World Psychiatric Association-Asian Journal of Psychiatry Commission on Public Mental Health

Although there is considerable evidence showing that the prevention of mental illnesses and adverse outcomes and mental health promotion can help people lead better and more functional lives, public mental health remains overlooked in the broader contexts of psychiatry and public health. Likewise, in undergraduate and postgraduate medical curricula, prevention and mental health promotion have often been ignored. However, there has been a recent increase in interest in public mental health, including an emphasis on the prevention of psychiatric disorders and improving individual and community wellbeing to support life trajectories, from childhood through to adulthood and into older age. These lifespan approaches have significant potential to reduce the onset of mental illnesses and the related burdens for the individual and communities, as well as mitigating social, economic, and political costs. Informed by principles of social justice and respect for human rights, this may be especially important for addressing salient problems in communities with distinct vulnerabilities, where prominent disadvantages and barriers for care delivery exist. Therefore, this Commission aims to address these topics, providing a narrative overview of relevant literature and suggesting ways forward. Additionally, proposals for improving mental health and preventing mental illnesses and adverse outcomes are presented, particularly amongst at-risk populations.

The Provision of Psychosocial Support to Students in Jordan: Teachers' Knowledge, Attitudes, Skills, Practices, and Perceived Barriers

BACKGROUND

Psychosocial support provision in schools is a promising strategy for overcoming barriers to accessing mental health care. This study aimed to assess teachers' knowledge, attitudes, practices, skills, and perceived barriers in providing psychosocial support to students in Jordan.

METHODS

The sample included teachers working in public schools, private schools, the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) schools, and Zaatari camp schools, as well as non-formal education centers. The study utilized a multi-stage stratified cluster sampling technique to select a nationally representative sample.

RESULTS

A total of 549 teachers were included, and only 25.2% have ever received mental health training. Most teachers reported a high level of good and acceptable knowledge of psychosocial support and had a positive attitude toward the provision of psychosocial support, however, about a quarter (25.5%) agreed on feeling nervous in discussing students' psychosocial problems with their parents or school administrators. The least enacted practice was the systematic engagement with parents, school administration, and other community resources in students' well-being (sometimes, 31.6%; rarely, 20.4%). Gaps in skills were mainly in communicating with external resources and parents. The main barriers included parents' misunderstanding of teachers' role in providing psychosocial support to students (56.8%), lack of integration of psychosocial support in the curriculum (55.6%), and challenges in identifying students with psychosocial problems due to large class sizes (54.3%).

CONCLUSION

The results show that gaps extend beyond the individual level of teachers to the community level. School-based psychosocial support interventions must consider the multiple factors that influence their implementation at multiple levels, including the individual, relational, community, and societal levels.

Propelling the Global Advancement of School Mental Health

Rates of mental health problems and disorders in children and youth have been increasing for at least three decades, and these have escalated due to the pandemic and multiple other societal stressors. It is increasingly recognized that students and families frequently struggle to receive needed care through traditional locations such as specialty mental health centers. Upstream mental health promotion and prevention strategies are gaining support as a public health approach to supporting overall population well-being, better utilizing a limited specialty workforce, and reducing illness. Based on these recognitions, there has been a progressive and escalating movement toward the delivery of mental health support to children and youth "where they are," with a prominent and more ecologically valid environment being schools. This paper will provide a brief review of the escalating mental health needs of children and youth, advantages of school mental health (SMH) programs in better meeting these needs, example model SMH programs from the United States and Canada, and national and international SMH centers/networks. We conclude with strategies for further propelling the global advancement of the SMH field through interconnected practice, policy, and research.

Effect of a mental health education intervention on children's life satisfaction and self-confidence in rural China

Children living in rural areas may potentially experience low levels of life satisfaction and face challenges in developing self-confidence. The purpose of the current study was to examine the impact of a mental health education intervention on the life satisfaction and self-confidence of children residing in rural areas of China. A total of 1,001 children from grades 4 to 6 were randomly assigned to an intervention group (475 children, 250 boys, M = 11.57 years, SD = 1.082 years) and a control group (526 children, 279 boys, M = 11.38 years, SD = 0.980 years). Over 16 weeks, the intervention group received a mental health education program, while the control group did not. The levels of life satisfaction (including five dimensions: family, school, environmental, friends, and self-satisfaction) and self-confidence (including three dimensions: self-efficacy, self-assurance, and self-competence) were rated by all children at baseline and post-intervention. Results from paired samples t-test showed that post-intervention, the intervention group exhibited significant improvements in the areas of family, environmental, school, and self-satisfaction as well as self-efficacy, self-assurance, and self-competence. However, there was no significant improvement in friend satisfaction. Conversely, the control group showed decreases in school, environmental, and friend satisfaction, along with decreases in self-efficacy, self-assurance, and self-competence. No significant change was observed in family and self-satisfaction in this group. These findings emphasize the importance of implementing mental health education interventions for rural children, who are at risk for low life satisfaction and self-confidence. Some specific recommendations are provided for policymakers and practitioners.

Awareness and Attitudes Toward Childhood Mental Disorders Among Primary School Teachers in Taif, Saudi Arabia

Background and aim Early detection and intervention can improve the treatment outcome of childhood mental disorders, and primary school teachers may play an important role in referring suspected cases to mental health facilities if they have good awareness and attitudes toward these disorders. The aim of this study is to assess the awareness and attitudes of primary school teachers toward childhood mental disorders in Taif, Saudi Arabia. Methods This is a cross-sectional study conducted among classroom teachers in primary schools in Taif, Kingdom of Saudi Arabia. It was conducted during the period from 2022 to 2023 in both public and private schools. An anonymous, self-administered, online questionnaire was used to assess participants' awareness and attitudes toward pupils with mental health issues. The collected data were analyzed using the chi-square test to examine the associations between various categories and the ANOVA test to compare means. Results The study included 417 teachers, 63.5% of whom were males, the mean of their ages was 39.59 years (SD±8.66), and the mean of their work experience was 12.8 years (SD±8.02) in different teaching specialties. Among participants, 60.2% claimed that no pupils had mental health problems in their classes, 80.1% had not referred any pupils to mental health facilities, and 88.5% did not receive any training related to childhood mental health problems. A humble percent (12.2%) of the participants claimed a good awareness of the signs and symptoms of childhood disorders. Only 54% of teachers advise visiting a psychiatric clinic in case of psychiatric problems, and a similar percentage of teachers believe that psychiatric drugs cause addiction. The male gender, being specialized in humanitarian subjects, having relatives or friends with childhood mental disorders, and receiving training related to childhood mental health were significantly associated with teachers' better awareness. Conclusion Primary school teachers generally lack awareness of childhood mental health and have underestimation and poor recognition of cases of mental disorders. There are many teachers who also have unfavorable attitudes toward psychiatric disorders, patients, and treatments, which requires much effort to improve their awareness and attitudes toward childhood mental disorders.

Development and Implementation of DIALOG+S in the School Setting as a Tool for Promoting Adolescent Mental Well-Being and Resilience in a Post-Armed Conflict Area in Colombia: Exploratory Cluster Randomized Controlled Trial

BACKGROUND

Educational settings are ideal for promoting mental well-being and resilience in children. The challenges of the COVID-19 pandemic made evident the important role that teachers and school counselors play in the mental health of their students. Therefore, it is imperative to develop and implement cost-effective interventions that allow them to identify and address mental health problems early, especially in post-armed conflict areas, to reduce the burden of mental disorders in this population.

OBJECTIVE

This study aimed to adapt an existing patient-focused digital intervention called DIALOG+ from an adult clinical setting to an adolescent educational setting and to assess the feasibility, acceptability, and estimated effect of implementing this intervention as a tool for promoting quality of life, mental well-being, and resilience.

METHODS

We conducted an exploratory mixed methods study in 2 public schools in postconflict areas in Tolima, Colombia. This study was conducted in 3 phases. In the adaptation phase, focus groups were conducted with students and teachers to identify changes required in DIALOG+ for it to be used in the school setting. The exploration phase consisted of an exploratory cluster randomized controlled trial. A total of 14 clusters, each with 1 teacher and 5 students, were randomly allocated to either the experimental (DIALOG+S) group or to an active control group (counseling as usual). Teachers in both groups delivered the intervention once a month for 6 months. Through screening scales, information was collected on mental health symptoms, quality of life, self-esteem, resilience, and family functionality before and after the intervention. Finally, the consolidation phase explored the experiences of teachers and students with DIALOG+S using focus group discussions.

RESULTS

The changes suggested by participants in the adaptation phase highlighted the central importance of the school setting in the mental health of adolescents. In the exploratory phase, 70 participants with a mean age of 14.69 (SD 2.13) years were included. Changes observed in the screening scale scores of the intervention group suggest that the DIALOG+S intervention has the potential to improve aspects of mental health, especially quality of life, resilience, and emotional symptoms. The consolidation phase showed that stakeholders felt that using this intervention in the school setting was feasible, acceptable, and an enriching experience that generated changes in the perceived mental health and behavior of participants.

CONCLUSIONS

Our results are encouraging and show that the DIALOG+S intervention is feasible and acceptable as a promising opportunity to promote well-being and prevent and identify mental health problems in the school context in a postconflict area in Colombia. Larger, fully powered studies are warranted to properly assess the efficacy and potential impact of the intervention and to refine implementation plans.

TRIAL REGISTRATION

International Standard Randomised Controlled Trial Number (ISRCTN) registry ISRCTN14396374; https://www.isrctn.com/ISRCTN14396374.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/40286.

Improving Mental Health Literacy and Reducing Psychological Problems Among Teachers in Zambia: Protocol for Implementation and Evaluation of a Wellness4Teachers Email Messaging Program

BACKGROUND

Primary, basic, secondary, and high school teachers are constantly faced with increased work stressors that can result in psychological health challenges such as burnout, anxiety, and depression, and in some cases, physical health problems. It is presently unknown what the mental health literacy levels are or the prevalence and correlates of psychological issues among teachers in Zambia. It is also unknown if an email mental messaging program (Wellness4Teachers) would effectively reduce burnout and associated psychological problems and improve mental health literacy among teachers.

OBJECTIVE

The primary objectives of this study are to determine if daily supportive email messages plus weekly mental health literacy information delivered via email can help improve mental health literacy and reduce the prevalence of moderate to high stress symptoms, burnout, moderate to high anxiety symptoms, moderate to high depression symptoms, and low resilience among school teachers in Zambia. The secondary objectives of this study are to evaluate the baseline prevalence and correlates of moderate to high stress, burnout, moderate to high anxiety, moderate to high depression, and low resilience among school teachers in Zambia.

METHODS

This is a quantitative longitudinal and cross-sessional study. Data will be collected at the baseline (the onset of the program), 6 weeks, 3 months, 6 months (the program midpoint), and 12 months (the end point) using web-based surveys. Individual teachers will subscribe by accepting an invitation to do so from the Lusaka Apex Medical University organizational account on the ResilienceNHope web-based application. Data will be analyzed using SPSS version 25 with descriptive and inferential statistics. Outcome measures will be evaluated using standardized rating scales.

RESULTS

The Wellness4Teachers email program is expected to improve the participating teachers' mental health literacy and well-being. It is anticipated that the prevalence of stress, burnout, anxiety, depression, and low resilience among teachers in Zambia will be similar to those reported in other jurisdictions. In addition, it is expected that demographic, socioeconomic, and organizational factors, class size, and grade teaching will be associated with burnout and other psychological disorders among teachers, as indicated in the literature. Results are expected 2 years after the program's launch.

CONCLUSIONS

The Wellness4Teachers email program will provide essential insight into the prevalence and correlates of psychological problems among teachers in Zambia and the program's impact on subscribers' mental health literacy and well-being. The outcome of this study will help inform policy and decision-making regarding psychological interventions for teachers in Zambia.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/44370.

The Association Between Family Physical Abuse and Suicide Attempts Among Gender Minority Adolescents: A Comparison Study

Purpose: This study examines the prevalence of reported family physical abuse and the concurrent association between abuse and suicide attempts by adolescent gender identity. Methods: This study used the Profiles of Student Life: Attitudes and Behaviors dataset (N = 121,150 adolescents aged 11-19 [mean = 14.74, standard deviation = 1.78]) collected from 61 participating school districts and programs across the United States by Search Institute from 2012 to 2015. Multigroup logistic regression was used to examine the association between family abuse and suicide attempts by gender identity. Correlates included race/ethnicity, age, parent education, rurality, binge drinking, and tobacco use. Results: Results indicated that cisgender adolescents (i.e., participants who did not select a transgender identity) reported significantly less family abuse compared to gender minority adolescents. Family physical abuse was associated with higher odds of suicide attempts among all adolescents. The association was stronger for female adolescents compared to male adolescents but not significantly different across gender minority adolescents, including those who identify as transgender female to male, transgender male to female, and transgender without identifying or being unsure of their gender identity. The association between family physical abuse and suicide attempts was stronger among heterosexual female adolescents compared to sexual minority female, heterosexual male, sexual minority male, heterosexual gender minority, or sexual and gender minority adolescents. Conclusions: Findings highlight the importance of identifying and treating family abuse to prevent suicide attempts, particularly among gender and sexual minority adolescents.

Schulprogramme zur Förderung der psychischen Gesundheit. Die psychische Gesundheitskompetenz von Lehrpersonen als wichtiger Umsetzungsfaktor

Hintergrund

Weltweit sind bis zu einem Fünftel der Kinder und Jugendlichen von psychischen Störungen betroffen. Auffälligkeiten, die bereits im Schulalter auftreten, sind insbesondere für die Betroffenen, aber auch die Lehrpersonen belastend. Schulische Präventionsprogramme zur psychischen Gesundheit haben das Potenzial, die Belastungen beidseitig zu reduzieren. Die psychische Gesundheitskompetenz von Lehrpersonen, die nicht nur das Wissen und das Verständnis, sondern auch die Handlungen untersucht, gilt dabei als wichtiger Umsetzungsfaktor. Die Studienlage ist mager.

Ziele

Die Studie untersucht die psychische Gesundheitskompetenz von Lehrpersonen im Kontext von Belastungssituation der Schülerinnen und Schüler sowie das Vorhandensein entsprechender Schulprogramme.

Methoden

Im Schuljahr 2019/2020 wurden alle Lehrpersonen in einer Deutschschweizer Stadt zu einem Online-Survey eingeladen (n = 1514; Rücklauf: 38 %). Die Daten wurden quantitativ mittels bivariater und multivariater Methoden ausgewertet. Eine offene Frage zum Verständnis psychischer Störungen wurde qualitativ mittels einer Inhaltsanalyse ausgewertet.

Resultate und Diskussion

Die Befragten betreuten oder unterrichteten im letzten Jahr durchschnittlich 4,7 psychisch belastete Schülerinnen und Schülern. Die Anzahl Betroffener unterschied sich nach Schulstufe und Schulfunktion. Die Lehrpersonen schätzten ihre Fähigkeit, Informationen zum Thema zu finden und zu verstehen als (sehr) gut ein, es fiel ihnen jedoch schwerer, zu beurteilen, ob die gefundenen Informationen korrekt sind. Die Handlungskompetenz der Lehrkräfte war partiell gering, beispielsweise beim Wissen über Störungsbilder und stellt ein Hindernis in der Umsetzung von Schulprogrammen dar. Lehrkräfte relativierten auffälliges Verhalten, was die Triage für weitere Abklärungen erschwert. Den Schulen wird zum einen empfohlen in die Eigeninitiative der Lehrpersonen zu investieren, zum anderen sollte die Steigerung der psychischen Gesundheitskompetenz nicht nur Aufgabe der Lehrpersonen sein, sondern durch eine entsprechende Schulkultur und gesellschaftlich gefördert werden.

Australian School Staff and Allied Health Professional Perspectives of Mental Health Literacy in Schools: a Mixed Methods Study

Schools are an ideal setting to base mental health literacy programs as the learning environment is already established. Mental health literacy represents how to obtain and maintain good mental health and should be incorporated into the school curriculum. Collaboration with key stakeholders in youth mental health, such as school staff and allied health professionals, is critical in ensuring needs are addressed, and programs are sustainable. This study aimed to understand the perspectives of school staff and allied health professionals towards mental health literacy within Australian schools. An exploratory qualitative and quantitative survey was completed by 88 participants across Australia. Results indicated that school staff feel less competent to deliver mental health literacy content and perceive their training did not address mental health education compared to allied health professionals. Most mental health programs reported to be implemented within schools were social and emotional learning programs. School staff viewed mental health programs to strengthen academic performance less than allied health professionals. Thematic analysis of qualitative data identified that participants viewed mental health knowledge, where and how to seek help, and coping skills as vital content to cover in a school-based mental health literacy program. This study reveals that school staff need sufficient training and resources to address youth mental health literacy. Though mental health literacy is lacking in the Australian school system, the perspectives of school staff and allied health professionals in this study provide key ideas and considerations for the future development of school-based mental health literacy programs for youth.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10648-023-09725-5.

Educator-Informed Development of a Mental Health Literacy Course for School Staff: Classroom Well-Being Information and Strategies for Educators (Classroom WISE)

Educators play a critical role in promoting mental health and well-being with their students. Educators also recognize that they lack knowledge and relevant learning opportunities that would allow them to feel competent in supporting student mental health. As such, educators require resources and training to allow them to develop skills in this area. The Mental Health Technology Transfer Center (MHTTC) Network partnered with the National Center for School Mental Health at the University of Maryland School of Medicine to develop Classroom Well-Being and Information for Educators (WISE), a free, three-part mental health literacy training package for educators and school staff that includes an online course, video library, and resource collection. The Classroom WISE curriculum focuses on promoting positive mental health in the classroom, as well as strategies for recognizing and responding to students experiencing mental health related distress. This paper describes the curriculum development process, including results of focus groups and key informant interviews with educators and school mental health experts. Adoption of Classroom WISE can help educators support student mental health and assist in ameliorating the youth mental health crisis.

The Role of Organizational Factors in Nurses' Perceived Preparedness to Screen, Intervene and Refer in Cases of Suspected Postpartum Depression

Routine screening for postpartum depression (PPD) is widespread, yet little attention has been given to the perceived preparedness of health providers to perform screening procedures, or to the role of organizational factors in their preparedness, although these are crucial elements for optimal implementation. The aim of this study was to examine organizational factors associated with public health nurses' (PHNs) perceived preparedness to screen women for PPD, intervene, and refer them in cases of suspected PPD. Two hundred and nineteen PHNs completed a self-report survey regarding their perceived preparedness to carry out a screening program (including screening, intervening, and referring women), and their perceived organizational support, supervisor's support, colleagues' support, and colleagues' preparedness. A path analysis model was used to analyze the data. The results showed that perceived colleagues' preparedness was significantly associated with the three perceived preparedness constructs (screen, intervene, and refer). Perceived supervisor's support was positively associated with perceived preparedness to screen, and perceived organizational support was positively associated with perceived preparedness to intervene. This paper highlights the manner in which formal and informal organizational factors play an important role in the perceived preparedness of PHNs to carry out a PPD screening program, and how these factors impact the three different aspects of the screening program. Organizations implementing PPD screening should support PHNs in all aspects of the implementation process, provide guidance, and enhance peer-group continued learning through which PHNs could share knowledge, discuss barriers, and foster professional development.

Attitudes and beliefs of Tunisian High-School teachers about schizophrenia: The impact of vignette gender

BACKGROUND

Teachers have a crucial active role in provision of mental health services to students and fighting against mental health stigma in schools, hence their attitudes and beliefs toward mental illness should be assessed.

METHOD

We carried-out a cross-sectional study with a non-probabilistic sample of 304 higher secondary school teachers. We used a structured questionnaire in which a vignette describing an individual with schizophrenia was presented, and was followed by a series of stigma-related questions.

RESULTS

A substantial proportion of teachers endorsed stressful life events (79.6%) as a cause of schizophrenia, elicited feelings of discomfort (41.4%) and incomprehension (41.1%) with the person displaying symptoms of schizophrenia, and agreed that the person's condition will deteriorate even more (45.4%). Teachers perceived that the person described in the vignette is dependent on others, lacks will, is different from others and is unpredictable in 65.1%, 59.2%, 55.6%, and 49.7% of cases, respectively. In addition, 38.5% and 34.2% of teachers recommended turning to traditional healers and to a Sheikh or an imam of a mosque, respectively. Regarding gender effects, females with schizophrenia were regarded as more likely to be unable to make her own decisions and to be dependent on others than males, and were less likely to be recommended for seeking help from a family physician or to consult a psychiatric hospital than males.

CONCLUSION

In the light of our findings, raising awareness of teachers of the impact of mental health issues on students should be prioritized in high schools in Tunisia.

Supporting Indigenous Child Suicide Prevention Within Classrooms in Canada: Implications for School Psychologists and Educators

Indigenous young people in Canada are disproportionately overrepresented in suicide rates and alarmingly, young children are accounted for in these disparities. Since children spend much of their day at school, schools are a vital context for suicide prevention, identification, and intervention. However, research indicates that educators often report that they feel unprepared to address mental health challenges within the classroom. Indigenous communities are developing community driven responses to suicide that are culturally relevant and strengths based. It is critical that these models are considered when developing such suicide prevention within schools as they diverge from medicalized focused approaches and attend to broader social dimensions. It is imperative that educators and the education system are properly equipped with the training and resources to provide suicide prevention within schools and communities servicing Indigenous children. School psychologists can play an important role in providing this prevention leadership. Through interviews with educators, we learned about the types of supports that are needed within schools to address Indigenous child suicide, and in what ways school psychologists could enhance prevention efforts. Using a reflexive approach to thematic analysis, we identified four main themes related to support needed. Findings are discussed in conversation with the current state of child specific suicide and suicide prevention literature. Applied implications for suicide prevention within schools for Indigenous children, as well as future research and community-based recommendations are considered.

Mental health in higher education: faculty staff survey on supporting students with mental health needs

Purpose

The purpose of this paper is to examine how faculty staff on health and social care programmes support students with mental health issues.

Design/methodology/approach

The study used a qualitative survey design to gain in-depth information on faculty staff experiences. Seventy-one faculty staff at two universities in the South East of England out of an eligible population of 115 staff responded to an anonymous online questionnaire which were thematically analysed.

Findings

The findings indicated that faculty staff faced uncertainties in providing support to students with mental health needs. They reported tensions between their academic, professional and pastoral roles. There was a wide recognition that supporting students was physically and emotionally demanding for faculty staff and especially challenging when their roles and expectations were unclear. This was compounded by lack of explicit guidelines and an apparent severed connection between faculty staff and student support services.

Practical implications

A need for clearly defined roles and responsibilities for faculty staff in supporting students with mental health needs including a review of their pastoral role were identified. The study reinforces the need for effective collaborative arrangements and collective decision making and clearer procedures in the planning and implementation of students' personal support plans. A concerted effort into adopting a transpersonal approach which incorporates mental health staff awareness training, restorative spaces for reflection and supportive pathways for faculty staff are recommended.

Originality/value

This paper provides rare empirical evidence of faculty staff views on their role in supporting students with mental health needs on health and social care programmes.

Towards school-based mental health programs in Nigeria: the immediate impact of a depression-literacy program among school-going adolescents and their teachers

BACKGROUND

Depression-literacy, which is the foundational requirement for symptom recognition, positive attitude and help-seeking, is poor among adolescents in Nigeria. This study, therefore, aims to determine the impact of a school-based training program on depression-literacy among a cohort of high-school students and their teachers in South-West Nigeria.

METHODS

An adapted version of the Break Free from Depression, a 4-module depression awareness curriculum for staff and students, was implemented among students and their teachers. Paired-sample T-test was used to assess the domain-specific (knowledge, attitude, and confidence) impact of the training by comparing the baseline and immediate (within the week of the training) post-scores.

RESULTS

A total of 3098 students and 294 teachers from 21 schools across three states in South-West Nigeria successfully completed the training. There was a significant positive difference (p < 0.05), at post-test, in the knowledge, attitude, and confidence among the students. The same was observed among teachers except for attitude where positive change did not reach significant level (p = 0.06). When statistically significant, the calculated effect size (eta squared) was highest for knowledge (students: 0.07, p = 0.001; teachers: 0.08, p < 0.000) and least for attitude (students: 0.003, p = 0.002 teachers: 0.085, p = 0.06). Multiple regression analyses result showed that the level of pre-scores predicted the magnitude of change in all domains of depression-literacy (p < 0.05) after controlling for age, gender, and type of school among the students, but not for teachers.

CONCLUSIONS

School-based depression-literacy programs can lead to significant positive change in knowledge, attitude, and confidence of students and teachers.

Impact of Bullying and Facts on Victims in Elementary Schools

Background: Bullying is a serious problem for the mental health development of school-age children. Few studies in Indonesia have reported how the impact of bullying causes children to experience stress and difficulty in building social relationships. Aim: This study aimed to determine the impact and phenomenon of becoming victims of bullying in elementary schools in Indonesia.  Methods: This research used a mixed-method approach with a sequential explanatory design. The sampling technique used multistage random sampling. The sample population included 617 elementary school students who are in grades 4, 5, and 6. The quantitative data analysis used structural equation modeling (SEM) while the qualitative data analysis was based on the results of SEM analysis. Results: The impact of bullying on victims is stressful and symptomatic. The victims revealed they became depressed, had poor performance, had difficulty in socializing, did not dare to report fear of being ostracized, feared they would become the next victim, and was advised by the teacher not to reply, be patient, and just let it go. As a result, the victims complained they felt ugly, ashamed among friends, and reluctant to attend the class. Teachers consider bullying as ordinary delinquency because the victim can recover without help, think it is normal, or it was just a joke so there is no need for special rules. Conclusion: Bullying of elementary school students has a negative impact on their mental health and causes psychosocial problems. There is a tendency to become repeated victims, while the ambivalence of teachers makes victims more vulnerable to bullying.

Examining the Preliminary Effectiveness and Acceptability of a Web-Based Training Program for Australian Secondary School Teachers: Pilot Study of the BEAM (Building Educators' Skills in Adolescent Mental Health) Program

BACKGROUND

Secondary schools are increasingly supporting adolescents' mental health and well-being, yet many teachers report that they lack the skills and confidence to do so. Building Educators' skills in Adolescent Mental Health (BEAM) is a web-based training program developed to improve secondary school teachers' knowledge and confidence in caring for students' mental health.

OBJECTIVE

This pilot study examined the preliminary effectiveness and acceptability of the BEAM program for improving mental health knowledge, attitudes, confidence, helping behaviors, and psychological distress among secondary school teachers.

METHODS

A single-arm pilot trial was conducted from July to December 2019 among secondary school teachers located in New South Wales, Australia, who were employed in leadership positions responsible for managing student well-being (ie, Year Advisors). Participants had access to the BEAM program for 6 weeks. Self-report surveys, delivered at baseline, postintervention (6-weeks post baseline) and 3-month follow-up (19 weeks post baseline) were used to measure changes in training outcomes. Acceptability was assessed by program use, barriers, satisfaction, and participants' perceptions of program effectiveness.

RESULTS

A total of 70 secondary school teachers took part (mean age 36.5 years, SD 9.41 years, range 24-60 years). Significant improvements in confidence were reported at postintervention and 3-month follow-up. Significant improvements in helping behaviors were reported at 3-month follow-up only. There was also a significant reduction in psychological distress at postintervention. Participants agreed that the program content was easy to understand and relevant, but program completion was challenged by lack of time, competing priorities, and forgetfulness.

CONCLUSIONS

Findings indicated that a web-based training program may be beneficial for improving secondary school teachers' abilities to care for students' mental health; however, program modifications are required to increase training completions.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619000821190, Universal Trial Number U1111-1232-7680; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377529.

The program evaluation of 'Go-To Educator Training' on educators' knowledge about and stigma toward mental illness in six Canadian provinces

AIM

Schools are well positioned to promote mental health literacy and assist in the early identification of students who may have a mental disorder. However, many educators are unprepared to effectively address these issues. Enhancing this capacity may improve mental health outcomes for students. This report describes the application of a gatekeeper-type program, the 'Go-To Educator Training' (GTET), targeting educators whom students naturally gravitate toward for support, designed to improve educators' mental health knowledge and early identification skills and decrease stigma.

METHODS

GTET was conducted in six Canadian provinces (Ontario, Nova Scotia, New Brunswick, Newfoundland, Alberta and Manitoba) (2012-2015), with 949 secondary school educators involved. Pre- and postintervention mental health knowledge and stigma surveys were completed. Paired t-tests assessed change in knowledge and stigma. ANCOVA compared knowledge and stigma change across subgroups. Correlation measured the relationship between knowledge and stigma.

