PhD projects

Current PhD projects

How far can data from routine outcome measurement be used to inform the provision and management of children and young people's mental health services?

PhD researcher: Tom Bardsley

A great deal of research into outcome measures in child psychology has focussed on the practical, clinical or psychometric properties of different tools but, as the collection and reporting of such measures becomes increasingly embedded within national health policy, there is a growing need for research into how to interpret aggregated outcomes data as an indicator of service performance. This PhD will use a mixed-methods approach, combining analysis of routinely collected data from child mental health services with qualitative insights into the utility of using outcome measures to analyse service performance. In doing so, this research aims to provide a practical understanding of how individual-level outcome measures might be used to reflect broader aspects of quality in child mental health services.

Email: thomas.bardsley.19@ucl.ac.uk

Exploring self-care for young people's mental health

PhD researcher: Alex Truscott

This PhD project will explore self-care for young people’s mental health. Currently, roughly two in three young people with a diagnosable mental health condition do not receive care from the NHS (NHS, 2017), leaving a substantial gap between available and needed mental health support. Self-care often involves easily accessible everyday activities and could act as a valuable resource for young people experiencing mental health difficulties. It could be especially helpful for those not accessing professional help or those facing long waiting times.

The project will address gaps in the current evidence base and built an understanding of the relationship between self-care and young people’s mental health. Specifically, definitions of self-care will be explored from both academic and young people’s perspectives, alongside young people’s experiences of self-care and how self-care is related to mental health and wellbeing over time.

Email: Alexandra.Truscott@annafreud.org

The association between physical activity and mental health and wellbeing

PhD Researcher Georgie Parker

Engagement with physical activity during childhood and adolescence is associated with numerous positive outcomes for young people, including better mental health (Dale et al., 2019). However, engagement in physical activity tends to drop-off during this time (Farooq et al., 2020), which is also when many mental health disorders develop for the first time (Mulraney et al., 2021). Low levels of activity during childhood and adolescence also appear to predict activity levels later in life (Telama et al., 2005), which means that preventing disengagement from physical activity is important to improve lifelong outcomes for young people. However, despite evidence illustrating the link between physical activity and better mental health and wellbeing, this association is not clear cut. This includes questions surrounding the association between physical activity and specific areas such as self-esteem and body image, and the contextual factors of physical activity and how these impact engagement, which have not yet been fully explored. Research using more robust designs are needed to provide further insight into these areas.

This PhD project aims to address gaps in the current evidence using a mixed-methods design, to further understand the association between physical activity decline and the mental health and wellbeing of young people. Specifically, it will explore the association between self-esteem, body image, and physical activity in young people, and attempt to find out what young people and schools can tell us about the contextual factors associated with physical activity disengagement and their mental health and wellbeing.

Email: georgie.parker.17@ucl.ac.uk

How we assess mental health and wellbeing in adolescents with special educational needs (SEN)

PhD Researcher: Mairi Jeffery

This PhD research is about how we assess mental health and wellbeing in adolescents with special educational needs (SEN), in special schools/alternative provision settings. It will be mixed-methods, and is associated with the #BeeWell study, which is in its 3^rd year in Greater Manchester and is now being rolled out to the Isle of Wight, Hampshire, Portsmouth and Southampton.

Email: mairi.jeffery@annafreud.org

Past PhD projects

Understanding and facilitating self-management in child and youth mental health for LGBTQ+ young people

PhD researcher: Rosa Town

This PhD project explored the barriers and facilitators to self-management in young people with mental health difficulties from a socially excluded group, and from this, developed an intervention to facilitate self-management. One in eight young people will experience a mental health difficulty (NHS Digital, 2018), yet many choose not to access professional help (Demyttenaere et al., 2004). When help is accessed, reliable change is found in only around half of cases (Edbrooke-Childs et al., 2018). As such, greater emphasis is being placed on the need for effective self-management strategies to make best use of the limited resources available and encourage patient empowerment (Future in Mind, 2015; National Institute for Health and Care Excellence [NICE] 2019; Wolpert et al., 2016).

Specifically, this project will investigate how LGBTQ+ young people can self-manage their mental health. Recent evidence suggests that one in three young people who identify as lesbian, gay, bisexual or a sexual orientation other than heterosexual will have a mental health disorder (NHS Digital, 2018), and many people who identify as LGBTQ+ perceive traditional mental health services to be discriminatory (Hudson-Sharp & Metcalf, 2016). Additionally, one in seven LGBT people have avoided health services due to fear of discrimination, with this statistic increasing to approximately a third for trans and non-binary people (Stonewall, 2018). The newly developed intervention to facilitate self-management will be underpinned by the Behaviour Change Wheel, a method for characterising, understanding, and designing behaviour change interventions (Michie, Atkins, & West, 2012).

