum for the younger kids was created by Dr. Bajaj, the lead developer at the Anna Freud Centre's schools program, who consulted with experts in Protective Behaviors interventions for the Safety and Wellbeing lessons.

Opt-outs were offered to parents who didn't want their child's data collected for the study, but the pupils could still take part in the interventions, even if they or their parents chose not to take part in the evaluation. And after the study is complete, the faculty at the inactive "control" group schools will be offered the opportunity to receive specialized training, so that no one is left behind without something to share with students.

The researchers are evaluating the student outcomes now, 3-6 months after the intervention commenced—and they will look at the long-range effects of each intervention by surveying students again after a year, with the final data being released in 2021.

Outcomes measured will include changes to: positive well-being, behavioral difficulties, support from school staff, stigma-related knowledge, attitudes, behaviors, and mental health first aid. An economic evaluation will also assess the cost-effectiveness of the interventions.

As the data from the first wave of the trial is collected and processed, researchers will determine the impact of the interventions on mental health and wellbeing, and whether this is money well spent.

– Co-written by Jennifer Zolper with WS; Photo by Dystopos, CC license

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