Schools should be first stop for mental health prevention, early support

BRONWYNE COETZEE

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WHILE mental health problems among young people are increasing worldwide, local children face additional stressors like poverty, school and community violence and persistent inequality, says the writer.

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RECENTLY, I took part in a published debate series in the Journal of Child and Adolescent Mental Health on the future of universal or school-wide mental health interventions.

These interventions aim to reach all learners in schools, not only those already identified as needing help. The goal of most of these interventions is to equip children with skills that protect their mental health and wellbeing and help them to seek more targeted support when challenges arise.

Scepticism about these approaches has grown internationally. Large studies that randomly assigned participants (randomised controlled trials - RCTs) in high-income countries have shown modest or mixed effects of these approaches and, in a few cases, no measurable improvement, or even worsening of symptoms of common mental health conditions like depression.

These findings have raised doubts about whether school-wide mental health lessons were worth the effort.

However, they also revealed something important: programmes like these that are scaled up without being tailored to local realities, adequately prepared facilitators, or without including the voices of young people are unlikely to succeed.

The lesson is not that schools cannot play a role in the early identification or prevention of mental health problems, but rather that the success of the approaches depends as much on how, when and by whom they are delivered as on what they contain.