RESULTS

Knowledge significantly improved (t[919] = 58.40, P < .001, d = 2.12) and stigma significantly decreased (t[872] = 4.52, P < .001, d = 0.14). Similar results were identified within each province/region. Knowledge and stigma were correlated before (N = 922, r = .18, P < .01) and after the training (N = 888, r = .22, P < .01).

CONCLUSIONS

These results suggest GTET may be an effective school-based mental health related intervention. Further study is needed to measure its long-term impact and its role in addressing youth mental health care referrals.

System Responsiveness to the Psychosocial and Mental Health Needs of Children in Ethiopian Primary Schools: The Case of Gondar City, Northwest Ethiopia Needs

Background: Ethiopia is the second most populous nation in Africa with children and adolescents constituting more than 40% of the population. Evidence shows the onset of significant degrees of mental illnesses is detectable in this age range. For such early identification to be made there should be a system responding to those needs. Objective: The objective of this study was to explore the extent to which the education system is responsive to the psychosocial and mental health needs of children in primary schools through putting appropriate professionals in place, raising teachers' awareness and putting in place viable policies and guidelines. Methods: An exploratory qualitative study was conducted in public and private primary schools in Gondar city Data was collected through focus group discussions from seventeen participants drawn from both schools and key informant interviews with two experts from the zonal Department of Education. A thematic qualitative data analysis was employed. Themes were identified with the help of the Nvivo 12 plus software. Results: We found teachers' mental health awareness is very low with parameters such as magnitude, case identification and support. There is an exception in terms of causal attributions of mental illness that matches with scientific literature. Psychosocial support and mental health resources are not available and schools do not provide capacity building mental health trainings for teachers which might help them to identify, handle and make referrals of mental health cases. We also found the Ethiopian education policy and other guidelines do not address the issue of mental health at primary school level. Conclusion: The Ethiopian education system is not responsive to the psychosocial and mental health needs of children in primary schools. Implications: Arresting minor impairments before they become major disabilities is vital. Investing in childhood mental health enables a healthy and productive society to be cultivated. The Ethiopian education system should therefore respond to the psychosocial and mental health needs of children in primary schools.

Educators' perceived mental health literacy and capacity to support students' mental health: associations with school-level characteristics and provision in England

Conceptual frameworks for school-based, preventive interventions recognise that educators’ capacity is, in part, dependent on school-level characteristics. This study aimed to (i) examine the factor structure and internal consistency of the Mental Health Literacy and Capacity Survey for Educators (MHLCSE); (ii) assess responses in relation to supporting students’ mental health; (iii) describe schools’ mental health provision in terms of designated roles, training offered, and perceived barriers; (iv) investigate variance in MHLCSE outcomes explained by schools; and, (v) explore school-level predictors of educators’ perceived MHL and capacity after controlling for individual-level characteristics. A multi-level, cross-sectional design involving 710 educators across 248 schools in England was used, and secondary analyses of baseline data collected as part of the Education for Wellbeing Programme were conducted. Mental health provision data was available for 206 schools, of which 95% offered training to some staff, and 71% had a designated mental health lead. Secondary schools offered significantly more training than primary schools. Significant barriers included lack of capacity in Child and Adolescent Mental Health Services (CAMHS) and within school, and communication challenges between agencies. The amount of training offered by schools significantly predicted educators’ awareness and knowledge of mental health issues, treatments and services, legislation and processes for supporting students’ mental health and comfort providing active support, with increased training predicting higher scores. However, little variance was explained by schools (1.7–12.1%) and school-level variables (0.7–1.2%). Results are discussed in relation to current mental health and education policy in England.

The Building Educators' Skills in Adolescent Mental Health Training Program for Secondary School Educators: Protocol for a Cluster Randomized Controlled Trial

Background

In Australia, secondary school educators are well positioned to recognize mental illness among students and provide support. However, many report that they lack the knowledge and confidence to do so, and few mental health training programs available for educators are evidence based. To address this gap, the Black Dog Institute (BDI) developed a web-based training program (Building Educators’ Skills in Adolescent Mental Health [BEAM]) that aims to improve mental health knowledge, confidence, and helping behaviors among secondary school educators in leadership positions. A pilot study of the training program found it to be positively associated with increased confidence and helping behaviors among educators and reduced personal psychological distress. An adequately powered randomized controlled trial (RCT) is needed.

Objective

The primary objective of this cluster RCT is to evaluate the effectiveness of the BEAM program for improving educators’ confidence in managing student mental health. The trial will also evaluate the effect of the BEAM program in increasing educators’ frequency of providing help to students and improving their mental health knowledge and reducing educators’ psychological distress and stigma toward students with mental health issues.

Methods

The target sample size is 234 educators from 47 secondary schools across New South Wales, Australia. Four waves of recruitment and enrollment into the trial are planned. Schools will participate in one wave only and will be randomized to the intervention or waitlist control conditions. Participants from the same school will be assigned to the same condition. Assessments will be conducted at baseline, posttest (10 weeks after baseline), and follow-up (22 weeks after baseline) using the BDI eHealth research platform. Intervention participants will receive access to the BEAM program for 10 weeks upon completion of baseline, and the control condition will receive access for 10 weeks upon completion of the follow-up assessment.

Results

Recruitment for this trial began on July 21, 2020, with the first baseline assessments occurring on August 17, 2020. To date, 295 participants from 71 schools have completed baseline. Due to the unexpected success of recruitment in the first 3 waves, the final fourth wave has been abandoned. Intervention participants are currently receiving the program, with follow-up due for completion in March 2021.

Conclusions

This is one of the first RCTs to examine the effectiveness of a web-based adolescent mental health training program for Australian secondary school educators in leadership positions. If found to be effective, this training program will offer a sustainable and scalable delivery method for upskilling educators in caring for students’ mental health.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12620000876998; https://covid-19.cochrane.org/studies/crs-14669208

International Registered Report Identifier (IRRID)

DERR1-10.2196/25870

Beliefs about students’ mental health issues among teachers at elementary and high schools, Hail Governorate, Saudi Arabia

Background

Teachers’ awareness about and attitude towards students’ with mental health issues are often affecting their practical role in proper care of students with mental health problems. This is a cross-sectional study carried out among teachers in elementary (primary and middle) and secondary schools in Hail Governorate, Kingdom of Saudi Arabia (KSA). The objective of the study was to assess teachers’ awareness about and attitude towards student’s mental health issues through a response to a pretested constructed, semi-structured, anonymous self-administered questionnaire included 38 items.

Results

Consenting teachers returned 2398 completed questionnaires with response rate of 60.0%. Majority of respondents possessed favorable attitudes towards students with mental health issues attained 74.7% attitude score on a scale of maximum 55 points but revealed less awareness with students’ mental health issues; they just attained 55.1% awareness score.

Teachers acknowledged the importance of providing training programs regarding mental health issues for teachers (73.7%) and for other school staff (76.2%), availability of psychologist in schools (81.1%), providing schools with educational materials regarding students’ mental health (78.1%), providing telephone hotline to support dealing with students’ with mental health issues (78.5%), and promoting general media to increase community awareness with mental health (84.4%).

