Coproducing a school-based mental health literacy programme: exploring the views and experiences of primary school children in North-West England

Concern about school pupils' mental health has increased globally. Mental health programmes in state schools, including those provided by external partners, have also expanded. However, little research exists which explores the views and experiences of teachers and other school staff on the development of coproduced, contextually tailored, mental health literacy (MHL) programmes delivered with external partners (including academic researchers and community organisations) to support pupil mental health. This paper reports new interview data from 14 teachers and 1 teaching assistant based in 8 primary schools in north-west England who were involved with a sport- and art-based MHL programme (3 the Blues, TtB) during the school year 2022/23. Three themes were identifiable in the interviewees' comments: (i) Externality and navigating the constraints of the national curriculum; (ii) “It's opened my eyes”: developing and enhancing mental health literacy; and (iii) Supporting inclusive and proactive mentally healthy schools. Our findings suggest that TtB provided schools and teachers the opportunity to work with external organisations committed to working with, rather than on or for, them over the school year. This collaborative approach helped align TtB to the values, ethos, and strategic priorities of the school, including existing whole-school approaches to mental health within and beyond the curriculum. External partners' complementary expertise helped build capacity for delivering MHL work flexibly in schools, strengthened teachers' confidence, and expanded their understanding of pupils' diverse mental health needs. This further strengthened programme acceptability by fostering more pupil-to-pupil conversations which were perceived to positively contribute to stigma reduction and help-seeking efficacy.

School-based mental health literacy (MHL) programs are used to reduce stigma and promote help-seeking among students and teachers. This study aimed to adapt and evaluate a teacher-delivered MHL program in Cambodia, where the impact of MHL programs has not previously been evaluated. 67 teachers and 275 students from a high school in Phnom Penh voluntarily completed the study. School staff were randomly assigned, and classrooms purposively assigned, to either a 2-day MHL training program or a control condition. Four teachers in the intervention condition were also pragmatically selected to deliver a 6-week classroom MHL curriculum to students; these teachers receive an extra day of implementation training. Teacher and student MHL were assessed before and after the intervention. Results showed significant improvements in all indicators of teacher and student knowledge and attitudes about mental illness; largest improvements were in teachers’ perceptions of dangerousness and willingness to interact. This pilot RCT supports the potential benefits of school-based MHL training in Cambodia, where there is substantial mental health stigma and discrimination. However, small to moderate effect sizes, particularly for students outcomes, suggest a need for further refinement and testing of the curriculum to optimize impact, including further consideration of implementation strategies and supports.

PurposeThis pilot study of a culturally adapted online mental health literacy (MHL) program called ‘Tara, Usap Tayo!’ (C’mon, Let’s Talk) aims to assess the acceptability, appropriateness, feasibility, and potential effectiveness in improving the help-seeking behavior of Filipino migrant domestic workers in the United Kingdom (UK).MethodsUsing mixed methods, we conducted a non-randomized single-group study of the online MHL program with 21 participants. The development of this intervention was guided by the Medical Research Council Framework for developing complex interventions and utilized Heim & Kohrt’s (2019) framework for cultural adaptation. Content materials from the WHO Mental Health Gap Action Program (mhGAP), WHO Problem Management Plus (PM +) and Adult Improving Access to Psychological Therapies (IAPT) were modified and translated into the Filipino language. The MHL program was delivered online in three sessions for two hours each session. Data were collected at three time points: (T1) pretest; (T2) posttest; and (3) follow-up test. Quantitative data on participants’ attitudes towards help-seeking and level of mental health literacy as outcome measures of potential intervention effectiveness were collected at T1, T2 and T3, while focus group discussions (FGDs) to assess participants’ feedback on the acceptability, feasibility, and appropriateness of the online MHL program were conducted immediately at T2. Data analysis was done using a thematic approach for qualitative data from the FGDs and descriptive statistics and repeated-measures ANOVA were used to assess the difference in the T1, T2, and T3 tests. Both quantitative and qualitative results were then integrated and triangulated to answer the research questions.ResultsThe online MHL program is generally acceptable, appropriate, and feasible for use among Filipino migrant domestic workers. Preliminary findings lend support for its possible effectiveness in improving mental health literacy and help-seeking propensity. The cultural adaptation made in the content, form, and delivery methods of the intervention was acceptable and feasible for this target subcultural group.ConclusionBy improving their mental health literacy and help-seeking propensity, this online MHL program has the potential to provide support to the mental health and well-being of Filipino migrant domestic workers in the UK. Further feasibility study or large-scale randomized controlled trial is needed to confirm the preliminary findings of this study.

