Mental health pathways and treatment as usual for young people experiencing depression in the United Kingdom: A mixed methods study

Background Epidemiological data indicates that the prevalence of depression among young people (YP) is increasing. Evidence-based interventions are effective for many, but 20 to 40% fail to respond and relapse is frequent and therefore, this study placed a particular focus on second-line treatments. The modification of psychological processes that predispose treatment failure or relapse necessitates the development of specific interventions for those who need them. But their evaluation requires clear understanding of current practice to compare and demonstrate effectiveness. Methods: We explored treatment as usual (TAU) for young people (YP) receiving support for depression in a pilot 2-site feasibility trial comparing a Mindfulness for Adolescents and Carers (MAC) against TAU in Child & Adolescent Mental Health Services (CAMHS) in the UK. We collected qualitative data via interviews with senior managers and case-managing clinicians, as well as quantitative data via Treatment Recording Sheets completed by clinicians for participating YP and a clinical service audit. We synthesised these data across the two trial sites with the intention of providing a description of TAU that could be used to design a future definitive trial of MAC. Results: While there were differences in the approach and provision between the sites, it was possible to produce an understanding of the main components and processes of CAMHS TAU for young people who have depression. Typical pathways include entry/referral, screening and intake; waiting/supportive space; first-line and second-line treatment/s; discharge and re-referral; and crisis support. The most common second-line provision was care co-ordination, provided to YP in both arms of the trial. YP participating in the pilot feasibility trial received different combinations of support and those allocated to MAC received less support from CAMHS than those allocated to TAU. Conclusions: There is significant variability in the provision of services to YP experiencing depression. Future studies should compare the treatment plus care coordination with TAU.