Mental health problems can emerge as early as childhood and, if left unaddressed, can be an indicator of problems later in life.
Early intervention in mental health involves identifying and addressing these problems as soon as possible to prevent more severe and long-lasting issues. To do this, we first need to identify interventions and treatments that work for young people.
This was the focus of Professor Willem Kuyken and his team in the My Resilience in Adolescence (MYRIAD) project. Funded by Wellcome, the study investigated the effectiveness of a brief school-based mindfulness intervention in supporting the mental health of young people in secondary schools aged 11 to 16 – a demographic increasingly vulnerable to mental health problems in the UK.
The result? It didn't help.
Now, this important project offers valuable insight for researchers, policymakers and educators to help shape future interventions for young people.
What is the MYRIAD project?
The MYRIAD project was led by Professor Willem Kuyken and Mark Williams at the University of Oxford, Sarah Jayne Blakemore, formerly at University College London and now at the University of Cambridge, and Tim Dalgleish at the Medical Research Council Cognition and Brain Sciences Unit.
The project spanned over eight years, from 2015 to 2023, and involved more than 28,000 students, 650 teachers, 100 schools and 20 million data points. Mindfulness training was developed by the Mindfulness in Schools Project and taught by teachers to their students after completing the programme themselves.
The study specifically investigated the use of a brief school-based mindfulness intervention to improve the mental health of early teens aged 11 to 16, which was found to be ineffective.
Decision-makers must rely on evidence to find solutions
Professor Kuyken urges policymakers and decision-makers to consider the evidence before implementing mental health interventions in schools.
“In my view, the ethical thing to do as a head teacher, policymaker or teacher is to consider the science. Because, if you invest in something that doesn't have evidence, you’re taking those resources away from something else that might,” he says.
Regarding school-based mindfulness, he believes that “enthusiasm was ahead of the evidence”.
Although inconsistent practice was one reason mindfulness didn't work in the study, Kuyken and his team believe there's more to it.
He says that for any intervention to work, we must consider a range of factors from individual to societal.
“For example, we know that inequalities, deprivation and poverty drive mental health problems. And maybe we need to be thinking about interventions which help improve those first,” says Kuyken.
Finding what doesn’t work moves mental health science forward
Reporting null findings in research can be challenging, but at Wellcome, we believe finding out what doesn't work is just as important as finding what does.
Mindfulness training is an example of how interventions are not universally effective. While research has proven it to be effective in treating adults, Kuyken emphasises that “one size doesn't fit all” when it comes to mental health, especially among young people.
The MYRIAD project highlights the importance of how interventions are delivered and by whom. According to Kuyken, the treatment of mental health problems belongs in the hands of experienced and qualified mental health providers, not teachers and schools.
“We are placing children and teachers in an untenable position when we ask them to deal with complex mental health problems that they don't have the competence, experience and confidence to work with,” he says.
Kuyken also notes that secondary school is a time “when young people are shifting their frame of reference away from adults towards their peers,” which may be one reason why students did not engage with mindfulness training delivered by their teachers.
Using insights from MYRIAD, we can focus resources on finding more effective interventions that address the specific needs of young people and advance the field of youth mental health.
We need to involve young people
Kuyken advises that the best way to find effective interventions for young people is to work with them.
Lived experience is essential in mental health research to ensure that interventions and treatments support the people they aim to help. This is something that Wellcome advocates for across the field of mental health science and in the projects we fund.
The study included a number of public engagement activities and a youth advisory group was used to advise on the MYRIAD project design, however they did not contribute to the design of the intervention itself, which was designed by experienced school teachers.
“If given the opportunity again, I would co-design an intervention with young people,” Kuyken says.
He believes that young people are best placed to advise what works for them and what does not. “It's about making sure that whatever we do, the young people will actually want to do it and engage with it,” he says.
The project also co-designed a sub-study with students, asking them if there were any questions missing from the project's measures that they would include. One question that emerged was: “Do you have a close friend that you can share all your troubles with?”
“This turned out to be one of the most important questions, with about one in three kids saying they didn't, which is quite striking,” says Kuyken.
This is an example of how co-designing research with young people can lead to important insights about what is crucial to their mental health. By listening to young people, we can identify gaps and work to develop more effective and targeted interventions.
Collaboration is key to advancing mental health science
The MYRIAD project was not only rigorous in scope and scale, but its findings are also supported by the expertise of the transdisciplinary team involved.
“The problems we're facing in mental health research are increasingly complex,” says Kuyken. “They won't be solved by people with just one disciplinary knowledge set or skill.”
The project benefited from an extraordinary team of professionals, including educators, psychiatrists, school researchers, health economists and statisticians. That’s why, he explains, they are so confident in their findings.
Looking to the future, Kuyken encourages people to learn from this study.
“I hope this serves as a wake-up call in the broader field of young people's mental health, school-based interventions and universal interventions,” he says.
“If we're serious about the mental health of young people, we need to ask ourselves: what can we learn from this trial that can be applied to all school-based interventions?”
We’re funding research to help create transformative change in early intervention for anxiety, depression and psychosis. Explore our current funding call: