Lindsay M. Smith

Globally in 2021, about 1 in 4 children and young people (CYP) below age 25 lived with poor mental health. Various forms of digital health interventions (DHIs) have been introduced in attempts to address unmet mental healthcare needs among young people. DHIs use websites or applications in computers, tablets, or smartphones to deliver mental health interventions, which are either self-directed, or therapist guided. This rapid review synthesises the evidence on the cost-effectiveness of DHIs for supporting mental health in CYP. A literature search was carried out in MEDLINE and PsycINFO using Ovid platform. The search was restricted to peer-reviewed studies published in English between Jan 2018 to May 2025. Eligible studies were identified using the population, intervention, comparator, outcome, and study design (PICOS) framework. Studies were eligible for inclusion if they provided a trial- or model-based full economic evaluation or return on investment of a DHI targeting mental health in CYP up to 25 years of age. Titles and abstracts of 1,265 records were screened. 15 studies met the criteria for inclusion following full-text screening of 28 studies. The focal outcomes in the studies included reduction in symptoms linked to depression, anxiety, and alcohol use. Most studies evaluated computerised cognitive behaviour therapy (CBT) or interventions that included aspects of CBT as the primary intervention. All studies except two reported the DHIs to be cost-effective, at least under certain conditions. Two model-based and three trial-based studies reported that the interventions were dominant (cost saving and more effective) with respect to at least one outcome measure. There is some evidence to suggest DHIs hold the potential to expand and extend mental health support for CYP with minimal therapist involvement. Yet, the evidence is not conclusive due to short follow-up periods, variability in the methodological approaches and reporting of results. High quality evidence on cost-effectiveness of DHIs with comparable methodological approaches is needed to inform implementation decisions.

Objectives: To evaluate an arts‐enhanced dialectical behavioural therapy skills group for managing emotions and self‐harm, implemented via an innovative public sector/third sector partnership to increase access to care. Design: This is a pilot mixed‐methods study. Methods: To assess participant experience in the ‘Imagining Futures’ programme, we examined self‐report questionnaires and qualitative focus group interviews using framework analysis. We collected recruitment, session attendance and programme completion rates. To explore impact, we also report on quantitative psychological outcome measures, including self‐harm frequency and overall well‐being. Results: We recruited 45 young women (mean age: 15.9, s.d. = 1.24, range 13.9–18.0 years) with a history of emotional dysregulation, self‐harm and other contextual risks who were not receiving support from statutory child and adolescent mental health services in the United Kingdom. Participants were 22% not in education, employment or training and 77% were from United Kingdom racially minoritized backgrounds. The overall completion rate was 62% ( n = 28/45). Qualitative data analysed from respondents ( n = 25/28 young people and n = 12 parents) suggested high levels of satisfaction with the project. Thirteen themes were identified which described service elements perceived to support engagement and observed impact. There was an important role for relationships and the creative components. Quantitative clinical data indicated reductions in the frequency of self‐harming, significant reductions in the perceived impact of difficulties and increased perceived social support. Conclusions: This novel delivery of a DBT skills group, incorporating blended psychology arts activities, has the potential to support engagement with psychological supports that improve mental well‐being.

As part of the ATTUNE project, this article critically appraises the strengths of community dance as a trauma-informed practice and examines areas for development in relation to guidelines on trauma-informed care. In the context of exacerbated mental health problems amongst young people in the United Kingdom, meeting the diverse needs of people who attend community dance spaces requires robust and empathetic enquiry across sectors. This article presents a critique of regularly cited literature from the distinct disciplines of dance and psychology and focuses specifically on the merits of relational approaches within community dance.

Review question / Objective: What are the ethical and practical considerations of gaming interventions in mental health? What existing viewpoint, commentary or theoretical points have been made in the literature regarding ethical issues in the development of serious games? What benefits and risks of games development in mental health are discussed in the literature? How are the core healthcare ethical principles of beneficence, non-maleficence, autonomy and justice discussed as relating to applied games in mental health? How might this information inform future thinking regarding the ethical development of serious games in mental health? Information sources: The search was conducted across four electronic databases covering science and arts and humanities titles: Scopus, PUBMED, PsycNET, EthxWeb and additionally, the journal, Game Studies, which contrary to other gaming journals does not exist in any of these databases. Given the recency of games design in this area, the search was limited to the preceding 30-year period, til January 2023, where available.

Objectives: At least one in four persons with bipolar disorder (BD) are estimated to have experienced auditory verbal hallucinations (AVH) or heard voices at some point. Yet few studies have investigated AVH in detail in this population. This preliminary study examined the phenomenology of AVH in BD to identify commonalities and differences relative to other psychiatric disorders where AVH are commonly reported. Method: Twenty‐one participants diagnosed with BD were recruited across two international sites in the UK and Australia. All participants underwent a structured clinical interview to verify psychiatric diagnosis and completed standardised measures of symptomatology, including mood states. Phenomenological information of AVH was gathered using select questions from the comprehensive Mental Health Research Institute Unusual Perceptual Schedule (MUPS). Results: AVH experienced by this BD sample were broadly similar in form and content to characterisations reported in the schizophrenia spectrum disorders (SSD) in prior literature, with some exceptions including frequency, duration and the changeability of tone and content. Conclusions: The study highlights possibly subtle differences in the experience of AVH in BD, including the potential influence of mood congruence as a pertinent clinical feature. Further research into these differences might inform adaptations to existing AVH interventions to ensure they are relevant for BD.