This project was funded by a PhD Studentship from NIHR ARC North Thames and sponsored by University College London.

Email: rosa.town@annafreud.org

This project concluded in 2023.

Factors associated with the sustainability of mental health and wellbeing programmes in schools

PhD researcher: Anna March

The substantial time that young people spend in schools makes them a practical context for reaching young people for early prevention and intervention, and there has been an increasing focus on effective universal approaches to supporting young people’s mental health and wellbeing. There is good evidence that well-designed and well-implemented interventions can lead to positive changes in students’ mental health and wellbeing, but increasingly reports have also shown poor sustainability of school-based interventions. Given the considerable investment of resources it is clearly in the interests of health and education systems, as well as individual schools and pupils, to achieve long-term sustainability of such interventions.

This PhD project developed our understanding of this area, using mixed-methods to explore factors that affect the sustainability of mental health and wellbeing programmes in schools. The project drew on data from the Education for Wellbeing programme, which works with over 370 schools in England to evaluate different types of mental health and wellbeing support for primary and secondary pupils.

Email: Anna.Moore2@annafreud.org

This project concluded in 2023.

Ending treatment with children and young people when clinical improvement is unlikely: considering curability and chronicity

PhD researcher: Holly Bear

The topics of interest within this project were: clinical treatment response following routine mental health care, better understanding the association between cognitive illness representations and treatment response expectations among practitioners, children and families, practitioners’ shared or incongruent experiences, feelings and insights surrounding treatment failure and treatment endings across mental and physical healthcare contexts.

Finally, the project looked at the ways in which we can improve understanding, consideration and communication about the limitations of interventions in child and adolescent mental health services in order to inform clinical decision making.

This project concluded in 2020.

Power Up for Parents: parental involvement and shared decision making through technology

PhD researcher: Shaun Liverpool

This project addressed policy calls to promote shared decision making in services for young people with long-term conditions. It built on prior research by the Anna Freud National Centre for Children and Families to develop a mobile app called Power Up, supporting shared decision making with young people, caregivers and therapists. Crucially, this project aimed to develop and evaluate a new app (Power Up for Parents), enabling greater involvement of mothers and fathers (or caregivers) in their child’s therapy.

Email: shaun.liverpool@annafreud.org

This project concluded in 2020.

A community-led and co-produced intervention to support and promote resilience in schools and services

PhD researcher: Bettina Moltrecht

Alarming prevalence rates (10-20%) of mental health difficulties in young people highlight the importance of mental health prevention and promotion for this population. It has been argued that this peak in psychopathological symptoms is a result of developmental changes, which hamper adequate emotion regulation. This PhD project aimed to investigate and promote effective emotion regulation in youth, through the development of a mobile app-based intervention.

Email: bettina.moltrecht@annafreud.org

This project concluded in 2020.

What constitutes a good outcome in child and adolescent mental health?

PhD researcher: Karolin Krause

Over the past decade, there has been a push towards the routine measurement of treatment outcomes in child and adolescent mental health services (CAMHS). At the same time, there is a lack of consensus about the types of change that constitute a ‘good outcome’ and that should be prioritised when evaluating treatments effectiveness.

This PhD project explored what outcomes are considered important by different stakeholders, including clinicians, commissioners and young people themselves, in the UK and overseas. It looked at the importance of symptom change relative to other possible changes in young people’s lives, such as in their interpersonal relationships, identity and self-esteem, or physical health.

The PhD took a mixed-methods approach combining qualitative interviews, Q-methodology, and quantitative analysis of routine monitoring CAMHS data.

Email: karolin.krause@annafreud.org

This project concluded in 2020.

How can investigations into risk, stressors, and protective factors inform the development of initiatives for the promotion of mental wellbeing?

PhD researcher: Mia Eisenstadt

This PhD aimed to examine stressors, risk-factors and protective factors and effects on mental wellbeing from the perspectives of adolescents to inform intervention design. The term ‘risk factors’ refers to variables associated with the increased likelihood of a negative outcome and ‘protective factors’ are those variables that decrease the likelihood of said outcome (Kazdin et al., 1997). The PhD analysed data from a longitudinal qualitative study that involves annual interviews with adolescents in six regions across England as part of HeadStart. HeadStart is a national programme seeking to reduce the rate of mental disorder and promote emotional wellbeing in English adolescents.

Email: mia.eisenstadt@annafreud.org

This project concluded in 2020.