Background/Objectives: We aim to assess the effect of the Espaijove.net mental health literacy program on adolescents’ quality of life (QOL). Additionally, we aim to describe their QOL and mental well-being. Methods: A multicenter, randomized, controlled trial was conducted, with pre- and post-intervention assessments and 6- and 12-month follow-ups. A total of 1032 students aged 13–14 from 18 schools in Barcelona participated in one of the three following mental health literacy (MHL) programs or were placed in a control group (CG): (1) a 1 h awareness session (G1h); (2) a 6 h MHL program (G6h); (3) a 7 h MHL program with stigma reduction (G7h). Measures: (1) Mental well-being: Strengths and Difficulties Questionnaire (SDQ); (2) QOL: EuroQol 5D-5L with its two parts: the EuroQol 5D-5L Index (0–1) and EuroQol 5D-5L visual analog scale (EQ-VAS) (0–100). Analyses were conducted on an intention-to-treat basis, using data imputation methods for missing data. Intervention effects were assessed using multilevel models. Results: Baseline EQ-VAS and EQ-5D-5L index scores were 77.84 (CI = 76.77–78.91) and 0.91 (CI = 0.90–0.92), respectively. Boys reported higher QOL and SDQ scores (p < 0.001), whereas participants of foreign nationality showed lower scores in QOL (EQ-VAS; p = 0.039) and mental well-being (p < 0.001). Post-intervention, all groups (intervention and control), except G6h, showed QOL improvements. However, in the 6-month follow-up, the CG outperformed the other groups. At 12 months, G7h achieved the highest EQ-VAS scores compared to the other groups. Conclusions: MHL-based interventions improved short-term QOL but failed to sustain these improvements over time. Groups with lower QOL and SDQ scores included girls and adolescents of foreign nationality.

Adolescence is marked by a high prevalence of mental health concerns, with approximately 14% of young individuals receiving a diagnosis of a mental illness disorder. This figure is projected to rise in the future. However, barriers such as limited access to mental health services, a shortage of mental health professionals, and the enduring stigma surrounding mental health prevent many adolescents from seeking help, potentially resulting in long-term negative outcomes. To address these challenges, an evidence-based mental health literacy program implemented within schools offers a promising avenue for imparting knowledge and improving adolescents' mental well-being. This paper presents a mental health literacy and action program specifically tailored for adolescents, developed in collaboration with professionals, teachers, parents, and adolescents themselves. Lessons learned from program development and implementation in Australia and the United States are shared, providing insights into the process of designing and executing such programs. By enhancing mental health literacy and promoting help-seeking behaviors, this program has the potential to facilitate positive changes in adolescents' mental health outcomes.

Mental health literacy (MHL) programs, which aim to improve knowledge, reduce stigma and promote help-seeking behavior, are a promising approach to meeting the growing mental and behavioral health needs of youth. This study aimed to understand the relational impacts of a MHL curriculum on students and teachers. A MHL curriculum was delivered in middle school classrooms across 11 schools in two diverse school districts in the Mid-Atlantic and Southeast regions. Fifteen teachers and counselors who delivered the MHL curriculum participated in focus groups to describe their experiences using the curriculum and perceptions of its impact. Qualitative focus group data were analyzed via team-based inductive thematic analysis following a grounded theory approach. Findings indicate that educators perceived the universal school MHL program to have a positive impact on relationships amongst students and between students and teachers. Participants reported that the MHL curriculum helped to open conversations about mental health and related topics by developing common language and providing an opportunity to model vulnerability. Having these conversations improved classroom rapport and helped teachers develop deeper connections with students. As a result, teachers and students achieved greater empathy and students advocated more for themselves and their peers. Implications for integrating MHL programs into multi-tiered frameworks in schools to expand access to mental health supports are discussed.

