Cost-effectiveness of school-based interventions for well-being and mental health literacy of pupils in year 9 in England: AWARE cluster randomised controlled trial

TY - JOUR

T1 - Cost-effectiveness of school-based interventions for well-being and mental health literacy of pupils in year 9 in England

T2 - AWARE cluster randomised controlled trial

AU - Zhang, Kyann

AU - King, Derek

AU - Boehnke, Jan

AU - Deighton, Jessica

AU - Thompson, Abigail

AU - Thornton, Emma

AU - Knowles, Christopher

AU - Hayes, Daniel

AU - Stallard, Paul

AU - Santos, Joao

AU - Ashworth, Emma

AU - Evans-Lacko, Sara E.

N1 - Publisher Copyright: © The Author(s), 2026. Published by Cambridge University Press on behalf of Royal College of Psychiatrists.

PY - 2026/6/8

Y1 - 2026/6/8

N2 - Background AWARE (Approaches for Wellbeing and Mental Health Literacy: Research in Education) is a three-arm, parallel-group, cluster randomised controlled trial. It assessed the effectiveness of two interventions – the Youth Aware of Mental Health (YAM) programme and Mental Health and High School Curriculum Guide – in addressing emotional well-being, compared with usual practice, among year 9 students in England. Aims To evaluate the cost-effectiveness of YAM and The Guide to inform policy decisions regarding the implementation of these mental health interventions in schools. Method Cost-effectiveness was assessed using self-reported information from participants in the trial at baseline and two follow-ups – at 3–6 months after the start of intervention, and at 9–12 months post-intervention. Quality of life was measured with the Child Health Utility Index. Intervention delivery costs were calculated with data provided by the delivery teams. Service use costs were calculated with a short version of the Client Service Receipt Inventory, with unit costs obtained from publicly available sources. Results For both interventions, difference in outcomes (change in quality-adjusted life-years over time) between the intervention group and control group were close to zero, with the largest change being an improvement of 0.0055 quality-adjusted life-years at the second follow-up for students in schools randomised to YAM. Changes in costs were likewise small. Conclusions At first follow-up, neither intervention is likely to be considered cost-effective. At second follow-up, YAM has a high probability of being considered cost-effective, with an incremental cost-effectiveness ratio of around £23 000 per unit of improvement in the quality-of-life measure, which falls within the threshold (£20 000 to £30 000) as used by the National Institute for Health and Care Excellence.

AB - Background AWARE (Approaches for Wellbeing and Mental Health Literacy: Research in Education) is a three-arm, parallel-group, cluster randomised controlled trial. It assessed the effectiveness of two interventions – the Youth Aware of Mental Health (YAM) programme and Mental Health and High School Curriculum Guide – in addressing emotional well-being, compared with usual practice, among year 9 students in England. Aims To evaluate the cost-effectiveness of YAM and The Guide to inform policy decisions regarding the implementation of these mental health interventions in schools. Method Cost-effectiveness was assessed using self-reported information from participants in the trial at baseline and two follow-ups – at 3–6 months after the start of intervention, and at 9–12 months post-intervention. Quality of life was measured with the Child Health Utility Index. Intervention delivery costs were calculated with data provided by the delivery teams. Service use costs were calculated with a short version of the Client Service Receipt Inventory, with unit costs obtained from publicly available sources. Results For both interventions, difference in outcomes (change in quality-adjusted life-years over time) between the intervention group and control group were close to zero, with the largest change being an improvement of 0.0055 quality-adjusted life-years at the second follow-up for students in schools randomised to YAM. Changes in costs were likewise small. Conclusions At first follow-up, neither intervention is likely to be considered cost-effective. At second follow-up, YAM has a high probability of being considered cost-effective, with an incremental cost-effectiveness ratio of around £23 000 per unit of improvement in the quality-of-life measure, which falls within the threshold (£20 000 to £30 000) as used by the National Institute for Health and Care Excellence.

KW - Mental Health

KW - Health Economics

KW - Cost-effectiveness analysis

KW - Education

KW - Quality of Life

KW - Mental health literacy

KW - Stigma

KW - Help-seeking

KW - education

KW - Mental health

KW - cost-effectiveness analysis

KW - quality of life

KW - health economics

U2 - 10.1192/bjo.2026.11015

DO - 10.1192/bjo.2026.11015

M3 - Article

C2 - 42253041

SN - 2056-4724

VL - 12

JO - BJPsych Open

JF - BJPsych Open

IS - 4

M1 - e155

ER -