Conclusion

The current study gives insight to policy makers about teachers’ awareness and attitude they have towards mental health issues in schools. Training programs in mental health appear to be crucial for teachers. Providing enough resources for schools to support their roles in mental health will advance healthy development in children.

Short-term fetal nutritional stress and long-term health: Child height

OBJECTIVE

This study examined the impact of in utero exposure to Ramadan, the Islamic fasting month, by trimester on height at ages 0 to 18 for a sample of children from Tehran, Iran. If exposure to Ramadan is associated with significant nutritional stress to the fetus, the fetus's adaptive responses to nutritional insufficiency could manifest as changes in height during childhood, long before any effects on aging or disease risk at older ages.

METHODS

Children who were exposed and not exposed to Ramadan in utero were compared to identify any systematic difference between their parents' and households' characteristics (including height, age, education, and indicators of wealth). Also, the seasonal pattern of food consumption in Tehran was analyzed. Finally, the association of child height with prenatal exposure to Ramadan was measured, controlling for seasonality and parent and household.

RESULTS

Ramadan associated fasting in the second trimester of gestation was associated with 0.091 age-adjusted SDs (ie, 0.60-0.67 cm) decrease in children's height at age 10 years or older. The negative association was largest in male children and was approximately 1 cm at age 12 years or older among male children.

CONCLUSION

Maternal Ramadan fasting in the second trimester, the critical period for long bone development, was associated with decreased height. Exposure to ritual fasting is important because approximately 75% of all Muslim children are exposed to Ramadan in utero.

A longitudinal cohort study to explore the relationship between depression, anxiety and academic performance among Emirati university students

BACKGROUND

Many university students experience depression and anxiety, both of which have been shown to affect cognitive function. However, the impact of these emotional difficulties on academic performance is unclear. This study aims to determine the prevalence of depression and anxiety in university students in United Arab Emirates (UAE). It further seeks to explore the relationship between emotional difficulties and students' academic performance.

METHODS

This longitudinal study recruited 404 students (aged 17-25 years) attending one UAE university (80.4% response rate). At baseline, participants completed a paper-based survey to assess socio-economic factors and academic performance, including most recent grade point average (GPA) and attendance warnings. PHQ-9 and GAD-7 scales were used to assess depressive and anxiety symptoms. At six-month follow-up, 134 participants (33.3%) provided details of their current GPA.

RESULTS

Over a third of students (34.2%; CIs 29.7-38.9%) screened for possible major depressive disorder (MDD; PHQ-9 ≥ 10) but less than a quarter (22.3%; CIs 18.2-26.3%) screened for possible generalized anxiety disorder (GAD; GAD-7 ≥ 10). The Possible MDD group had lower GPAs (p = 0.003) at baseline and were less satisfied with their studies (p = 0.015). The MDD group also had lower GPAs at follow-up (p = 0.035). The Possible GAD group had lower GPAs at baseline (p = 0.003) but did not differ at follow-up. The relationship between GAD group and GPA was moderated by gender with female students in the Possible GAD group having lower GPAs (p < 0.001) than females in the Non-GAD group. Male students in the Possible GAD group had non-significantly higher GPA scores. Higher levels of both depression and anxiety symptoms scores were associated with lower GPAs at baseline. PHQ-9 scores, but not GAD-7 scores, independently predicted lower GPA scores at follow-up (p = 0.006). This relationship was no longer statistically significant after controlling for baseline GPA (p < 0.09).

CONCLUSION

This study confirms previous findings that around a third of university students are likely to be experiencing a depressive disorder at any one time. Furthermore, it provides important evidence regarding the negative impacts of emotional difficulties on students' academic performance. The results support the need to consider the mental health of students who are struggling academically and highlight the importance of signposting those students to appropriate support, including evidence-based therapies.

The Hummingbird Project: A Positive Psychology Intervention for Secondary School Students

Mental health in schools has attracted a lot of attention in recent years. Positive Psychology Interventions (PPIs) in secondary schools have been shown to improve mental health outcomes for students. Previous PPIs have tended to be delivered by trained Psychology specialists or have tended to focus on a single aspect of Positive Psychology such as Mindfulness. The current study involved 2 phases. Phase 1 was a pilot PPI, delivered by current university students in Psychology, which educated secondary school students (N = 90) in a variety of Positive Psychology concepts. Phase 2 involved delivering the PPI to secondary school students (N = 1,054). This PPI, the Hummingbird Project, led to improvements in student well-being, as measured by the World Health Organization Well-Being Index (WHO-5). The intervention also led to improvements in student resilience, as measured by the Bolton Uni-Stride Scale (BUSS), and hope, as measured by the Children's Hope Scale (CHS). Results are discussed in the context of their implications for the future of psychological intervention in secondary school settings.

Pathways linking mental health literacy to professional help-seeking intentions in Korean college students

WHAT IS KNOWN ON THE SUBJECT?: People in their twenties, including college students, experience a high level of stress and prevalence of related mental health problems including depression, anxiety and alcohol addiction, but they are the least likely age group in Korea to utilize professional help for mental health issues. Mental health literacy (MHL) refers to the knowledge and abilities necessary for maintaining mental health and preventing mental health problems. MHL also plays an important role in help-seeking for mental health issues. Therefore, studying MHL and other variables related to help-seeking is likely to enhance our overall understanding of students' mental health. WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE?: Although there have been some studies of college students' MHL in Korea, this is the first study to identify the paths and relationships between MHL and help-seeking intentions in Korean college students. Additionally, this study examined the mediating role of stigma in the relationship between MHL and attitudes toward help-seeking. The findings of this study suggest that MHL promotion can have a positive impact on the mental health of Korean college students by improving their attitudes toward help-seeking and increasing their help-seeking intentions. This study supports the idea that increased social support among Korean college students may reduce stigma and facilitate their seeking of professional help. The paths and relationships found in the present study provide evidence that a nursing intervention on-campus that improves students' MHL and reduces stigma may facilitate more effective use of help-seeking services among college students. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: MHL plays a significant role in how college students manage their mental health and the likelihood that they will seek professional help for mental health issues. Increasing MHL reduces mental health-related stigma and promotes positive attitudes toward help-seeking. A mental health nursing intervention that includes MHL improvement strategies would likely enhance students' utilization of mental health services on campus. Although students' MHL is improved by existing campus programmes and educational efforts to raise awareness of mental health, interventions should also address campus culture and stigma to facilitate mental health help-seeking. Ultimately, enhancing MHL will contribute to the prevention of mental health problems and protect the deterioration of mental health among college students. ABSTRACT: Introduction There is a high prevalence of mental health problems among college students in Korea. Although the usage rate for mental health services among Korean college students was not reported, it is known that the usage rate for Koreans is low compared to that in the United States. Aim To explore the relationships linking mental health literacy (MHL) to intentions of help-seeking in a sample of Korean college students. Method Using a cross-sectional study, data from 200 participants were analysed using a structural equation modelling approach. Results Mental health literacy had both direct and indirect effects on attitudes toward help-seeking and an indirect effect on attitudes toward help-seeking through stigma. The direct effect of MHL on attitudes toward help-seeking was fully mediated by stigma. Discussion Mental health nursing professionals have a responsibility and a challenge to enhance MHL in college students through individual or group interventions. Implications for practice MHL plays a significant role in individuals' willingness to seek professional help when in need of mental health care. Thus, mental health nursing interventions that include MHL improvement strategies would favourably enhance students' use of adequate sources of care and contribute to the prevention of mental health problems in college students.

