Examining the Evidence about School-Based Mental Health Interventions

Isn’t heightened awareness always a good thing? Isn’t education always a good thing? More specifically, isn’t it logical to assume that training in emotion management is beneficial for all children and youth? Several writers (e.g. Barry, 2024) have questioned these assumptions, especially critiquing school-based interventions that heighten young people’s awareness of depression and anxiety, causing them to interpret mild ups and downs as symptoms of mental disorder. British psychologist Lucy Foulkes and Australian psychologist Jack Andrews proposed a “prevalence inflation hypothesis” which asserts that heightening awareness of mental disorders can lead to recognition (a beneficial outcome—if it results in treatment that is needed) or overinterpretation of everyday distress (a negative outcome, wherein labeling oneself as anxious or depressed can produce a sense of powerlessness over the disorder) (Foulkes & Andrews, 2023). Youth who perceive their distressful symptoms as a biological disorder may not perceive they can attain control and may engage in maladaptive catastrophizing or ruminating (Ahuvia et al., 2024).

The mental health of youth across the globe is surely a serious concern, as evidenced by statistics on anxiety, depression, and suicidality. Rates of anxiety and depression have doubled worldwide since the pandemic (Barry, 2024). Today’s youth are being termed more “emotionally fragile” than previous generations (e.g. Shpancer, 2023). Pundits propose etiologies such as the pandemic’s disruption of school connectedness; school-related violence (aggression, shootings); societal violence (including terrorism and war); smartphone and social media addiction; and despair over climate change. Causes of emotional distress are undoubtedly multifactorial and will not be further explored here. What we will examine are some of the interventions that are being implemented to promote youth mental health, and the efficacy of these interventions. Schools are a logical site to reach children through psychoeducational programs that can be delivered by their teachers or counselors.

According to Barry (2024), recent studies are finding “lackluster or negative effects” for school-based psychoeducational programs. For example, an Australian study (Andrews er al., in press) evaluated the effectiveness of a school-based prevention program for depression and anxiety involving 19 treatment schools (cognitive behavior therapy eHealth program) and 18 control schools. Students’ knowledge of mental health improved, but depression and anxiety did not. A study in the UK on mindfulness followed 28,000 adolescents over 8 years to evaluate the effectiveness of school-based mindfulness training in reducing the risk of mental health problems and increasing student well-being (Kuyken et al., 2022). The researchers found no support for the hypothesis that mindfulness training improved mental health, and students at highest risk for mental health problems fared worse after training. The researchers speculated that mindfulness fostered the teens sitting with dark feelings without providing solutions. Foulkes (cited in Barry, 2024) pointed out that mindfulness training is unlikely to help youth who struggle with issues such as poverty, bullying, or violence in their homes.

Researchers have devoted considerable attention to “social and emotional learning” (SEL) training programs taking place in grades 1–12 in schools across the globe. Social and emotional learning (SEL) includes activities that promote students’ emotional intelligence and positive peer relationships. Although specific psychoeducational content varies, SEL emphasizes strategies for self-management, problem-solving, and non-aggressive conflict resolution. Teachers (rather than outsiders) most often deliver the lessons and conduct the classroom activities. SEL is commonly based on theories such as Social Cognitive Theory, Mindfulness-Based Stress Reduction, and Cognitive Behavior Therapy (Cipriano et al., 2023).

Cipriano et al. (2023) conducted a massive meta-analysis of 424 studies reflecting 252 different SEL interventions in 53 countries, with 575,361 students ranging in age from 5–17 years. Learning sessions ranged from an average of 43.88 min in grades K–5, to 51.06 min in grades 6–8, and 55.83 min in grades 9–12. The number of sessions ranged from 6 to 180. Readers are encouraged to access the full report, which is quite detailed, but the findings generally supported SEL’s effectiveness in promoting improved student attitudes/behaviors and peer relationships, and in decreasing their emotional distress. The students’ sense of safety and belonging in their school also improved. The researchers found that teaching intrapersonal emotion skills before teaching social skills was most effective.

Cipriano and colleagues acknowledged limitations of their meta-analysis (i.e. SEL is not a homogeneous construct; assessment of intervention fidelity was often lacking; measurement of constructs varied widely; and inadequate attention has been paid to culturally sensitive teaching and learning practices). Future research on SEL must address these limitations and more carefully delineate the optimal number and length of sessions for students at each developmental level. Involving families and communities in SEL to a greater extent would be desirable, as the majority of studies included in the Cipriano meta-analysis had no community engagement component.

Based on the impressive results of this meta-analysis, however, the evidence supports fostering the social-emotional health of children and adolescents with school-based SEL programming. Zachary Blumkin, a child psychologist at Columbia University (cited in Barry, 2024), pointed out that “Especially with teens, we need more universal interventions, not less.” Many youths in both developed and less-developed countries lack access to psychiatric care, unless a severe crisis lands them in a hospital emergency room.

You can add your voice to the ongoing discussion of school-based mental health interventions. Empirical, theoretical, and clinical manuscripts are invited!

Sandra P. Thomas, PhD, RN, FAAN,
College of Nursing, University of Tennessee, Knoxville, Knoxville, Tennessee, USA
[email protected]