Educating and sensitization through mental health literacy (MHL) programmes is germane to raising awareness, reducing stigma towards help-seeking, and ultimately improving help-seeking behaviours in young male adults. This theoretical paper problematises various trajectories and approaches that are engaged with; in providing mental health literacy to enhance young male adults’ help-seeking behaviour. It further advances the critical pedagogical (CP) approach as an alternative trajectory for this task. This was achieved by positioning mental health literacy as a critical engagement that relies on transformative education in order to enhance help-seeking behvaiour. This article discusses the relevance of some prominent themes in critical pedagogy to the design of mental health literacy programmes for enhanced help-seeking. It, therefore, submits that for any meaningful improvement and change to take place in the ideologies, beliefs, and attitudes of young male adults towards help-seeking, a critical pedagogical approach should be engaged, with believed that this approach will facilitate critical dialogues, reflexive thinking, and participatory learning processes. It is anticipated that embedding the CP principles into the design of MHL programmes would assist practitioners and health educators to produce a transformational change in the behaviour of young male adults towards help-seeking.

Evaluation of a youth mental health literacy and action program: Protocol for a cluster controlled trial

Students with developmental disabilities (DD) have significant rates of comorbid mental health challenges but are underserved in mental health interventions. In this study, 10 students with DDs attending inclusive classrooms who participated in a classroom-based mental health literacy (MHL) and dialectical behaviour therapy (DBT) skills program were interviewed about their experiences in the program and its impact on their well-being. Interviews were conducted three times in the year and analyzed through thematic analysis. Students described a developmental continuum of how MHL and DBT skills improved coping skills and their relationships with self, peers, and teachers; mitigated bullying and externalizing behaviour; and created a positive, inclusive climate. Findings suggest students with DDs can benefit from universal programming with peer modelling and support and can identify effective mental strategies and their outcomes.

This chapter presents the mounting evidence regarding the success of school-based universal mental health promotion and prevention (MHPP) programs for students, from primary through postsecondary education, throughout the world. The chapter highlights the ability of these programs (MHPPPs) to promote students’ adjustment and lessen the likelihood of many subsequent adjustment problems, and discusses some critical issues facing this field in terms of further understanding the impact of MPPPs in diverse settings around the globe, and what needs to occur to encourage the larger-scale adoption of universal prevention to reach more students.

Improved knowledge about, and positive attitudes towards, people with mental illness could lead to improved support and decreased stigma for people with mental illness, including their families and carers. The aims of our study were to evaluate the perspectives of community leaders about the usefulness of a cluster randomized trial of a problem-solving and Story-bridge based mental health literacy (MHL) programme and to understand whether they utilized the knowledge acquired from the programme in their usual interactions with people with mental illness and their families. Twenty-five participants were sampled randomly from the intervention cluster of the trial to participate in a qualitative process evaluation, and individual interviews were used to collect data. A thematic analysis of the data was undertaken. Three themes were abstracted from the data, reflecting participants' perspectives about the usefulness of the programme: overcoming fear of perceived dangerousness, increasing willingness to engage, and becoming empathetic and non-judgemental. This qualitative process evaluation offers insights into how a problem-solving and Story-bridge based MHL programme to a targeted group could lead to real and supportive actions/attitudes to people with mental illness. The findings have clinical relevance for a collaboration among family members and caregivers, community leaders and community psychiatric nurses, and other primary healthcare workers to develop community MHL strategies to improve the quality of care, support and life of people with mental disorders.

BackgroundSchools are an ideal setting in which to promote health. However, empirical data on the effectiveness of school-based mental health promotion programs are rare, and research on universal Internet-based prevention in schools is almost non-existent. Following the life skills approach, stress management training is an important component of health promotion. Mental health literacy is also associated with mental health status, and it facilitates formal help-seeking by children and adolescents (C&A). The main objectives of this study are (1) the development and evaluation of an Internet-based version of a universal school-based health promotion program called StresSOS and (2) demonstrating non-inferiority of the online setting compared to the face-to-face setting. StresSOS aims to improve stress management and mental health literacy in C&A.Methods/designA school-based sample of 15,000 C&A (grades 6–13 and older than 12 years) will be recruited in five regions of Germany within the ProHEAD Consortium. Those with a screening result at baseline indicating no mental health problems will be invited to participate in a randomized controlled trial comparing StresSOS online to an active online control condition (Study A). In addition, 420 adolescents recruited as a separate school-based sample will participate in the StresSOS face-to-face intervention. Participants in both intervention groups (online or face-to-face) will receive the same eight treatment modules to allow for the comparison of both methods of delivery (Study B). The primary outcome is the number of C&A with symptoms of mental health problems at a 12 months follow-up. Secondary outcomes are related to stress/coping (i.e., knowledge, symptoms of stress, coping resources), mental health literacy (knowledge and attitudes toward mental disorders and help-seeking), program usage patterns, cost-effectiveness, and acceptability of the intervention.DiscussionThis study represents the first adequately powered non-inferiority trial in the area of school-based mental health promotion. If online StresSOS proves efficacious and non-inferior to face-to-face delivery, this offers great potential for health promotion in youths, both in and outside the school environment.Trial registrationGerman Clinical Trials Register, DRKS00014693. Registered on 14 May 2018.

