Mental health interventions in schools

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1 The Lancet Psychiatry. The right place at the right time. Lancet Psychiatry 2014; 1: 319. 2 ADOCARE. Toward good mental health care for adolescents in Europe. Conference at the European Parliament, Brussels. Oct 16, 2014. http://adocare.eu/wp-content/ uploads/2014/10/Adocare-ConferenceProgram-06-10.pdf (accessed Oct 18, 2014). 3 Fazel M, Hoagwood K, Stephan S, Ford T. Mental health interventions in schools in high-income countries. Lancet Psychiatry 2014; 1: 377–87. 4 Rimpela A, Caan W, Bremberg S, Wiegersma PA, Wolfe I. Schools and the health of children and young people. In: Wolfe I, McKee M, eds. Lessons without borders. European Child Health Services and Systems. Maidenhead: Open University Press, 2013: 145–82. 5 Caan W, Cassidy J, Coverdale G, Ha M-A, Nicholson W, Rao M. The value of using schools as community assets for health. Public Health 2014, in press. 6 Caan W. Re: Safeguarding children: a challenge to doctors. BMJ 2014; 349: g5898. 7 Yousafzai M. I am Malala. The girl who stood up for education and was shot by the Taliban. London: Weidenfeld & Nicolson, 2013. improvement of adolescent mental health. We heard fi rst-hand accounts of mental health promotion, early intervention, and specialist community and residential care. Finland off ered a particularly good example of local linkage between school health services and secondary care for young people. Fazel and colleagues review research gaps and service development priorities for mental health in schools, including the “education and health interface”. Before readers of The Lancet Psychiatry rush to start mental health interventions locally, might I urge them to consider the wider school health systems within which professionals need to function. Integration and synergy of eff ort were key themes at our European meeting. Those seeking to understand and mobilise the many stakeholders involved across the education and health interface will fi nd seeing research and development through the lens of Asset-Based Community Development (ABCD) helpful. For both planners and practitioners, this ABCD model enables school health to assemble and sustain the building blocks of eff ective interventions. If planners see the whole school community, including teachers and learners, as a democratic asset, progress on really challenging issues will be enabled. In isolation, “in real-world settings”, I doubt that any of the interventions reviewed would work for schoolchildren who were being abused or exploited. Protection of such children needs the integration of many assets in the right place at the right time. In October, 2014, one schoolgirl living in Birmingham reminded me of the importance of seeing young people themselves as assets. Nobel peace prize winner Malala Yousafzai has been a victim of violence and forced migration, and she has also been a powerful peer advocate for young people: we have said, that psychiatric diagnosis includes much more than a series of classifi cations. Psychiatric diagnosis refl ects a whole way of thinking, embedded in social, psychological, political, and economic processes well beyond questions of its scientifi c status. Although we are clear about the alternative principles, how they will work in practice will take a long time to fi gure out. Nevertheless, the need for this change can no longer be denied.