Scope, Scale, and Dose of the World’s Largest School-Based Mental Health Programs

Abstract

Untreated mental health problems are among the most disabling, persistent, and costly health conditions. Because they often begin in childhood and continue into adulthood, there has been growing interest in preventive mental health programs for children. In recent years, several such programs have been implemented at regional, state, or national scale, and although many experimental studies have documented positive outcomes of individual programs, this article represents the first attempt to systematically compare the largest programs in terms of scope, scale, and dose. The school-based mental health programs discussed in this review appear to have reached more than 27 million children over the last decade, and many of these programs have collected systematic outcomes data. The role that such programs can play in low- and middle-income countries (LMICs) is a secondary focus of this article. Until recently, wide-scaled, preventive, mental health interventions for children have been studied almost exclusively in high-income countries even though around 80% of the global population of children reside in LMICs. Since a number of programs are now operating on a large scale in LMICs, it has become possible to consider child mental health programs from a more global perspective. With both the increasing diversity of countries represented and the growing scale of programs, data sets of increasing quality and size are opening up new opportunities to assess the degree to which preventive interventions for child mental health, delivered at scale, can play a role in improving health and other life outcomes.

Prevalence and Pattern of Mental Illness among School Age Children Seen at the University of Port Harcourt Teaching Hospital: A Six Year Study

“…Our finding is also in agreement with the report of Ashenafi et al [41] that the most diagnosed mental health disorder in their study was anxiety disorder. However, it contrasts with the report of Tunde-Ayinmode [36] in South West Nigeria who found schizophrenia as the most common mental health disorder in his study. It also contrasts with report of Lawrence et al [43], who found ADHD as the most common mental health disorder amongst Australian school children.…”

“…The developed world realizing the importance of sound mental health in the development of children and adolescents, organized several school-based mental health interventions geared towards mental health promotion or primary prevention for all students in school [35]. Available researches have shown moderate to strong evidence that these interventions are effective in promoting good mental health and related outcomes among school children [36]. Research has also demonstrated that students who receive social, emotional and mental health support achieve better academically, because the school climate, classroom behaviour, on-task learning and students' sense of connectedness and well-being tend to improve [9].…”

“…Research has also demonstrated that students who receive social, emotional and mental health support achieve better academically, because the school climate, classroom behaviour, on-task learning and students' sense of connectedness and well-being tend to improve [9]. Unfortunately, such interventions are lacking in schools in Nigeria as well as in other developing countries, where 85% of the global population of children and adolescents live [36], and where adverse conditions are most prevalent and their impact most devastating [37].…”

Training teachers in classroom management to improve mental health in primary school children: the STARS cluster RCT

“…Others would reserve this term for broader programmes that worked at universal, targeted and indicated levels of prevention simultaneously, which often include a mixture of environment, didactic and individualised content. 130,131 The training of a critical mass of school staff in IY TCM shows promise. A quasi-experimental Norwegian evaluation matched 21 schools in which all Grade 1-3 teachers (children aged 6-8 years) were trained with 22 matched schools that did not receive training.…”

Three‐Year Outcomes of a School‐Hospital Partnership Providing Multitiered Mental Health Services in Urban Schools

“…The aims of MTSS are to prevent and ameliorate MH problems while promoting social, emotional, and academic success among all individuals in a school . Although a robust evidence base exists for the effectiveness of singular school‐based prevention and intervention programs, little evidence is available to support the feasibility and effectiveness of MTSS models in “real world settings” that embed a continuum of whole‐school and classroom‐level prevention and early intervention programs alongside small group and individual services for selected youth.…”