Background Preventing mental health problems and promoting mental wellbeing is the aim of school-based mental health literacy (MHL) programs. Previous research suggests that good MHL (knowledge and skills regarding mental health, resilience, and help-seeking) helps people to take good care of their own and others’ mental health and use support-services. In this context the MHL of teachers is highly relevant, as they act as role models and interact with affected pupils on a regular basis, for which certain knowledge and skills are necessary. In this study, we therefore seek to investigate the level of MHL in German high-school teachers as well as their exposure to impaired students and their desire for further education on pupils’ mental health. Methods The data are collected as part of an effectiveness study of a school-based intervention to strengthen MHL (BEWARE), which was developed by our working group. We collect data from teachers who are involved in BEWARE as coaches as well as from those not directly involved (n ≈ 300). Data collection takes place online at three measurement timepoints (6 months apart each). For the analysis presented here, data of the first measurement timepoint with respect to MHL, skills in handling affected students and wishes for additional education on pupils’ mental health are included. Results As the data collection is still ongoing, statistical analyses are not yet completed. We will present data on the current state of knowledge on MHL in German teachers as well as their abilities to deal with affected pupils and their wish for further education. In addition, we will relate the number of affected pupils they teach to depict the relevance in their daily life at school to the above-mentioned measures. Conclusions The acquired data and respective analyses will give us important insights about the objective and subjective need of MHL training in schoolteachers (based on assessed knowledge and their reported wish of additional education). Key messages • Our study will give us important insights about the objective need of MHL training in high-school teachers based on assessed knowledge. • Our results will depict which formats of training teachers would prefer for additional education on pupils’ mental health, which will be a valuable basis for the development of future programs.

PurposeMental health literacy programmes can help reduce stigma towards people who experience mental health challenges. Co-facilitated mental health literacy programmes, delivered by a person with lived experience of mental health challenges in partnership with a person with clinical experience in mental health services, may further reduce stigma. This qualitative study aims to explore participants’ satisfaction with a co-facilitated mental health literacy programme and facilitator characteristics influencing satisfaction.Design/methodology/approachThe authors used deidentified post-workshop evaluation data from 762 community mental health literacy programme participants (86% response rate). Thematic analysis of qualitative data used a general inductive approach.FindingsFindings indicate high satisfaction with the co-facilitation model used to deliver a mental health literacy programme. Three key themes related to co-facilitation satisfaction: how participants perceived the co-facilitation model overall; the impact of having two facilitators that offered different knowledge and perspectives about mental health challenges; and the impact of personal stories shared. The personal stories shared by facilitators were perceived as bringing the workshop content to life and providing insights into people’s experiences and well-being journey. Key themes influencing co-facilitation satisfaction related to facilitator knowledge, skills, values and attitudes.Practical implicationsFindings indicate the positive impact of incorporating people’s lived experience into the design and delivery of mental health literacy programmes. Findings highlight key facilitator characteristics and support needs when recruiting facilitators to deliver programmes. This includes good facilitation skills alongside personal experiences.Originality/valueTo the best of the authors’ knowledge, this is the first large study examining satisfaction with a co-facilitated mental health literacy programme for the general public.

Limited empirical evidence is available regarding the uptake and effectiveness of school-based mental health and wellbeing programs implemented in Australian schools. This study aimed to characterise the delivery of programs in primary (elementary) schools across New South Wales, Australia, and to assess this information against published ratings of program effectiveness. Delivery of programs in four health-promoting domains—creating a positive school community; teaching social and emotional skills; engaging the parent community; and supporting students experiencing mental health difficulties—were reported by 597 school principals/leaders via online survey. Although three quarters of principals reported implementing at least one program, many of these programs were supported by little or no evidence of effectiveness. There was also variability in the use of evidence-based programs across the four domains. Findings indicate a need to provide educators with improved support to identify, implement, and evaluate effective evidenced-based programs that promote student mental health.