Mental health support and training to improve secondary school teachers’ well-being: the WISE cluster RCT

Background Health and Safety Executive data show that teachers are at heightened risk of mental health difficulties, yet few studies have attempted to address this. Poor teacher mental health may impact on the quality of support provided to young people, who also report increased mental health difficulties themselves. Objective To test the effectiveness of an intervention aiming to improve secondary school teachers’ well-being through mental health support and training. Design A cluster randomised controlled trial with embedded process and economic evaluations. Setting Twenty-five mainstream, non-fee-paying secondary schools in the south-west of England and South Wales, stratified by geographical area and free school meal entitlement, randomly allocated to intervention or control groups following collection of baseline measures (n = 12, intervention; n = 13, control) between May and July 2016. Participants All teachers in the study schools at any data collection. All students in year 8 (baseline) and year 10 (final follow-up). Intervention Each intervention school received three elements: (1) a 1-day mental health first aid for schools and colleges training session delivered to 8% of all teachers; (2) a 1-hour mental health session delivered to all teachers; and (3) 8% of staff trained in the 2-day standard mental health first aid training course set up a confidential peer support service for colleagues. Control schools continued with usual practice. Main outcome measures The primary outcome was teacher well-being (using the Warwick–Edinburgh Mental Wellbeing Scale). Secondary outcomes were teacher depression, absence and presenteeism, and student well-being, mental health difficulties, attendance and attainment. Follow-up was at 12 and 24 months. Data were analysed using intention-to-treat mixed-effects repeated-measures models. Economic evaluation A cost–consequence analysis to compare the incremental cost of the intervention against the outcomes measured in the main analysis. Process evaluation A mixed-methods study (i.e. qualitative focus groups and interviews, quantitative surveys, checklists and logs) to examine intervention implementation, activation of the mechanisms of change outlined in the logic model, intervention acceptability and the wider context. Results All 25 schools remained in the study. A total of 1722 teachers were included in the primary analysis. We found no difference in mean teacher well-being between study arms over the course of follow-up (adjusted mean difference –0.90, 95% confidence interval –2.07 to 0.27). There was also no difference in any of the secondary outcomes (p-values 0.203–0.964 in the fully adjusted models). The average cost of the intervention was £9103 (range £5378.97–12,026.73) per intervention school, with the average cost to Welsh schools being higher because of a different delivery model. The training components were delivered with high fidelity, although target dosage was sometimes missed. The peer support service was delivered with variable fidelity, and reported usage by teachers was low (5.9–6.1%). The intervention had high acceptability, but participants reported low support from senior leadership, and minimal impact on school culture. Limitations Participants and the study team were unblinded, self-report for the main outcome measures and inaccurate measurement of peer support service usage. Conclusions The Wellbeing in Secondary Education (WISE) intervention was not effective at improving teacher or student well-being, or reducing mental health difficulties, possibly because of contextual barriers preventing it becoming embedded in school life. Future work Identification of ways in which to achieve system-level change and sustained support from senior leaders is important for future school-based mental health interventions. Trial registration Current Controlled Trials ISRCTN95909211. Funding This project was funded by the National Institute for Health Research Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 12. See the NIHR Journals Library website for further project information. Intervention costs were met by Public Health Wales, Public Health England and Bristol City Council.

