Emily Stapley’s research while affiliated with University College London and other places

Despite recent investments in school-based mental health and wellbeing promotion in England, the sustainability of mental health interventions remains a substantial challenge. This article brings together potential solutions to sustaining interventions in schools, drawing on insights from an online roundtable discussion held in July 2022. Facilitated by researchers and informed by recent research on barriers and facilitators to sustaining school-based mental health interventions, 16 participants came together to discuss challenges and solutions. Participants included school staff, policy makers, educational psychologists, researchers and mental health intervention developers. The discussion explored the need for accountability at all levels (e.g., from school leaders to policy makers and Ofsted) and the potential value of engaging schools more consistently with academic evidence. Participants also discussed the importance of creating a healthy and sustainable ecosystem for interventions (underscoring the significance of staff wellbeing, adequate resourcing, and longer-term funding commitments), and moving beyond separate, isolated interventions. The findings offer a range of recommendations for school decision makers, mental health researchers, intervention developers, and those working in the wider system around schools.

Background The escalating prevalence of mental health issues among university students is alarming, particularly as many do not receive necessary mental health interventions. While existing qualitative research has shed light on the perceived barriers students face accessing mental health care, our study explored the experiences of healthcare professionals who interact with these students. Our aim is to enhance the understanding of students’ accessibility to mental health care. Methods Between June 2022 and January 2023, we conducted semi-structured interviews with 23 professionals from university services, NHS general practice, crisis teams and psychological services in London. Data analysis was carried out concurrently with data collection, utilising reflexive thematic analysis and abductive analysis principles. The concept of ‘candidacy’ was instrumental in deciphering the ongoing phenomena observed in the data. Results Our findings indicate that students’ access to appropriate mental health care is intricately linked to their evolving social context, the structure, and pressures of the local health system. Professionals highlighted variability in students’ perceptions of what health issues warranted medical attention. The students who made it to a professional’s service were often those with more resources and better relationships to leverage. Once in the system, the actions professionals took were heavily influenced by their specific roles and expertise, available resources, but also by their service’s relationship with other organisations, and the types of support students deemed acceptable. Conclusions The concept of candidacy offers a useful lens to view university students’ access to mental health support. Access appears to be an increasingly intricate task for students, given the fragmented service landscape, surging demand for mental health care and the challenges of emerging adulthood. Our research suggests that mere policy shifts promoting increased use of mental health services may not yield better outcomes for students without holistic consideration of inter-service relationships and available resources.

Objectives In order to develop a better understanding of students’ access to mental health services, we explored the experiences of health care professionals interacting with university students with mental health problems. Methods We interviewed 23 professionals working across university advice and counselling services, NHS general practice, crisis, and psychological services in North and East London between June 2022 and January 2023. Our approach drew on reflexive thematic analysis and the principles of abductive analysis. The notion of candidacy – that is, how different needs are deemed deserving of health service attention – was particularly helpful to our understanding of the ongoing phenomenon of interest in the data. Results Each student’s access to mental health support was highly contingent on the student’s dynamic social context and the pressures and organisation of the local health system. Professionals described how different students viewed different needs as deserving of health service attention. Which students reached the professional’s service depended on the resources and relationships a student could draw upon, and the service’s relative permeability. Once there, what action professionals took was strongly influenced by the professional’s service expertise, resource constraints, the relationships the professional’s service had with other organisations, the students’ wishes, and whether students regarded treatment offers as acceptable. Conclusions Candidacy offers a useful lens to view university students’ access to mental health support. Access appears to be an increasingly intricate task for students, given the fragmented service landscape, surging demand for mental health care and challenges of emerging adulthood. Our findings suggest that policy goals to increase use of mental health services are unlikely to improve outcomes for students without policy makers and health systems giving holistic consideration of inter-service relationships and available resources.

