Problem-solving skills may boost student wellbeing in India: Lancet study

Problem-solving-based counselling delivered by non-specialists may prove to be a cost-effective intervention to improve an array of stress-inducing problems faced by high school students in India, according to a study.

The results from the 'PRIDE' project, published in the journal Lancet Child & Adolescent Health, showed that a three-week programme delivered within a school setting could be an effective first-line mental health intervention for young people in the country.

The study participants were aged 12-20 years and were selected on the basis of having persistently high mental health symptoms linked to a variety of psychosocial problems, including difficulties experienced at school, with peers and in family contexts.

The sessions were delivered by school counsellors with no prior mental health training and centred on a well-established problem-solving approach, according to Goa-based mental health research organisation Sangath, which collaborated with researchers from the Harvard Medical School in the US, University of Sussex and London School of Hygiene & Tropical Medicine in the UK.

The team noted that mental health problems are a leading health concern for young people in India, with suicide as the leading cause of death for 15–24-year-olds.

However, almost all adolescent interventions to date have focused on high-income and high-resourced settings, leaving a gap in effective programmes for low-resource settings, they said.

The PRIDE school-based intervention model has been developed on the basis of stepped care, where increasingly specialised, resource-intensive interventions are reserved individuals, who do not respond to simpler first-line treatments, the researchers said.

Rather than focusing on a single mental health condition, the programme offers the promise of a broadly applicable, simple and scalable solution to improve mental health outcomes within a low-income setting, the researchers said.

"I am especially excited that these results show how a very low cost psychological intervention can be delivered by counsellors with no prior mental health training to students in the poorest neighbourhoods of New Delhi," said Vikram Patel, Professor of Global Health at Harvard Medical School, and Principal Investigator of the study.

"We must now work towards improving the effectiveness of the interventions and scaling these up across the school sector," he said in a statement.

The study was conducted over an academic year at six large Delhi Government schools in 2018-19.

As part of the programme, students and school faculty were introduced to basic mental health concepts through interactive audio-visual presentations.

The students were then invited to volunteer to join the programme, according to the researchers.

The counselling itself was delivered in four or five 30-minute sessions supported by explanatory comic-style booklets, spread over three weeks.

The content of the programme was designed to help students learn problem-solving skills, they said.

The researchers explained that these skills fall under the larger umbrella of cognitive-behavioural therapies, which help people to develop personal coping strategies for life difficulties and associated stress.

The study found that the students who took part in counselling, reported significant reductions in their main problems and associated stress levels, compared to the control group, who received only the booklets.

The researchers said this programme could be scaled up in various languages and offered widely to schools across the country, given the low input in terms of time and resources, but high impact in terms of mental health outcomes for students.

Daniel Michelson, from the University of Sussex, who co-led the study said that a short counselling programme -- involving no more than five brief meetings with a school counsellor over three weeks -- helped to reduce stressful problems faced by vulnerable teens in Delhi.

"Moreover, demand for the counselling programme was such that we filled our counselling slots ahead of schedule. The high level of interest that we observed among students runs counter to ideas that young people are reluctant to seek help for emotional, behavioural and interpersonal difficulties," said Michelson.

This, he said, has important lessons for how we can deliver cost-effective, non-stigmatising mental health support for some of the most disadvantaged young people in society.