Mental health and cultural and linguistic diversity as challenges in school? An interview study on the implications for students and teachers

Mental health and cultural and linguistic diversity in classrooms are part of students’ lives. Both factors can lower the achievements of students and classrooms and pose a challenge for teachers. Yet, little is known about the effects on other areas of school life besides achievements. Also, the consequences for classmates and teachers as well as possible resources are mostly disregarded. Semi-structured interviews were held to investigate the diverse effects of mental health issues and cultural and linguistic diversity on students, classmates and teachers. In total 20 interviews were conducted, seven with teachers, seven with external professionals and six with students. Recordings were transcribed and analysed using qualitative text analysis. Results show that especially externalizing symptoms of mental health issues are a burden to classmates and teachers. Teachers face time management problems and emotional stress. Linguistic diversity constitutes a serious challenge at school for students, classmates and teachers. Yet, cultural and linguistic diversity also imports several resources like fostering openness and integration. Future research should expand this research to older children and investigate the specific needs of teachers.

MENTAL HEALTH IN KENYAN SCHOOLS: TEACHERS' PERSPECTIVES

INTRODUCTION

This qualitative study, conducted in public primary and secondary schools, sought teachers' perceptions of mental health concerns that are relevant in school settings. Based on the phenomenological theory, the study aimed to understand the teachers experiences of mental health problems in the schools and how they handled them.

METHOD

The schools sampled represented rural, suburban and urban sections of Kiambu County in Kenya. Data were collected through Focus Group Discussions (FGDs). The researcher made summary notes from both audio taped interviews and notes made by the research assistants and summarized the major themes.

RESULTS

Teachers reported that they were aware that students suffered from mental health problems. They recognized learning difficulties, externalizing problems, internalizing problems, bizarre behavior, and problem substance use among students. Teachers reported that lack of skills and time were challenges in dealing with student mental health problems.

CONCLUSION

Teachers perceive presence of mental health problems among the students. There is need for in- service training for identification and referral and that school psychologists be employed to deal with student mental health problems.

Teacher Mental Health Literacy is Associated with Student Literacy in the Adolescent Depression Awareness Program

The Adolescent Depression Awareness Program, developed by psychiatrists and psychiatric nurses at the Johns Hopkins University School of Medicine, is a depression literacy program delivered to high school students by teachers. This mode of delivery represents an effective and sustainable way to increase awareness of mental health, reduce stigma, improve early detection, and facilitate help-seeking behavior among adolescents. The present study explores the depression literacy and stigma of teachers and their students. Survey responses of 66 teachers and 6679 high school students about depression literacy and stigma pre- and post-education intervention were analyzed using a multilevel model fit in Mplus. Teacher depression literacy was significantly associated with student depression literacy [β = 0.199, SE = 0.095, p = 0.035, 95% CI (0.044, 0.355)] at the post-assessment, but was not associated with student stigma. Teacher stigma was not significantly related to student depression literacy or stigma in the post-assessment. These findings highlight the importance of optimizing teacher depression literacy in order to maximize student depression literacy while also diminishing concerns about the transmission of stigmatized beliefs from teachers to students.

"EspaiJove.net"- a school-based intervention programme to promote mental health and eradicate stigma in the adolescent population: study protocol for a cluster randomised controlled trial

BACKGROUND

One half of adults who develop any mental disorder do so during adolescence. Previous literature showed that Mental Health Literacy (MHL) interventions impact mental health knowledge, reduce the associated stigma, and promote help-seeking among the adolescent population. However, evidence for the effectiveness and cost-effectiveness of these programmes remains inconclusive. The aim of this paper is to present a study protocol that evaluates the effectiveness of the " EspaiJove.net " programme. " EspaiJove.net " consists of a universal MHL intervention designed to promote mental health knowledge, increase help-seeking, reduce the stigma associated with mental illness, and prevent mental disorders in Spanish school settings.

METHODS

A school-based clustered randomised controlled trial (cRCT) design with 12 months of follow-up.

SUBJECTS

At least 408 secondary school students who attend the 3rd year of E.S.O (Compulsory secondary education for 13- to 14-year- olds) will be recruited from 8 schools within Barcelona city, Catalonia (Spain).

INTERVENTION

A dose-response intervention will be delivered with 4 arms: 1) Sensitivity Programme (SP) in Mental Health (1 h); 2) Mental Health Literacy (MHL) Programme (6 h); 3) MHL plus first-person Stigma Reduction (MHL + SR) (7 h); 4) Control group: waiting list. Primary outcomes: 1) MHL: EspaiJove.net MHL Test (EMHLT); 2) Stigma: Reported and Intended Behaviour Scale (RIBS) and Community Attitudes toward the Mentally Ill (CAMI). Others outcomes: 1) Acceptability of intervention; 2) Mental health symptoms and emotional well-being (SDQ); 3) States of Change Scale (SCS); 4) Bullying and Cyberbullying; 5) Quality of life (EQ-5D); 6) Help seeking and use of treatment; 7) Health benefits.

DISCUSSION

Results would be informative for efforts to prevent mental disorders and promote mental wellbeing in secondary school students.

TRIAL REGISTRATION

NCT03215654 (date registration July 12, 2017).

World Health Organization "School Mental Health Manual"-based training for school teachers in Urban Lahore, Pakistan: study protocol for a randomized controlled trial

Background

The teacher’s role in school mental health initiatives cannot be overemphasized. Despite global evidence of educational interventions in improving teachers’ knowledge and attitudes regarding mental health, this area remains under researched in Pakistan. This paper presents a study protocol of a pilot randomized controlled trial to examine the effectiveness of a teacher training intervention for improving mental health literacy and self-efficacy among school teachers in urban Lahore, Pakistan.

Methods

The randomized controlled trial will follow the CONSORT guidelines. Participants will be allocated to the Intervention group (receiving the World Health Organization, Eastern Mediterranean Region (WHO-EMRO) School Mental Health Manual-based intervention in three 6-h, face-to-face sessions) or a waitlist control group (not receiving training during the study period). Participants will be teachers of private schools with similar broad demographic characteristics in an inner city area of Lahore. The primary outcome measures for the trial is teachers’ mental health literacy. It will be assessed by using the previously applied (during WHO training of Master Trainers) self-administered questionnaire in both groups pre and post training and at 3 months’ follow-up. Secondary outcomes include: for teachers: Teachers’ self-efficacy (assessed by the Teachers’ Sense of Self Efficacy Scale (TSES) short form.); for students (11–16 years): socio-emotional skills and psychological problems measured by the Strengths and Difficulties Questionnaire (assessed at baseline and 3 months post intervention); for schools: the WHO School Psychosocial Profile Questionnaire (baseline and 3 months post intervention).

Discussion

Given the high prevalence of child mental health problems, stigma and lack of services, it is important to consider alternate avenues for promoting positive mental health among youth. This pilot study should establish the effectiveness of the WHO-EMRO School Mental Health Manual-based Intervention improving teacher’s mental health literacy and helping them to learn practical steps that can be implemented at low cost in school settings. It will also provide information regarding intervention implementation and sustainability.

