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

Zhang, K, King, D, Boehnke, J, Deighton, J, Thompson, A, Thornton, E, Knowles, C, Hayes, D, Stallard, P, Santos, J, Ashworth, E ORCID: 0000-0002-5279-4514 and Evans-Lacko, S (2026) 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. BJPsych Open, 12 (4). ISSN 2056-4724

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Abstract

Background
AWARE (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.

Aims
To evaluate the cost-effectiveness of YAM and The Guide to inform policy decisions regarding the implementation of these mental health interventions in schools.

Method
Cost-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.

Results
For 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.

Conclusions
At 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.

Item Type:	Article
Uncontrolled Keywords:	1103 Clinical Sciences; 1117 Public Health and Health Services; 3202 Clinical sciences; 4203 Health services and systems
Subjects:	B Philosophy. Psychology. Religion > BF Psychology L Education > LB Theory and practice of education > LB1603 Secondary Education. High schools
Divisions:	Psychology (from Sep 2019)
Publisher:	Cambridge University Press
Date of acceptance:	19 February 2026
Date of first compliant Open Access:	9 June 2026
Date Deposited:	09 Jun 2026 13:16
Last Modified:	09 Jun 2026 13:16
DOI or ID number:	10.1192/bjo.2026.11015
URI:	https://researchonline.ljmu.ac.uk/id/eprint/28785

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