Aims: Previous research has established a relationship between self-management and better emotional health. However, self-management has not been explored amongst LGBTQ+ adolescents, who are more likely to have a mental health difficulty than their non-LGBTQ+ peers, but less likely to access specialist mental health services. Furthermore, self-management has not been investigated as a mediator or a moderator of the established relationships between outness and minority stress and emotional health difficulties. This study aims to clarify the relationships between these topics to inform early interventions involving self-management. Methods: Data were collected via an anonymous online survey on REDCap. Participants completed validated measures of outness, anxiety, depression, minority stress, and self-management, as well as demographics. Data were analysed in SPSS 25. Results and Conclusions: 3,541 participants aged 16 to 25 completed all or part of the survey. Significant correlations were observed between outness and depression, self-management and anxiety/depression, and minority stress and anxiety/depression. Self-management significantly moderated the relationship between outness and depression. Self-management significantly mediated the relationship between minority stress and depression, but not anxiety. Greater capacity to self-manage had a larger impact on depression for participants experiencing low minority stress compared to those experiencing higher levels of minority stress. Future self-management interventions should consider targeting LGBTQ+ young people experiencing lower levels of minority stress. Greater financial support and systemic prioritisation of self-management interventions is needed, particularly for LGBTQ+ adolescents.

Background Help-seeking is intrinsic to efforts to manage the onset, maintenance, or escalation of mental health difficulties during adolescence. However, our understanding of adolescent help-seeking remains somewhat nebulous. A greater comprehension of help-seeking behavior from the perspective of adolescents is needed. It is also prudent to explore help-seeking behavior in the context of perceived cause for emotional distress, particularly as causal beliefs have been found to influence help-seeking behavior in adults. Objectives The present study sought to categorize adolescents' experiences of help-seeking, and to examine the extent to which these categories (or “types”) of help-seeking behavior are associated with their perceptions of causal factors for emotional distress. Methods The data for this study were drawn from interviews conducted as part of the HeadStart Learning Programme. The sample comprised of 32 young people aged 11–12 years. Ideal-type analysis, a qualitative form of person-centered analysis, was used to construct a typology of adolescent help-seeking. Participants' help-seeking “type” was then compared with their perceived cause for emotional distress “type.” Findings We developed four distinct categories of help-seeking: (1) guided by others who have taken notice; (2) skeptical with unmet needs; (3) motivated and solution focused; and (4) preference for self-regulation. Simultaneously, we identified principal associations between perceived cause of emotional distress—(1) perceived lack of control; (2) unfair treatment; (3) others: their actions and judgements as the catalyst; (4) concern for self and others; and (5) self as cause—and help-seeking approaches. “Perceived lack of control” was most likely to be associated with “others who have taken notice”; “Unfair treatment” with “skeptical with unmet needs”; “others: their actions and judgements as the catalyst” with “motivated and solution focused”; “concern for self and others' with ‘guided by others who have taken notice”; finally, “self as cause” was most likely to be associated with “preference for self-regulation.” Conclusions This study demonstrates meaningful and distinct categories of adolescent help-seeking and offers empirical evidence to support the assertion that perceived cause for emotional distress may influence the help-seeking approaches of adolescents.

There is growing interest in the role of Social Prescribing (SP) to help promote mental well-being and support individuals with mental health difficulties. Yet, implementation of SP to children and young people (CYP) has proved slow and underdeveloped compared with adult populations. Understanding the barriers and facilitators will help key stakeholders to better embed SP for CYP into practice. Using the Theoretical Domains Framework (TDF), a comprehensive, theoretical-led framework, underpinned by 33 behaviour change theories and 128 constructs, perceived barriers and facilitators to SP were investigated. The sample comprised of 11 Link Workers and 9 individuals involved in facilitating SP with CYP, who took part in semi-structured interviews. Transcripts were analysed using a deductive thematic analysis, and themes were coded under each theoretical domain. Overall, 33 barriers and facilitators for SP were identified across 12 domains of the TDF. Under capability, barriers and facilitators were found for knowledge, skills, memory/attention/decision making processes, and behavioural regulation. For opportunity, barriers and facilitators were found for social/professional influences, as well as environmental context and resources. Finally, for motivation, domains covered included: beliefs about consequences, beliefs about capabilities, optimism, motivations/goals, reinforcement, and emotions. Findings suggest that a wide range of barriers and facilitators affect the implementation of CYP SP to improve mental health and well-being. Interventions which target different domains related to capability, opportunity and motivation should be developed to better facilitate CYP SP.

