Optimising cultural expeRIences for mental health in underrepresented younG people onlINe (ORIGIN)

Research question: Is an optimised, co-designed online intervention based on culture and the arts effective in reducing depression and anxiety in diverse young people (aged 16-24)? Background: Three–quarters of mental disorders emerge before the age of 25, yet young people (YP) are the least likely to receive appropriate care, particularly among underrepresented YP such as ethnic minorities and those that live in deprived areas. With YP we co-produced an online intervention for anxiety and depression based on the human stories behind arts and artefacts called Ways of Being (WoB). A pilot study demonstrated proof of concept, preference for online access, and human stories as the most important ingredient for mental health benefit. We recruited 463 RCT participants aged 16-24 rapidly, WoB was more effective for negative affect (low mood) than the control condition (Ashmolean museum website), and to a greater extent among ethnic minority participants. The intervention proved popular with YP who asked for more diverse content. Aims and Objectives: Our main aim is to test whether an intervention based on online arts and culture reduces anxiety and depression, and is cost-effective in a diverse sample of young people (aged 16-24) who have not sought help or are on NHS waiting lists. We will use co-design to refine WoB for YP of diverse identities (LGBTQ+, race/ethnicity, neurodiverse) and who live in deprived areas in England. Methods: We propose six linked and iterative work packages (WPs), comprising in-depth study of experiences and influences that shape mental health trajectories in YP with particular attention to identity and place (WP1); exploration of how we might adapt the intervention for YP with autism (WP2); review and synthesis of the evidence for arts and cultures interventions in YP and the mechanisms through which these work (WP3); co-designed refinement of the Ways of Being, including personalisation (WP4); and an online randomised control trial, supported by health economic evaluation (WP6). PPIE, inclusion and impact will be woven into the programme from the outset. We will focus recruitment on YP living in deprived areas including Cornwall, Liverpool, Sheffield, Oxfordshire and Blackpool, but will include diverse YP from across England. Timelines for delivery: We propose a programme of research over 60 months. Anticipated Impact: WoB is targeted at YP with depression and/or anxiety. As an accessible, acceptable, self-directed personalised intervention, it has potential to significantly reduce demand (and hence waiting times) for over-stretched youth mental health services, and NHS costs. Dissemination: The findings from consecutive WPs will be summarised as briefing papers and as infographics, co-written with young people, as well as academic papers. We will hold policy workshops following the trial results, and also engage stakeholders including cultural industry partners, more widely to engage in discussion about emergent findings, and implications for their localities, commissioning, training, and addressing inequalities. We will use social media and blogs, as well as lay and academic press.