How we introduced a new drug-free therapy programme for young people with depression
Virgin Care’s Devon Child and Adolescent Mental Health Service introduced a pioneering programme for more than 50 young patients – and their parents too – recovering from depression to teach them Mindfulness-based Cognitive Therapy skills and offer a stable support network at home helping patients to stay well. Through the programme we’ve helped parents and young patients use their new skills to disengage from negative thoughts, helped reduce their sense of isolation and taught them that negative thoughts are universal, which helps them cope with and avoid further depression. The programme was the first of its kind in the country to run parallel child and adult sessions.
The Child and Adolescent Mental Health Service in Devon, which Virgin Care run as part of our Devon Integrated Children’s Services contract, helps all children and young people under the age of 18 who are experiencing mental health difficulties. The service supports some of the most severe and complex emotional and mental health difficulties among children and young people by finding strategies and techniques which help them achieve their full potential.
Children and young people with serious mental health issues can often feel lonely and often also have problems at school and in life with behavioural problems too. Parents and carers need help and advice to support their family to work through those issues – CAMHS offers direct support to parents, carers and young people with those problems.
In 2012 we trialled and introduced a new therapy programme to help improve the care we offer to both young people and their parents which uses parallel Mindfulness-based Cognitive Therapy (MBCT) sessions for young people suffering from depression and their parents over an eight week period. The course builds skills and tools which helps them overcome and avoid depression in the future, and – by including family members too, in the first programme of its kind – builds a support network at home.
NICE, who review drugs and treatments for the NHS, recommend MBCT for depression and research increasingly suggests Mindfulness-based interventions have the potential to treat a range of other mental health conditions.
The programme is specifically targeted towards young people aged 14 to 18 who have previously been treated successfully for depression or are coming to the end of a treatment period which appears to have been successful. Virgin Care’s innovation fund, an initiative which supports ideas for improving projects put forward by frontline colleagues, provided funding for the trial.
Demand for mental health services rising quickly
We know from research that people who have had depression during adolescence are more likely to face a recurrence or develop other mental health issues in the future. Long-lasting treatment is important to help us keep people well, and treating people earlier saves the NHS money. Around 60% of adults diagnosed with depression have suffered their first episode during their younger years.
Demand for mental health services for children and adults in the UK is rising quickly, despite increased funding, and parents are reluctant to treat their children for depression with medication. The demand, coupled with this reluctance, mean waits for treatment can be long in all but the most severe cases.
National research shows that about 50% of adults who have depression and are subsequently treated using anti-depression drugs suffer from a further episode of depression which requires treatment. In adults, where MBCT is offered regularly as a treatment for depression and anxiety and as a long-term preventative treatment, success rates are similar.
Using Mindfulness to ease distress for young people
We knew from emerging evidence from trials that using MBCT can be helpful in easing distress for young people experiencing depression and anxiety and the possibility of recurring episodes.
Mindfulness helps people focus their minds and become aware of thoughts and feelings and accepting them, but not focusing on or reacting to them. NICE recommend MBCT for depression and have suggested that Mindfulness-based interventions have the potential to treat a range of other mental health conditions.
We developed a programme, based around a reduced version of the adult MBCT course, which set out to evaluate how feasible MBCT treatment was for young people. The programme not only trained the children and young people themselves in MBCT techniques, but also provided parallel sessions for parents to begin building a support network in the family.
Service user feedback
“It’s extremely useful. Parents are given the ammunition for themselves, but also to help the young person and understand what’s going on for them and how it can help. Because when your young person’s in, you know, mental strife, you feel like you have no idea what to do to help. So if you’re given that ammunition to try and help, that’s got to be a good thing.”
The eight week course offered shorter session times, shorter activities, more varied activities, shorter home practice sessions recommended and more frequent ‘booster’ sessions during the course compared to the adult equivalent.
We taught young people and their families to become Mindfulness practitioners and to use the skills they’d learnt to prevent depressions in the future, as an alternative to drug-based interventions. All of the people who took part were also given additional support from our team and access to a clinically approved smartphone app.
During the pilot we saw that our MBCT treatment had some tangible benefits over other treatments:
- It takes just eight weeks
- It’s low cost
- It teaches skills to disengage from rumination
- It reduces the sense of isolation and teaches young people that negative thoughts are universal
- It’s a skill that is learnt, not a ‘treatment’
- Further booster and help can be provided remotely, or by App
- It can be standardised
- It can provide parallel training for parents and carers
After our trial was successful, we ran further groups with young patients and their parents who met the criteria we’d set out.
The only provider to run parallel groups
Three other NHS providers have been piloting MBCT interventions for children, but we are the only provider to have run a parallel parent group to build a Mindfulness support network at home for our patients.
In our initial trial we saw very positive results. Using standardised scoring, we saw there was a decrease in depression severity from 27.7 to 12.8 and a decrease in rumination (negative thoughts about the past) scores from 59.2 to 45.2. Following treatment 75% no longer reported they had the symptoms of depression.
As part of the trial, we also found that MBCT has a relatively high adherence rate for a group programme, 75% of young people who commenced the course completed it.
Since then, we’ve helped more than 50 young patients and families become independent Mindfulness practitioners so they can use the skills as a prevention technique in the future.
Service user feedback
“I’m happier. I don’t think about the past as much and I notice when I start to think about the past. I can mould it (Mindfulness) into pretty much any place…wherever I am.”
Patients have told us that the skills they acquired during the course are useful and it was often reported that they had already begun to use the techniques informally when in stressful situations.
This was equally true of parents and carers who joined the course despite more than 40% never being diagnosed or treated for depression before.
Since the trial, we‘ve been able to run six additional courses and begun to develop it further too – the project has evolved to include a group of young people who have suffered with an Eating Disorder as well as depression or anxiety.
We’re confident that, despite having costs associated with it, the MBCT course with occasional ‘booster’ sessions is lower than the cost of ongoing medication and associated consultant and doctor time.
We’re continuing to run the programme in our Devon service.