Understanding and facilitating self-management in child and youth mental health for socially excluded populations

Department Name:

Evidence-Based Practice Unit, University College London

Supervisors names and email addresses:

1) Prof Peter Fonagy: p.fonagy@ucl.ac.uk

2) Dr Daniel Hayes: d.hayes@ucl.ac.uk

3) Dr Emily Stapley: Emily.stapley@annafreud.org

Application Deadline: 14:00 on 27/03/19

Interviews: during the w/c 08/04/19

Project Title:

Understanding and facilitating self-management in child and youth mental health for socially excluded populations

Project Description:

One in eight young people will suffer from a mental health difficulty (NHS Digital, 2017). There is evidence this may be higher in socially excluded groups such as LGBT individuals, asylum seekers, and those from poorer backgrounds (Jakobsen, Demott, & Heir 2014; NHS Digital, 2017). Even when young people may suffer from a mental health difficulty, many choose not to access professional help (Demyttenaere et al., 2004). When help is accessed, reliable change is found in only around half of cases (Edbrooke-Childs et al. 2018). As such, greater emphasis is being placed on the need for effective self-management strategies to make the best use of the limited resources available and encourage patient empowerment and self-activation (Future in Mind, 2015; NICE 2005; Wolpert et al., 2016). This may be particularly important in socially excluded populations, who suffer increased difficulties but are less likely to seek help and more likely to drop out of services. As such, there is a need to investigate strategies for self-management in such populations.

A recent review conducted considering strategies not accompanied by a professional found 103 strategies suggested as potentially helpful to children and young people with depression and anxiety up to the age of 25. However, only 22 of these were rigorously evaluated (Wolpert et al., 2018).

While qualitative findings in this field are scant, a recent study with young people aged 9-12 has highlighted the types of strategies and sources of support that young people draw on to self-manage their problems (Stapley & Deighton, 2018). However, the barriers and facilitators that young people may identify concerning using self-management strategies have not yet been explored.

This PhD project is proposed to understand self-management in children and young people with mental health difficulties from a socially excluded population, and from this, develop an intervention. This PhD will be underpinned by the Behaviour Change Wheel (Michie et al., 2012); a method for characterising, understanding, and designing behaviour change interventions. The BCW has already been successfully applied in many contexts to change behaviour including improving medication prescribing and increasing healthy eating in young people (Curtis 2017; Sinnott 2015). Recently, it has been used in child and youth mental health for shared decision making (Hayes, 2018). The proposed PhD studies are outlined below:

Study 1: An updated review of the literature of self-management interventions in child and youth mental health.

Studies 2 and 3: Qualitative studies of the barriers and facilitators to self-management drawing on the Theoretical Domains Framework (Cane, 2012)

Study 4: Intervention development

Study 5: Intervention piloting

All candidates should hold a Master’s qualification (or complete their Master’s by September 2019) in an appropriate discipline and have a minimum of a 2:1 or equivalent in their first degree. Applicants should preferably have knowledge of the UK health and care system. All applicants are required to have excellent written and verbal communication skills. They should also be willing to work collaboratively in multi-disciplinary and multi-professional teams.

Project-specific skills and experience required:

Qualitative research skills (data collection, analysis, and dissemination)

Quantitative research skills (data collection, analysis, and dissemination)

Interest and experience in conducting research around child and youth mental health and wellbeing

Experience of using software packages (e.g. SPSS, STATA, NVivo)

CLAHRC Research area: Mental health

References :

Cane, J., O’Connor, D., & Michie, S. (2012). Validation of the Theoretical Domains Framework for use in behaviour change and implementation research. Implementation Science, 7(1), 37.

Curtis, K. E. (2016). Development of a Theory and Evidence Based, User-Centered Family Healthy Eating App. University of Warwick.

Demyttenaere, K., Bruffaerts, R., Posada-Villa, J., Gasquet, I., Kovess, V., Lepine, J., … & Kikkawa, T. (2004). Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. Jama291(21), 2581-2590.

Department of Health. (2015). Future in mind: Promoting, protecting and improving our children and young people’s mental health and wellbeing. London.

Edbrooke-Childs, J., Wolpert, M., Zamperoni, V., Napoleone, E., & Bear, H. (2018). Evaluation of reliable improvement rates in depression and anxiety at the end of treatment in adolescents. BJPsych open4(4), 250-255.

Hayes, D. (2018). Developing an intervention to promote shared decision making in child and youth mental health: Integrating theory, research and practice. Univiersity College London.

Jakobsen, M., Demott, M. A., & Heir, T. (2014). Prevalence of psychiatric disorders among unaccompanied asylum-seeking adolescents in Norway. Clinical practice and epidemiology in mental health: CP & EMH10, 53.

Kalff, A. C., Kroes, M., Vles, J. S. H., Hendriksen, J. G. M., Feron, F. J., Steyaert, J., … & van Os, J. (2001). Neighbourhood level and individual level SES effects on child problem behaviour: a multilevel analysis. Journal of Epidemiology & Community Health55(4), 246-250.

Michie, S., Atkins, L., & West, W. (2014). The Behaviour Change Wheel: A guide to designing interventions. London: Silverback Publishing.

NHS Digital. (2018). Mental Health of Children and Young People in England, 2017. London.

NICE. (2007). Depression in children and young people: Identification and management. Clinical guideline [CG28]. London. Retrieved from https://www.nice.org.uk/guidance/cg28

Sinnott, C., Mercer, S. W., Payne, R. A., Duerden, M., Bradley, C. P., & Byrne, M. (2015). Improving medication management in multimorbidity: Development of the MultimorbiditY COllaborative Medication Review And DEcision making (MY COMRADE) Intervention using the Behaviour Change Wheel. Implementation Science, 10(1), 132.

Stapley, E., & Deighton, J. (2018). Headstart Year 1:  National Qualitative Evaluation Findings – Young People’s Perspectives. London: CAMHS Press.

Wolpert, M., Dalzell, K., Ullman, R., Garland, L., Cortina, M., Hayes, D., … & Law, D. (2018). Strategies not accompanied by a mental health professional to address anxiety and depression in children and young people: a scoping review of range and a systematic review of effectiveness. The Lancet Psychiatry.

Wolpert, M., Harris, R., Hodges, S., Fuggle, P., Ames, R., Wiener, A., … Munk, S. (2016). THRIVE elaborated: 2nd Edition. London.
Retrieved from https://www.annafreud.org/media/4817/thrive-elaborated-2nd-edition.pdf

Funding Notes:

Start date: 01/10/19

Duration: 3 years, full time

Stipend: £17,803

Institution: UCL

Enquiries email name and address:

For general enquiries, please email: clahrc.academy@ucl.ac.uk

For project specific queries, please contact: p.fonagy@ucl.ac.uk