Research priorities for youth public mental health
This paper contributes a detailed set of priority areas and questions for future research in youth public mental health, defined through a priority setting process involving young people, academics, practitioners, and policymakers from across different public and mental health related disciplines. Our study broadly supports several of the research priority areas identified by the McPin study [13]. For example, improving working relationships/links between organisations that support young people’s mental health, and training for school/college staff to better support young people’s mental health. As noted, the McPin study was limited to priority areas and did not develop research questions. A separate stakeholder engagement exercise by NIHR aligned the McPin priorities with specific research questions, however the results have not yet been published. Similarly, several of the research themes identified by the Satellite study [16] are broadly consistent with priorities identified by the TRIUMPH Network. For example, the themes ‘lack of mental health literacy’ and ‘enhance role of education system’. The key contribution of our study to the existing literature on research priorities in youth mental health is: a focus on public mental health; more granular research questions on the thematic areas of Key Groups, Social Connections and Relationships, and Schools and Other Education Settings with clear direction for where future research, intervention development and evaluation could be beneficial; and our approach to priority setting.
Reflections on the priority setting approach
This paper describes the co-production approach and design engagement that the TRIUMPH Network used to define research priorities for youth public mental health. Here, we return to the New Economics Foundations co-production principles to reflect upon our process and our learning.
Taking an assets-based approach: Through co-producing the TRIUMPH Network’s research priorities, we ensured that young people, practitioners and policymakers were involved as partners in developing our research agenda from the start, which will be used to define the direction of future Network activities. This is important because young people and other stakeholders are often brought into the research process after the research topic and questions have been defined by academics. Through involving stakeholders from the beginning of the process we value and validate the knowledge, skills and experience that they bring to the work.
Building on people’s existing capabilities: Although all of the stakeholder groups are viewed as equal partners, the TRIUMPH Network has a clear process for building young people’s capacity to participate in research processes, in the form of the YAG, whereas processes to involve practitioners and policymakers are less structured. This is reflected in the involvement of different stakeholder groups in the priority setting process where YAG members had multiple points where they could influence the priorities, whereas practitioner and policymaker involvement was largely limited to the priority setting workshops and online consultation. The co-production approach and stakeholders’ views clearly influenced the final research priorities. For example, at the first workshop the YAG members provided feedback on the language used to discuss the different aspects of their lives and suggested changes in the names of the thematic areas, which were subsequently updated as suggested, and many of the final research priorities reflect the practice-based focus of the priority setting workshop discussions among practitioners and policymakers.
Reciprocity and mutuality: This principle speaks to the transdisciplinary nature of the TRIUMPH Network, where research collaboratives are built not only across academic disciplines but also across different stakeholder groups. YAG members provided positive feedback on their experiences of the priority setting workshop. In particular, they valued the opportunity to express and share their views and potentially improve experiences for other young people. For example, one young person commented “[It] was an amazing opportunity to meet young people like myself and hear what they had to say while getting my own opinion voiced” and “It was a great experience and really fun to get together and talk about our experiences and how we could improve them for other young people”. Other stakeholders who attended the subsequent priority setting workshops similarly provided positive feedback. In particular, stakeholders commented on the value of the opportunity to discuss youth public mental health with people from different backgrounds, job roles and sectors, and having young people involved as active participants alongside adults and hearing their views and experiences.
Peer support networks: Defining research priorities was the TRIUMPH Network’s first major task and building relationships within the Network team, across sectors and disciplines, and between professionals and young people was an ongoing aspect of the priority setting process. Building trusting relationships both between Network staff and YAG members, and between YAG members themselves, has been a priority and significant staff time has been invested in these relationships. Discussing research priorities with YAG members has both benefited from these relationships and, in turn, strengthened the relationships as we learn more about each other and discover shared and differing experiences and views. While the Network had existing relationships with some stakeholders, the priority setting process provided an opportunity to strengthen these relationships, as well as developing new relationships with other individuals and organisations.
Blurring distinctions: A key strength is that the TRIUMPH Network prioritises including views, ideas and experiences across stakeholder groups in all of our work. At the priority setting workshops we repeatedly heard that people have multiple intersecting professional and personal identities (for example, LGBTQ+ young people are also interested in other topics; some professionals are also under 24; some policy makers also have lived experience of mental health issues). While these multiple identities were respected and explored in the TRIUMPH Network workshop discussions, as a Network, and in research more widely, these groups of stakeholders are often identified as being distinct. In future, it is likely to be beneficial to approach transdisciplinary research that encompasses the intersectionality of people’s professional and personal identities, rather than requiring people to fit into specific stakeholder groups with certain expectations around their needs and experiences.
Facilitating rather than delivering: Romney [28] describes dialogue as “focused conversation, engaged in intentionally with the goal of increasing understanding”. In the process outlined in this paper, the conversation templates were designed to facilitate dialogue between the different stakeholders in order to hear each other’s thoughts, explore similarities/differences and arrive at a set of priorities that reflect the full range of experiences and viewpoints. However, despite its transdisciplinary nature, the TRIUMPH Network is located primarily within academia and its focus is upon research as a means to improving youth mental health, whereas priorities for non-academic stakeholders were often related to development of practice. For example, where academics might want to ask questions about evidence, practitioners often wanted to ask questions about how a service should be provided and the funding available for it. Where this was the case, academic members of the team needed to make judgements about whether these practice-based priorities could be adapted to focus upon research. Therefore, while all stakeholders had the opportunity to engage in the focused conversation, they did not have the power to fundamentally change or meaningfully challenge the primary focus on research. While this dialogue shaped the final research priorities, the power to make final decisions about the priorities lay with the TRIUMPH Network Theme Leads (all academics) and the wider TRIUMPH Network team (mostly academics).
Limitations
A limitation with our study is that the three broad thematic areas, upon which the priority setting process was based, were identified by the TRIUMPH Network team and not co-produced with stakeholders, including young people. Further, that other influences on young people’s mental health not covered within the three thematic areas did not form an intentional part of the workshop discussions. However, given the broad range of influences on young people’s mental health, these thematic areas, identified from the literature and the Theme Leads’ ongoing research, provided a productive frame for stakeholder discussion. An additional limitation is that, while the UK-wide priority setting workshops were open to all young people, those aged 10–12 years were not represented. In addition, workshop attendance was by invitation only to ensure a broad spread across disciplines, therefore some relevant individuals or organisations may have been overlooked.