Scientists funded to review "active ingredients" for youth mental health

In 2020 we launched our new mental health strategy. A first step was to invite researchers from across the broad spectrum of mental health science to propose their "best bet" for one "core component" of an approach to prevent, treat, stop relapse or manage ongoing anxiety or depression relevant for young people aged 14-24.

Around two hundred mental health teams submitted proposals to undertake insight analyses of their chosen "best bet". Today we announce the funded teams.

In this post I am going to talk about why we are now referring to "active ingredients", what we hope to achieve through this work, how we chose the first list of active ingredients for review, which ones have been chosen, what happens next, and how you can be involved.

Why we are now referring to "active ingredients"

When we launched this commission we framed it in terms of considering the "core components" of prevention, treatments and approaches.

We have found ourselves increasingly using the analogy of cooking. With this in mind "core components" can be viewed as the "active ingredients" in a recipe i.e. those ingredients essential for the success of a recipe. We have decided for clarity, to use the term "active ingredients" in place of "core components" going forward. Key is that these ingredients are hypothesised to be active in preventing or treating the difficulties - not just seen as related to causing the difficulties.

To continue the cooking analogy, when assembling ingredients many considerations need to be made, including:

• the needs and preferences of those for whom the food is being prepared
• the necessary quantity and quality of ingredients needed
• the cost and accessibility of these ingredients.

All of these are relevant in terms of our work going forward.

What we hope to achieve

This is the first step on an ambitious journey. Wellcome wants to work with the mental health science community to refine and review these first selected list of active ingredients to a more focused core foundational set that are thought to be the "best bets" for the most young people, in the most contexts, globally.

A version of this exercises will be repeated in 2021 and we are also looking at best ways to consider different evidence bases going forward.

Learning from these first two years of iterative reviews, allied consultation and exploration, we aim to identify the most promising active ingredients to prevent or treat youth anxiety or depression at scale globally as the potential focus for future research, innovation and development from 2022.

This is part of Wellcome’s longer-term agenda to advance mental health science and find the next generation of treatments and approaches for anxiety and depression in young people to help create a world where no one is held back by mental health problems.

Choosing and challenging the active ingredients

We did not seek to pick a list that would be comprehensive nor necessarily reflect current consensus from the field. Indeed it is because such consensus is so hard to achieve, and there are so many varied and divergent ideas about where best to focus, that Wellcome is undertaking this approach.

We selected from the submitted proposals using the criteria in our request for proposals. This included balancing a review of the logic, clarity and rigour of the proposal whilst also seeking diversity in terms of both ingredients and of scientists. No easy task!

We are fully expecting constructive challenge and debate about this first list of proposed active ingredients. Indeed we would be disappointed if there was none.

Involved in the selection were both internal peer reviewers and external youth advisers with lived experience of anxiety and depression from our strategic advisory board.

All selected proposals needed to demonstrate their ability to include lived experience perspectives as part of their approach to undertaking the insight analysis.

The first chosen active ingredients

The table below shows the active ingredients chosen for review in this first commission. A full list of teams funded and key references for each active ingredient can be found here.

Three things to note (of many that could be noted!)

1. Whilst we had invited applicants to specify focus in terms of four categories (prevention, treatment, stopping relapse and manage ongoing difficulties) very few differentiated in terms of the last three categories - hence we have collapsed these into a broader category in the table above.
2. The context identified in the table above is the chosen focus by the funded research team e.g. prevention rather than intervention post-problems arising or anxiety rather than depression. This does not mean these ingredient might not be relevant for other contexts.
3. We recognise there are gaps in the table and everyone will have their key preferences and views. A key challenge is that the reviews will be exploring existing research and it is therefore important for us to note that there may be gaps in evidence due to lack of involvement of people with lived experience or other diverse perspectives in mental health research. We are currently considering best ways to address this.

Next steps

We will convene the funded teams to meet in small groups on a monthly basis over the course of the next three months to share learning and start to explore how the different active ingredients relate to each other. 

The teams will report on their findings in October 2020 and we hope to engage with the field in considering learning from this.

We are also auditing all the applications received to understand better where applications came from across the world and the full range of active ingredients proposed. We will share findings and the inferences we draw from this in the Autumn.

We want to work with the mental health science community to refine and review these initial active ingredients and others identified to a core foundational set that are the most promising for most young people, in the most contexts, globally.

This first commission marks a step on our journey to finding the next generation of treatments and approaches for anxiety and depression in young people aged 14-24.

Get involved

1. Complete this three minute survey to choose from the commissioned list up to three active ingredients you consider most promising and up to three you feel are least promising. You also have the option to suggest up to three you think should be added
2. Tell us what you think in comments below or via Twitter
3. Write your own articles or blogs on this topic and let us know so we can disseminate

We are excited to have started on the journey. We hope you will join us as we seek active ingredients to inform both new and improved recipes for youth mental health worldwide.