Families Overcoming Risks and Building Opportunities for Well-being (FORBOW): evaluating pre-emptive early interventions for antecedents to prevent severe mental illness

Severe mental illness, such as schizophrenia, bipolar disorder and severe recurrent depression, typically starts in late adolescence or early adulthood and causes disability throughout life-course. Severe mental illness tends to run in families. Most cases of severe mental illness are preceded by earlier smaller problems, including unstable mood, anxiety, unusual sensory experiences (psychotic-like experiences) or sudden lapses in previously mastered abilities (basic symptoms). These antecedents precede and predict the onset of severe mental illness years later. We propose to investigate if these antecedents responds to psychological pre-emptive intervention in young people depending on whether their parents suffer from mental illness. In the FORBOW study, we will recruit young people aged 9 to 21 from schools and from mental health services. We will assess antecedents and all types of mental illness. Youth with antecedents will be randomly selected to be offered a psychological skill-building intervention (funded separately) or no intervention. We will assess antecedents and mental illness again after the intervention and follow-up every year to see if the intervention makes difference in the long term. We will explore whether having a parent with mental illness leads to persistence of antecedents and more need for interventions. By doing this, the FORBOW study will help understand why some youth overcome early antecedents while others progress to develop severe mental illness. FORBOW will also find out which young people need psychological interventions to develop mental health. The FORBOW cohort will be a resource for further research into mental health and illness and early interventions.