Background: Radically Open Dialectical Behaviour Therapy (RO DBT) is a novel transdiagnostic treatment that targets ‘maladaptive overcontrol’; a transdiagnostic cluster of traits associated with excessive emotional and behavioural inhibitory control. Outcomes are promising for adults with a range of psychiatric disorders. No study to date has explored the adolescent experience of RO DBT. Methods: Of the 25 eligible adolescents who received RO DBT between March 2015 and April 2017, 15 (14–17 years) consented and completed a semi-structured interview about their experience of treatment within 1 month of discharge. Interviews were recorded and then transcribed manually. Free text responses were analysed using reflexive thematic analysis. Results: The majority (n = 13) had a primary diagnosis of anorexia nervosa, although comorbidity was the norm, with 80.0% having two or more predicted comorbid psychiatric diagnoses. All had received some prior psychological treatment. Four themes were identified from analysis of transcripts: 1) Broadening Horizons, 2) Building Connections, 3) Flexibility, 4) Information Overload. Generally, RO DBT was perceived as helpful in both content and process. The focus on social and broader well-being, rather than specific mental health symptoms, was considered beneficial by many. Adolescents appreciated the group-based format of skills classes and reported benefiting from learning and practicing skills each week. The fourth theme, Information Overload, highlighted that for some, the amount of content felt overwhelming and that it was hard to remember and digest all the information, suggesting that adaptations, or simplifications, may be required to ensure accessibility for adolescents. Conclusions: RO DBT is perceived as a relevant and beneficial new treatment for adolescents with maladaptive overcontrol. The broad treatment focus is perceived as unique and of particular benefit. It is reported to help with general and social functioning and foster cognitive and behavioural flexibility. Nevertheless, the amount and complexity of material was felt to be very large by some and may suggest the need for modified adolescent-specific materials.

Context: Participatory arts‐based methods such as photovoice, drama and music have increasingly been used to engage young people who are exposed to psychosocial risks. These methods have the potential to empower youth and provide them with an accessible and welcoming environment to express and manage difficult feelings and experiences. These effects are, however, dependent on the way these methods are implemented and how potential ethical concerns are handled.Objective: Using the current literature on arts‐based health research as a foundation, this paper examines ethical issues emerging from participatory arts methods with young people with traumatic experiences.Results: We present a typology covering relevant issues such as power, accessibility, communication, trust and ownership, across the domains of partnership working, project entry, participation and dissemination. Drawing on our extensive clinical and research experiences, existing research and novel in‐practice examples, we offer guidance for ethical dilemmas that might arise at different phases of research.Conclusion: Adequate anticipation and consideration of ethical issues, together with the involvement of young people, will help ensure that arts methods are implemented in research and practice with young people in a fair, meaningful and empowering way.Patient or Public Contribution: The issues reviewed are largely based on the authors' experience conducting participatory research. Each of the projects referenced has its own systems for PPI including, variously, consultations with advisory groups, coproduction, youth ambassadors and mentor schemes. One of the coauthors, Josita Kavitha Thirumalai, is a young person trained in peer support and has provided extensive input across all stages.

UNSTRUCTURED Participatory arts-based methods such as photovoice, drama and music have been increasingly used to engage young people who are exposed to psychosocial risks. These methods have the potential to empower young people and provide them with a safe and accessible environment to express and manage difficult feelings and experiences. These effects are, however, dependent on the way these methods are implemented and how potential ethical concerns are handled. Using the current literature on arts-based health research as a foundation, this paper examines ethical issues emerging from participatory arts methods with young people with traumatic experiences. A typology is presented covering ethical issues such as power, accessibility, communication, trust and ownership, across the domains of partnership working, project entry, participation and dissemination. Drawing on our extensive clinical and research experiences, existing research, and novel in-practice examples, we offer creative solutions to ethical dilemmas that might arise at different phases of research. Adequate anticipation and consideration of these issues, together with the involvement of young people, will help ensure that arts-based methodology is implemented in research and practice with young people in a fair, meaningful and empowering way.

This study aimed to investigate potential ethnic differences in cognitive responses to caregiving in psychosis that might be relevant to the delivery of caregiver interventions for difficulties related to psychosis. We compared cross-sectional outcomes across early-stage caregivers who self-identified as white British (n = 37) and those who self-identified as black African or Caribbean (n = 41) using United Kingdom (UK) census ethnicity criteria. Self-report questionnaires were used to examine caregiver beliefs about psychosis, including the perceived causes, consequences, timeline, the degree of control that patients have over their difficulties, as well as their appraisals of caregiving. Caregivers from black African or Caribbean backgrounds reported a significantly shorter expected duration of illness than white British caregivers. They were also more likely to cite psychosocial causes (e.g., relationship issues), and less likely to cite biological and genetic causes, as their principal explanations for problems. However, overall differences in perceived causes of illness between ethnicities were not significant, despite the power in this sample to detect medium-sized effects. Factors associated with ethnicity may contribute to individual differences in explanatory models of illness and in experiences of caregiving. A degree of sensitivity to the range of views that people might hold about psychosis may help to engage caregivers from diverse ethnic backgrounds.