The effectiveness of school based interventions to prevent psychotic experiences over a year period

Prevention is a key step to improving public mental health. Psychotic experiences, transient hallucinations/delusions which occur outside of a psychotic disorder, are relatively prevalent in the general population, particularly in childhood (∼15%) and adolescence (7-8%). They are associated with high psychopathology, increased risk of mental disorders, and suicidal behaviours. Therefore, psychotic experiences are well-placed to be used as a “marker” for prevention interventions. Current knowledge on prevention of psychotic experiences is extremely limited, with one previous study. With such limited information, but such potential benefits, we opted to conduct a secondary data analysis to test three school based interventions for their potential efficacy at preventing psychotic experiences. This study used the Saving and Empowering Lives in Europe study, Irish site (n = 1096). The interventions were a teacher training intervention, an educational tool, and a universal mental health screener and selective referral system (ProfScreen). A minimal intervention arm was used as a control. Schools were randomly assigned to one of the arms, and the students were followed over a year period. ProfScreen showed a 12-month reduction in point prevalence in psychotic experiences. This intervention was also associated with prevention of incident psychotic experiences, and a reduction in depression and anxiety scores in those with psychotic experiences. Ours is the first study to look at school based interventions for psychotic experiences, offering promising evidence for universal screening and selective referral strategies. Notably, the intervention showed improvements for all students in that sample, not just those who attended the clinical referral. This suggests that universal screening may itself support better mental health, and may be an important integrative component to improving mental health at a population level. KEY MESSAGES: • Psychotic experiences are a valid marker of vulnerable youth, and prevention of psychotic experiences in schools is possible using a universal screening and selective referral intervention. • Regardless of if the child was referred/attended services, overall mental health rates improved in this arm, suggesting a universal mental health screening tool in schools itself may be valuable.