Objective The prevalence of mental health difficulties among children and adolescents is rising. This study aimed to explore early adolescents’ lived experiences of a school- and community-based prevention program, including what helps, why, and when. Method Seventy-eight semi-structured interviews were conducted with early adolescents (aged 10 to 13) as part of the evaluation of HeadStart, a UK-based program. A reflexive thematic analysis was conducted and a typology was developed to facilitate comparisons between participants' experiences. Results The typology consisted of five groups, including early adolescents who described positive or helpful experiences of HeadStart support, those who wanted more support, those who described more mixed or unhelpful experiences of support, and those who did not report receiving much or any support. Cross-group themes highlighted the ‘bridges’ that interventions can build to promote mental health and wellbeing, e.g. learning new coping or problem-solving skills. There was more variation between the groups in terms of the ‘walls’ (e.g. issues with intervention content, timing, or location) that may limit intervention effectiveness. There were also some group differences in terms of the other sources of social support that participants had access to and the level of difficulties that they were facing in their lives. Discussion The findings suggest that intervention developers should tailor design and delivery according to different profiles of early adolescents who may be more or less able or willing to accept help, and who may experience different formats, structures, and content of support as either more or less useful.

There are increasing rates of internalising difficulties, particularly anxiety and depression, being reported in children and young people in England. School-based universal prevention programmes are thought to be one way of helping tackle such difficulties. This paper describes an update to a four-arm cluster randomised controlled trial (http://www.isrctn.com/ISRCTN16386254), investigating the effectiveness of three different interventions when compared to usual provision, in English primary and secondary pupils. Due to the COVID-19 pandemic, the trial was put on hold and subsequently prolonged. Data collection will now run until 2024. The key changes to the trial outlined here include clarification of the inclusion and exclusion criteria, an amended timeline reflecting changes to the recruitment period of the trial due to the COVID-19 pandemic and clarification of the data that will be included in the statistical analysis, since the second wave of the trial was disrupted due to COVID-19. Trial registration ISRCTN Registry ISRCTN16386254. Registered on 30 August 2018.

Causal attributions and help-seeking is not well explored among adolescents, despite evidence of perceived causes for difficulties influencing how adults engage with treatment and seek help. This study reviewed extant literature to understand what adolescents at increased risk of developing mental health difficulties and those with clinically significant symptoms perceive to be the cause of emotional distress; to determine the extent to which perceived cause influences help-seeking; and to identify potential differences/commonalities between these groups. A systematic review and qualitative thematic synthesis were conducted. 3,691 articles were identified, 18 were eligible to be included and were synthesized using thematic synthesis. Six main themes related to perceived cause are reported. Three of those themes were shared between the clinical and at-risk groups: (1) challenging social factors and perceived difference, (2) problematic family dynamics, and (3) cause is complex and multifaceted. Three themes were not: (4) unfairness and perceived lack of agency and (5) concern for self and others, were exclusive to the at-risk group, and (6) coping with a mental health difficulty was exclusive to the clinical group. Four main themes related to causal attributions and help-seeking were found, including: (1) cause and implications for self-preservation; (2) the degree of personal and wider knowledge and understanding of cause; (3) perceived extent of control in managing cause; and (4) cause having potential to affect others. The findings of this review demonstrate that perceived cause for emotional distress plays a role in help-seeking among adolescent groups and highlights likely differences in how adolescents at-risk of mental health difficulties and those with clinically significant symptoms attribute cause for their difficulties and subsequently seek help. This has important implications for how to support young people experiencing or at risk of mental health difficulties and presents a strong case for pursuing more research in this area.