Why do doctors seek peer support? A qualitative interview study

ObjectivesTo understand how doctors reflect on when and why they seek help from an organised peer-support service.DesignData were collected through audiotaped, qualitative, semi-structured interviews. The interviews were analysed with systematic text condensation.SettingA peer-support service accessible to all doctors in Norway.ParticipantsThirteen doctors were interviewed after attending a counselling service in fall 2018. They were selected to represent variation in gender, demographics, and medical specialty. Doctors were excluded if the interview could not be held within 10 days after they had accessed peer support.ResultsThe doctors’ perspectives and experiences of when and why they seek support and their expectations of the help they would receive are presented, and barriers to and facilitators of seeking support are discussed. Three categories of help-seeking behaviour were identified: (1) ‘Concerned—looking for advice’ describing help seeking in a strenuous situation with need for guidance; (2) ‘Fear of not coping any longer’ describing help seeking when struggling due to unreasonable stress and/or conflict in their lives; and (3) ‘Looking for a way back or out’ describing help seeking when out of work. Expectations to the help they would receive varied widely. Motivations for seeking help had more to do with factors enabling or restricting help-seeking than with the severity of symptoms.ConclusionsMany different situations lead doctors to seek peer support, and they have various expectations of the service as well as diverse needs, motivations and constraints to seeking peer support. Further research is warranted to investigate the impact of peer support and how to tailor the service to best suit doctors’ specific needs.

Thematic analysis of mechanisms underpinning email peer support for young people with eating disorders

Purpose Peer support, such as mentorship and befriending, has been found to have a valuable impact on a range of outcomes. There are multiple formats, including face-to-face (individually and group), and in online forums. Advancement in technology has enabled online peer support to increase in popularity; however, little is known about mechanisms underpinning individual one to one online peer interactions. The purpose of this paper is to qualitatively explore the mechanisms underpinning email exchanges in an eating disorder peer support service. Design/methodology/approach Email transcripts from dyads in a moderated peer-to-peer email support service were analysed using inductive thematic analysis (Braun and Clarke, 2006). Findings The thematic analysis generated five themes as mechanisms of peer support. Relating and reflecting experience was the central superordinate theme. Subthemes included Positive Encouragement, Checking in and Prompting, Being a Confidante and Defining Recovery. Originality/value The current findings align with previous research and add new developments. The theme of Defining Recovery added the awareness of the personal perception of recovery, which had not been considered as a mechanism in previous literature and may be specific to this digital platform. This study could assist in the development of training for the provision of further peer support within eating disorder services.

Delivery of a Mental Health First Aid training package and staff peer support service in secondary schools: A process evaluation of uptake and fidelity of the WISE intervention

Background: Improving children and young people’s provision for mental health is a current health priority in England. Secondary school teachers have worse mental health outcomes than the general working population, which the Wellbeing in Secondary Education (WISE) cluster randomised controlled trial aimed to improve. The WISE intervention comprised a Mental Health First Aid (MHFA) training package to at least 16 percent of staff, a short mental health awareness session to all teachers, and development of a staff peer-support service. Twenty-five schools were randomised to intervention or control arms. This paper reports findings regarding the extent of uptake and fidelity of the intervention. Methods: Mixed methods data collection comprised researcher observations of training delivery, training participant evaluation forms, trainer and peer supporter interviews, peer supporter feedback meetings, logs of support provided, and teacher questionnaires. Quantitative data were summarised descriptively, while thematic analysis was applied to the qualitative data. Results: In the 12 schools assigned to the intervention arm, 113 (8.6%) staff completed the two-day standard MHFA training course, and a further 146 (11.1%) staff completed the one-day MHFA for Schools and Colleges training. In seven (58.3%) schools the required eight percent of staff completed the MHFA training packages. A one-hour mental health awareness raising session was attended by 666 (54.5%) staff. Delivery of the MHFA training package was achieved with high levels of fidelity and quality across schools. All schools set up the peer-support service following training, with a majority adhering to most of the operational guidelines developed from the pilot study at the outset. Teachers reported limited use of the peer support service during follow-up. At the one year follow up, only three (25.0%) schools indicated they had re-advertised the service and there was evidence of a reduction in support from senior leadership. Conclusion: The MHFA training package was delivered with reasonably high fidelity, and a staff peer support service was established with general, but not complete, adherence to guidelines. In some schools insufficient staff received MHFA training and levels of delivery of the peer support service compromised intervention dose and reach.

