ArticleBJPsych open2026
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.
Article in BJPsych open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAWARE (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.
aimsTo evaluate the cost-effectiveness of YAM and The Guide to inform policy decisions regarding the implementation of these mental health interventions in schools.
methodCost-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.
resultsFor 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.
conclusionsAt 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.
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