Expanding mental health counselling from primary care to reach at-risk youth (Expanding MINDS-Y).

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Ensuring youth (aged 15-24) who are at high risk for common mental disorders like depression and hazardous alcohol use have access to mental health counselling could improve their emotional well-being and prevent injuries, the acquisition of communicable diseases such as HIV, and the onset of non-communicable diseases (NCDs). Like many low- and middle-income countries (LMICs), South Africa (SA) faces the challenge of how to reduce the high prevalence and impact of communicable diseases and NCDs, including mental disorders where limited services are available. Common mental disorders among youth are important to address to prevent these future physical health problems. Yet, the mental health treatment gap in SA is large, particularly for youth. Failure to reach 15-24 year olds is a major service gap as this is often the age of onset for common mental disorders. Service planners recognise that they need to expand the coverage of mental health counselling to include at-risk youth. However, a lack of information about where to situate mental health counselling services, who should be delivering these services, and how to format services to ensure acceptability to and utilisation by at-risk youth has hampered the expansion of available services to this key population. The expansion of mental health counselling to at-risk youth also has been delayed by a lack of youth-oriented counselling programmes that are acceptable to and effective for improving the mental health of at-risk youth. The goal of this study is to address this knowledge gap by providing information on youth preferences for mental health counselling services, adapting an adult-oriented programme to meet the needs of youth; and testing the feasibility of recruiting youth and initial outcomes of this adapted counselling programme on mental health outcomes. Through this study, we hope to obtain information that can be directly useful to health planners for the design and development of youth-friendly mental health counselling services and have a feasible, youth-friendly counselling programme that shows promise for reducing both depression and hazardous alcohol use among at-risk youth. Findings from this study are likely to be highly relevant for use in other LMICs given similarities between the burden of disease, treatment populations, and profile of risk behaviours among youth in SA and other LMICs.The study will comprise three phases. In the first phase, we will conduct in-depth interviews with service providers, at-risk youth, and their caregivers to assess barriers to youth participation in mental health counselling and to identify youth preferences for where and how services should be delivered (Aim 1). Findings from this phase will be used to initially adapt our proposed programme to address these barriers and ensure acceptability. In Aim 2, we will demonstrate this adapted intervention in focus groups with at-risk youth in order to obtain information on how the intervention content, structure and layout should be adapted to meet the needs of youth. In Phase 3, we will test the feasibility of recruiting at risk youth to participate in the adapted intervention and the initial effect of the adapted intervention on depression and hazardous alcohol use. We will recruit 100 at-risk youth from impoverished community settings and we will randomize them to receive the intervention or be in a control group. We will assess the effect of the intervention on depression and alcohol use three months after study enrolment. Once the three month assessment has been completed, participants in the control group will be offered the counselling intervention. Findings from this phase will be used to initially evaluate the feasibility and effect of the intervention (Aims 3-4). If the outcomes are promising, findings will also be used to inform the design of a large trial to assess the effectiveness and cost-effectiveness of this intervention.