Feasibility and acceptability of the Multi-Modal Approach to Preventing Suicide in Schools (MAPSS) programme in England: a cluster-randomised controlled trial

Abstract

Abstract Background The Multi-Modal Approach to Preventing Suicide in Schools (MAPSS) was initially developed and trialled in Australia. It consists of universal, selective, and indicated components, with evidence to suggest it may improve help-seeking and reduce suicide ideation. However, cultural transferability of interventions cannot be assumed, and so we needed to establish whether it would be feasible to trial MAPSS in English schools. Aim To assess the feasibility of delivering the MAPSS intervention in English secondary schools, including the acceptability and safety of delivering MAPSS, the social validity of MAPSS, and the feasibility of a future large-scale efficacy trial. Secondary aims were to assess changes over time in mental health and wellbeing outcomes for students. Method A two-year cluster-randomised controlled trial (RCT) design was conducted. Schools (n = 6) were randomly assigned to implement MAPSS (n = 4) or continue their usual practice (UP) (n = 2). Participants were students (n = 887) in Year 10 (aged 14–15 years) attending participating schools. Quantitative data were collected from participants online at four timepoints (baseline, post-universal component, post-indicated component, one-year follow-up). Trial feasibility was assessed through monitoring of recruitment, attrition, missing data, participant engagement, acceptability of intervention components, and estimated change across time and variability in the primary outcome measures. Safety was assessed through the monitoring of adverse events. Results The progression criteria indicated strong feasibility for advancing MAPSS to a full effectiveness trial, with six of nine stop/go criteria fully achieved and three partially met but with solutions identified. The intervention was shown to be acceptable and safe, with no adverse events reported. Post-intervention, scores for suicidal ideation, depressive symptoms, and hopelessness in the MAPSS group were lower than in the control group, and help-seeking also improved in the MAPSS group. Conclusion All progression criteria were met or appropriate solutions were identified, supporting further evaluation of the intervention in a full-scale effectiveness trial. These findings add to the growing evidence base supporting the utility of multi-modal suicide prevention programmes in schools. MAPSS has potential as a school-based intervention for those struggling with suicidal thoughts and/or behaviours. Registration: The trial was pre-registered on clinicaltrials.gov (ISRCTN41891301) on 9th February 2024.