Delivery of a Mental Health First Aid training package and staff peer support service in secondary schools: A process evaluation of uptake and fidelity of the WISE intervention

Background: Improving children and young people’s provision for mental health is a current health priority in England. Secondary school teachers have worse mental health outcomes than the general working population, which the Wellbeing in Secondary Education (WISE) cluster randomised controlled trial aimed to improve. The WISE intervention comprised a Mental Health First Aid (MHFA) training package to at least 16 percent of staff, a short mental health awareness session to all teachers, and development of a staff peer-support service. Twenty-five schools were randomised to intervention or control arms. This paper reports findings regarding the extent of uptake and fidelity of the intervention, drawn from a wider process evaluation reported elsewhere. Methods: Mixed methods data collection comprised researcher observations of training delivery, training participant evaluation forms, trainer and peer supporter interviews, peer supporter feedback meetings, logs of support provided, and teacher questionnaires. Quantitative data were summarised descriptively, while thematic analysis was applied to the qualitative data. Results: In the 12 schools assigned to the intervention arm, 113 (8.6%) staff completed the two-day standard MHFA training course, and a further 146 (11.1%) staff completed the one-day MHFA for Schools and Colleges training. In seven (58.3%) schools the required eight percent of staff completed the MHFA training packages. A one-hour mental health awareness raising session was attended by 666 (54.5%) staff. Delivery of the MHFA training package was achieved with high levels of fidelity and quality across schools. All schools set up the peer-support service following training, with a majority adhering to most of the operational guidelines developed from the pilot study at the outset. Teachers reported limited use of the peer support service during follow-up. At the one year follow up, only three (25.0%) schools indicated they had re-advertised the service and there was evidence of a reduction in support from senior leadership. Conclusion: The MHFA training package was delivered with reasonably high fidelity, and a staff peer support service was established with general, but not complete, adherence to guidelines. In some schools insufficient staff received MHFA training and levels of delivery of the peer support service compromised intervention dose and reach.

Delivery of a Mental Health First Aid training package and staff peer support service in secondary schools: A mixed-methods implementation study of the WISE intervention

Background: Improving children and young people’s provision for mental health is a current health priority in England. Secondary school teachers have worse mental health outcomes than the general working population, which the Wellbeing in Secondary Education (WISE) cluster randomised controlled trial aimed to improve. The WISE intervention comprised a Mental Health First Aid (MHFA) training package to at least 16 percent of staff, a short mental health awareness session to all teachers, and development of a staff peer-support service. Twenty-five schools were randomised to intervention or control arms. This paper reports findings regarding the extent of successful intervention implementation, drawn from a wider process evaluation reported elsewhere. Methods: Mixed methods data collection comprised researcher observations of training delivery, training participant evaluation forms, trainer and peer supporter interviews, peer supporter feedback meetings, logs of support provided, and teacher questionnaires. Quantitative data were summarised descriptively, while thematic analysis was applied to the qualitative data. Results: In the 12 schools assigned to the intervention arm, 113 (8.6%) staff completed the two-day standard MHFA training course, and a further 146 (11.1%) staff completed the one-day MHFA for Schools and Colleges training. In seven (58.3%) schools the required eight percent of staff completed the MHFA training packages. A one-hour mental health awareness raising session was attended by 666 (54.5%) staff. Delivery of the MHFA training package was achieved with high levels of fidelity and quality across schools. All schools set up the peer-support service following training, with a majority adhering to most of the operational guidelines developed from the pilot study at the outset. Teachers reported limited use of the peer support service during follow-up. At the one year follow up, only three (25.0%) schools indicated they had re-advertised the service and there was evidence of a reduction in support from senior leadership. Conclusion: The MHFA training package was delivered with reasonably high fidelity, and a staff peer support service was established with general, but not complete, adherence to guidelines. In some schools insufficient staff received MHFA training and levels of delivery of the peer support service compromised intervention dose and reach.

