Fast-tracking training and investigating new therapy for young people with depression – the BAY research study
How is GMMH changing and improving the way we treat depression in young people? We sat down with Professor Bernadka Dubicka, Consultant Child and Adolescent Psychiatrist at GMMH and Chief Investigator for the BAY research study, to find out more about what may be the largest depression trial within specialist CAMHS internationally.
The Challenge
Emotional disorders, particularly depression, are a common problem in young people, with around one in five teenagers experiencing at least one episode of depression by the age of 18.
Symptoms can include sadness, irritability, loss of interest and pleasure in activities, tiredness or lack of energy, loss of confidence, trouble with concentration and sleep, and changes in appetite. Low mood may also affect young people’s relationships with others, education and physical health.
The number of children and adolescents who have an emotional disorder has been increasing in the last 20 years. In fact, overall the number of young people referred to Child and Adolescent Mental Health Servies (CAMHS) has doubled since the pandemic.1
However, young people face obstacles in receiving the care they need, such as long waits for therapy, and a lack of trained specialist staff; during the Covid-19 pandemic, services also had to adapt from face-to-face to remote delivery of therapy, and we still need to better understand the impact of different types of delivery on young people.
You can view the video here: BAY trial INTRO.mp4 (vimeo.com)
The aims of BAY study
The BAY study stands for Behavioural Activation in Young People and researchers want to know if this type of therapy – Behavioural Activation (BA) – can be delivered by junior mental health practitioners either online or in person. It is hoped that by fast-tracking training for junior clinicians – such as psychology graduates and newly-qualified nurses – this can provide this treatment quickly and effectively to young people who need mental health support. Additionally, researchers want to know if BA delivered in this way can improve young people’s depression, free up more experienced staff, and reduce waiting times.
A smaller feasibility study published in 2020 evaluated whether the therapy was effective and suitable for young people. The team trained junior clinicians with no previous therapy training and worked with 36 young people with an average age of 14, delivering the newly developed BeActive BA program. Of those in therapy, only three dropped out of the study, and approximately 36% were discharged from CAMHS – indicating that young people found the treatment helpful with their depression. In fact, young people attended an average of 7 out of the 8 sessions offered.
Whilst BA has been researched in the adult population, this new study will be the first definitive, large-scale randomised controlled trial of a newly developed BA program for young people attending specialist CAMHS, with an interactive website designed with young people through the GMMH digital unit.
Professor Dubicka told us: “Although BA is used in the NHS for young people with depression, we still don’t have enough research to know how effective it may be. We can’t assume that findings in adult studies will be the same for young people.”
What does it involve?
This larger trial is running across five NHS Trust sites across England and will include 528 young people who will be randomly assigned either Behavioural Activation plus standard treatment and psychoeducation (PE), or treatment as usual plus PE to test the effectiveness, cost-effectiveness and acceptability of this new approach.
Data about the participants will be collected before their treatment, after twelve weeks, six months, and at the one-year mark to measure how the treatments have impacted their mental health.
This newly-developed version of BA therapy is made up of eight sessions lasting around 40 minutes and delivered weekly either in person at a clinic or with a therapist online. The sessions help young people to identify activities that are meaningful and enjoyable, and they are encouraged to take part in these activities, with the support of carers. Young people are shown how to set goals, use problem solving, learn methods to deal with stress and avoidance, and will be taught what to do if they think their symptoms might return.
Professor Dubicka noted: “Although the participants in our feasibility study had complex difficulties which we routinely see in CAMHS, we found that young people enjoyed the intervention and attended most sessions.
“We are excited to offer our new, enhanced online BA, and hope, if successful, our intervention may help to reduce waiting times, offer flexibility in service delivery, and provide new staff with additional skills.”
The BAY study is being run across several NHS Trusts in the UK including GMMH, Pennine Care, MFT, Nottinghamshire Healthcare, Cambridgeshire and Petersborough, and other trusts may also be joining. The trusts are working in partnership with the University of York, Hull and York Medical School, the University of Manchester, and the study is funded by the National Institute for Health and Care Research (NIHR).
Within GMMH, researchers are currently working with Bolton CAMHS to deliver the study in Greater Manchester. “We hope to be able to extend our study to GMMH’s second CAMHS centre in Wigan in the future,” says Professor Dubicka.
You can find out more about the BAY research study by visiting their website: www.bayresearchstudy.co.uk . If you have any questions, please contact bay-project@york.ac.uk .
Prof Dubicka and colleagues have created a free learning module about Behavioural Activation in Young People through the Royal College of Psychiatrists. Register for an account and take the course here.
You can read the published article about the original feasibility study here (May 2021).
