A mixed methods exploration of mental health pathways and treatment as usual for young people experiencing depression in the United Kingdom

Abstract

Epidemiological data indicate that the prevalence of depression among young people (YP) is increasing. Although evidence-based interventions are effective for many, 20 to 40% fail, and relapse is common. This study focused on second-line treatments. Modifying psychological processes that predispose individuals to treatment failure or relapse necessitates the development of interventions, but their evaluation depends on a clear understanding of current practice to enable meaningful comparison and assessment of effectiveness. We explored treatment as usual (TAU) for YP receiving support for depression in a two-site pilot, feasibility trial comparing Mindfulness for Adolescents and Carers (MAC) and TAU against TAU in UK Child & Adolescent Mental Health Services (CAMHS). Qualitative data were collected via interviews with senior managers and case-managing clinicians. Quantitative data were gathered through Treatment Recording Sheets completed by clinicians and a clinical service audit. Data were synthesised across sites to provide a comprehensive description of TAU, informing the design of a future definitive trial of MAC. Despite site-level variation in service delivery, key components and processes of CAMHS TAU were identified. Typical pathways included referral and intake; waiting/supportive provision; first- and second-line treatment/s; discharge and re-referral; and crisis support. Care coordination emerged as the most common second-line provision and was provided to YP in both trial arms. Participants received varied combinations of support; those allocated to MAC received less CAMHS input than those allocated to TAU. There is substantial variability in service provision for YP experiencing depression. Future studies should compare treatment plus care coordination with TAU.