Delivery of a Mental Health First Aid training package and staff peer support service in secondary schools: A mixed-methods implementation study of the WISE intervention

Background: Improving children and young people’s provision for mental health is a current health priority in England. Secondary school teachers have worse mental health outcomes than the general working population, which the Wellbeing in Secondary Education (WISE) cluster randomised controlled trial aimed to improve. The intervention tested delivery of a Mental Health First Aid (MHFA) training package to at least 16 percent of staff, a short mental health awareness session to all teachers, and development of a staff peer-support service. Twenty-five schools were randomised to intervention or control arms. This paper reports findings from an embedded process evaluation to assess the extent of successful intervention implementation.Methods: Mixed methods data collection comprised researcher observations of training delivery, training participant evaluation forms, trainer and peer supporter interviews, peer supporter feedback meetings, logs of support provided, and teacher questionnaires. Quantitative data were summarised descriptively, while thematic analysis was applied to the qualitative data. Results: In the 12 schools assigned to the intervention arm, 113 (8.6%) staff completed the two-day standard MHFA training course, and a further 146 (11.1%) staff completed the one-day MHFA for Schools and Colleges training. In seven (58.3%) schools the required eight percent of staff completed the MHFA training packages. A one-hour mental health awareness raising session was attended by 666 (54.5%) staff. Delivery of the MHFA training package was achieved with high levels of fidelity and quality across schools. All schools set up the peer-support service following training, with a majority adhering to most of the operational guidelines developed from the pilot study. Teachers reported limited use of the peer support service during follow-up. At the second peer-supporter feedback meeting, only three (25.0%) schools indicated they had re-advertised the service and there was evidence of a reduction in support from senior leadership. Conclusion: The MHFA training package was delivered with reasonably high fidelity, and a staff peer support service was established with general, but not complete, adherence to guidelines. In some schools insufficient staff received MHFA training and levels of delivery of the peer support service compromised intervention dose and reach.

Using the behaviour change wheel to explore infant feeding peer support provision; insights from a North West UK evaluation

Background Breastfeeding peer support is advocated in national and international guidelines, but the evidence base is mixed. In the UK, breastfeeding peer support was found to be ineffective in randomised controlled trials, while women report positive impacts on breastfeeding experiences in qualitative studies. A key criticism levied against breastfeeding peer support is the lack of theory underpinning intervention design. Here we use the Behaviour Change Wheel to structure the analysis of evaluation data from an infant feeding peer support service in one area in North West England. We aimed to provide theoretically informed insights into how peer support can be operationalised to influence women’s breastfeeding experiences. Methods A 2 year mixed-methods evaluation (2014–2016) comprised surveys and interviews (individual or group) with peer supporters, health and community professionals, project leads and women, and routinely collected infant feeding data. We used the three layers (policies, intervention functions and behaviour-related components) of the Behaviour Change Wheel to structure and interpret the data. Results Overall data comprised 23 interviews (n = 14 - individual; n = 9 - group) and 409 completed surveys. The findings are presented in three sections. First, the ‘policies’ (outer) layer of the Behaviour Change Wheel provides insights into the existing context, infrastructure and resources that underpinned peer support delivery. Then the second (intervention functions) and inner (behaviour components) layers of the Behaviour Change Wheel are used to present three themes, ‘developing capabilities for infant feeding’, ‘motivating guidance and support’ and ‘opportunities for support’. These findings highlight that a peer support service delivered in a context of effective interdisciplinary partnerships, Baby Friendly Initiative accreditation, and flexible service planning, with peer support provided via different types of instrumental, social, practical and emotional support was perceived to be highly beneficial on women’s breastfeeding experiences. In the final section key challenges faced by the service are outlined. Conclusion While gaps and areas for development were highlighted, the service enhanced women’s capabilities, motivations and opportunities for breastfeeding. These theoretically informed insights into an organic and responsive peer support service help build the evidence base for breastfeeding peer support and to identify positive delivery features for future testing.