Approximately 70% of cases of mental disorder have their onset prior to 25 years of age. Thus, effective mental health interventions should be applied in youth for life-long benefits. Globally, most young people spend much of their day in schools, and they can be more easily reached there than through any other single public health or clinic-based intervention. Resultingly, effectively addressing mental health and early onset of mental disorders in schools must be an essential component of youth-focused mental health policy. The realization that school mental health is an important aspect of promotion, early intervention and treatment is not new. The World Health Organization report in 19941 was an early foray into this territory, and recent years have seen many school mental health activities across the globe2. A substantial corpus of work has now been published, allowing us to critically consider what components of school mental health interventions are both essential and can be systematically and frugally applied with success. These are: mental health literacy for both students and educators; training for both in-service and pre-service teachers; and school site provision of integrated mental health care to youth who require it. Mental health literacy has been defined as knowledge and competencies that encompass four separate but intertwined domains: understanding how to obtain and maintain good mental health; understanding mental disorders and their treatments; decreasing stigma; enhancing help seeking efficacy (knowing when and where to seek help, and learning skills to apply in the help seeking interaction)3. Mental health literacy has been considered to be the foundation for mental health promotion, prevention, early identification, and intervention and ongoing care3. In the school setting, it is essential that mental health literacy interventions are evidence-based, developmentally appropriate, integrated into curriculum, applied by appropriately trained teachers, frugal and easily accessible. While a few different approaches have been promoted globally, school and other educational institutions in many countries have been applying two evidence-based and freely accessible mental health literacy resources: the Mental Health b) they are designed to be youth friendly; c) they can provide a full range of health/mental health interventions (from promotion to prevention to care); d) they can be seamlessly linked to primary health care providers; e) they are relatively inexpensive to establish (i.e., require limited new infrastructure costs); f) they provide an easily accessible site for additional human health services; g) they can be enhanced by adding human resources such as mental health clinicians, h) they have a reasonable evidence base of positive results, that include better and more equitable academic, health and social outcomes8. When properly implemented, such centers can provide both site-based integration of services and horizontal integration into primary health care and social services. However, governance can be a challenge (who “owns” and who funds). They are not likely to be “branded” and so may not be good at raising funds from non-government sources. While well established in some developed countries, they are not well known in other countries; and full services sites may not be economically feasible in very small schools. Taken together, the above three components constitute the essential core elements of school mental health, and have a reasonable body of research that demonstrates their positive impact. They can be integrated into existing education and health infrastructure and are ready for scale-out in both low- and high-income settings9. Globally, governments should consider applying these school mental health interventions into their youth mental health policies, plans and programs.
Kutcher et al. (Mon,) studied this question.