Learning together for mental health: feasibility of measures to assess a whole-school mental health and wellbeing intervention in secondary schools

Background: Population mental health in young people worsened during and since the COVID-19 pandemic. School environments can play a key role in improving young people's mental health. Learning Together for Mental Health is a whole-school intervention aiming to promote mental health and well-being among young people in secondary schools. Before progressing to a Phase III effectiveness evaluation of the intervention, it is critical to assess the feasibility of trial measures at baseline and follow-up. Objective: To evaluate the feasibility of trial measures and procedures within a feasibility study of a whole-school intervention aiming to promote mental health and well-being among young people in secondary schools, including whether we met our progression criterion of survey response rates of 60% or more in two or more schools at baseline and follow-up. Design and methods: We conducted a feasibility study which included assessment of the indicative primary and secondary outcomes measures and procedures to be used in a future Phase III trial. Setting and participants: Setting for our feasibility study included five state, mixed-sex secondary schools in southern England (one of which dropped out after baselines and one of which replaced this). We recruited year-7 students to participate in the baseline survey and year-10 students to participate in the follow-up survey at 12-month follow-up. Baseline and follow-up participants were different groups, as the focus was assessing feasibility of measures for the age groups that would be surveyed at baseline and follow-up in a Phase III randomised controlled trial. Our study was not powered or designed to estimate intervention effects. Interventions: As part of our feasibility study, all schools received the Learning Together for Mental Health intervention for one academic school year. Main outcome measures: The indicative primary outcome measure trialled was the total difficulties score of the Strengths and Difficulties Questionnaire. Indicative secondary outcomes measures trialled were the: Warwick-Edinburgh Mental Well-being Scale; Short Moods and Feelings Questionnaire; Generalised Anxiety Disorder-7 scale; Eating Disorders Examination - Questionnaire Short, self-harm (single item from the Health Behaviour in School-aged Children study); bullying victimisation (Gatehouse Bullying Scale); cyberbullying (two items adapted from the Dose Adjustment for Normal Eating II questionnaire); substance use (National Health Service measure); and Beyond Blue School Climate Questionnaire. Results: Trial measures and procedures were feasible to implement and were acceptable to year-7 and year-10 students, teachers and parents. At baseline, response rates ranged from 58% to 91% between schools. Only two students were opted out by parents, and no students opted out in advance. Students refusing consent on the day of survey was rare (7%). Twelve per cent of students were absent. The follow-up survey had an overall response rate of 66%, ranging from 44% to 91%. Only two students were opted out by parents, and three students opted out in advance. Overall, 12% opted out on the day. Twenty per cent of students were absent. Variation in response rate reflected specific problems at certain schools. Surveys took 40-45 minutes at baseline and 30 minutes at follow-up. The trial progression criterion concerning response rates was achieved, with three of four schools at baseline and two of four schools at follow-up having responses rates above 60%. Limitations: Our study involved a small, purposive sample of schools and students which are not representative of those in England. Conclusions: With some minor amendments, trial measures and procedures should be applied in a future Phase III effectiveness evaluation of the Learning Together for Mental Health intervention. Future work: Survey response rates could be improved if baseline and follow-up surveys are not scheduled in the last weeks of term, on Fridays or near mock General Certificate of Secondary Education exams. Completion of some measures (such as Eating Disorders Examination - Questionnaire Short) among year-7 students may be improved if question wording is tailored to be age-appropriate.