Trial registration

ClinicalTrials.gov, ID: NCT02937714. Registered on 18 October 2016.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2679-3) contains supplementary material, which is available to authorized users.

Adolescent and Young Adult Male Mental Health: Transforming System Failures Into Proactive Models of Engagement

Adolescent and young adult men do poorly on indicators of mental health evidenced by elevated rates of suicide, conduct disorder, substance use, and interpersonal violence relative to their female peers. Data on global health burden clearly demonstrate that young men have a markedly distinct health risk profile from young women, underscoring different prevention and intervention needs. Evidence indicates that boys disconnect from health-care services during adolescence, marking the beginning of a progression of health-care disengagement and associated barriers to care, including presenting to services differently, experiencing an inadequate or poorly attuned clinical response, and needing to overcome pervasive societal attitudes and self-stigma to access available services. This review synthesizes key themes related to mental ill health in adolescent boys and in young adult men. Key social determinants are discussed, including mental health literacy, self-stigma and shame, masculinity, nosology and diagnosis, and service acceptability. A call is made for focused development of policy, theory, and evaluation of targeted interventions for this population, including gender-synchronized service model reform and training of staff, including the e-health domain. Such progress is expected to yield significant social and economic benefits, including reduction to mental ill health and interpersonal violence displayed by adolescent boys and young adult men.

A Mental Health Training Format for Adult Education Teachers

The present study investigated the needs of adult education staff pertaining to adult students’ mental health issues within a local school board. The study utilized mixed-methods design and was divided into progression of three separate studies. An initial focus group was conducted to identify the 12 participants’ concerns and provide a direction for the needs assessment survey that was administered to the entire population of adult education teachers in the board. Two 2-hr workshops were designed for the 114 members of the staff based on the needs identified by the surveys. An evaluation of the workshops indicated that the workshops were valuable and further training was desired. By educating teachers about students who are learning in the context of mental health challenges, we will be able to provide them with the necessary tools to do their jobs more successfully and comfortably.

Focus Groups Investigating Mental Health Attitudes and Beliefs of Parents and Teachers in South Lebanon: Are They Culturally Determined?

Introduction: The wars that Lebanon had endured led to a devastating number of deaths, injuries, and displacements. Such tragedies have detrimentally affected its civilians psychologically. Purpose: To identify knowledge, attitudes, and practices of teachers and parents concerning child/adolescent mental health. Method: Using purposeful sampling, five focus groups were conducted with teachers and parents of students from elementary, middle, and secondary levels in two private hub schools in South Lebanon. Results: A total of 27 teachers and 18 parents participated separately in focus groups. Three themes emerged: (a) Mental health care is a priority for overall health, (b) Mental illness is a cultural taboo, and (c) There is a need for better education and cultural understanding about mental health. Discussion: This is the first study in Lebanon directly targeted at parents’ and teachers’ mental health concerns. Such findings will add to transcultural nursing knowledge about the importance of mental health care.

The impact of a student's suicide: Teachers' perspectives

BACKGROUND

The impact of suicide of adolescents is devastating, yet little is known about the distressing impact for teachers. The aim of this study therefore is to explore the impact student suicide on teachers' personal and professional lives.

METHODS

A cross-sectional anonymous online survey of primary and secondary school teachers was conducted in Australia. The Impact of Event Scale - Revised, questions about personal and professional impact, help seeking, perceived needs and experiences after student's suicide were included in the analysis.

RESULTS

In total, 229 teachers commenced the questionnaire, with 138 (60.3%) completing the full questionnaire. Questions about exposure to students' suicide were completed by 145 teachers (63.3%). In total, 35.9% (n=52) were exposed to at least the suicide of one student (two or more: 54.8%). The most recent suicide of a student had (some or great) impact on the personal life of 76% of teachers and on the professional life of 85.7%. Impact on personal life was significantly higher for female teachers. The most frequent source for help seeking was family or partner (65.3%); use of professional help was also reported, with the school counsellor being the most frequent (30.6%). Following the most recent suicide of a student, 27.1% of teachers exposed to suicide felt that they needed more support.

LIMITATIONS

The potential for selection bias through the use of an online survey, and the relatively small sample.

CONCLUSION

The study showed high levels of distress among teachers after exposure to a student's suicide and greater need for help than that obtained.

Creating Inclusive School Environments

The neurobehavioural comorbidities associated with childhood epilepsy present significant physical challenges (i.e., excessive fatigue, memory impairment, headaches, visual impairments), emotional challenges (i.e., depression, anxiety), behavioural challenges (i.e., inattentiveness, distractibility, aggression), and social challenges (i.e., peer rejection, bullying, stigma) to children. Poor functioning within these domains can negatively affect academic success and school adjustment. As schools play a significant role in a child’s development, understanding how to support the social, psychological, and physical needs of these children is important. This article reviews literature examining the neurobehavioural comorbidities associated with childhood epilepsy and the barriers these conditions create to academic success and school adjustment. The article also provides recommendations based on the authors’ qualitative research about how best to support these children. Findings suggest that educating school communities about epilepsy and the challenges associated with it might promote inclusive school environments and mitigate negative school experiences. Findings also emphasize the need for an allied approach to the provision of support to ensure the needs of both students and faculty are met.

When Ideals Get in the Way of Self-Care

In the current study, we investigated whether adolescents high in perfectionism are prone to experiencing self-stigma for seeking psychological help. This work is based on the premise that the need to seek help for psychological difficulties is not consistent with idealistic personal goals of perfectionistic young people and their desire to retain an idealistic self-image. A sample of 85 high school students completed the Child and Adolescent Perfectionism Scale, the Self-Stigma of Seeking Help Scale, and a measure of contact with individuals with mental illness. Results indicated that perfectionism was associated with self-stigma among those students with little to no experience with people with a history of mental illness. These findings suggest that certain perfectionistic students have a propensity toward low self-acceptance and judge themselves negatively for needing help. Implications are discussed for prevention and intervention programs that emphasize contact and experiential opportunities with individuals who have mental illness.

Innovations in Practice: Grow2Grow - engaging hard-to-reach adolescents through combined mental health and vocational support outside the clinic setting

BACKGROUND

Based on an organic farm and education centre, Grow2Grow offers young people with complex mental health needs both clinical mental health support and vocational opportunities.

METHODS

Change in functioning (CGAS), vocational outcomes and client satisfaction were assessed for all young people completing Grow2Grow placements between June 2010 and July 2014.

RESULTS

Twenty-one young people completed Grow2Grow placements, achieving increased CGAS scores (p < .001) and reporting high levels of satisfaction with the project. Eighty-one per cent achieved educational and/or employment outcomes.

CONCLUSION

This innovative approach to working with hard-to-reach young people is achieving high levels of engagement and positive vocational and mental health outcomes.

Mental health literacy in secondary schools: a Canadian approach

"Mental health literacy is an integral component of health literacy and has been gaining increasing attention as an important focus globally for mental health interventions. In Canada, youth mental health is increasingly recognized as a key national health concern and has received more focused attention than ever before within our health system. This article outlines 2 unique homegrown initiatives to address youth mental health literacy within Canadian secondary schools."