Mental Health Promotion in School: An Integrated, School-Based, Whole School

About 20% of schoolchildren across different cultures experience mental health problems, such as conduct problems, anxiety, and depression, during the course of any given year and may need the use of mental health services (WHO, 2013).The most recent report by the Centre for Disease Control and Prevention (2013) shows that the prevalence of mental health difficulties amongst children and young people in the USA has been increasing in the last 25 years, and related services are costing the country about US$247 billion year. A report on adolescent health just published by WHO (WHO, 2014) portrays depression as the top global cause of illness and disability amongst adolescents, with suicide being the third biggest cause of death. The report mentions that half of mental health difficulties begin before the age of 14, underlining the need for early intervention and mental health promotion from an early age. Mental health and well-being are the result of the biological, psychological, and social systems in the child’s world, and the interaction of these influences shape the developmental trajectory of the child (Cooper, Bilton, & Kakos, 2011). Within such a biopsychosocial approach, systems such as the family, community, and school have a crucial role in providing contexts and tools which actively prevent or minimize the development of mental health problems on one hand, and promote the healthy social and emotional development of children and young people on the other (Guerra & Bradshaw, 2008; Furlong et al., 2011). The onset of social, emotional, and behaviour difficulties at an early age is a predictor of mental health difficulties in adolescence (Fergusson, Horwood, & Ridder, 2005; WHO, 2013), underlining the need for early identification and consequent early intervention at a time when children’s personality is still developing and before difficulties become more serious and entrenched (Domitrovich, Cortes, & Greenberg, 2007; McLaughlin & Clarke, 2010). Schools are thus ideally placed to operate as health-promoting contexts for children, having access to all children, from an early age and over an extended period of time, and possessing expertise and resources in health promotion (Greenberg, Domitrovich, & Bumbarger, 2001). This chapter will first discuss the role of schools as contexts for mental health promotion, arguing that schools need to broaden their agenda to focus on both the cognitive and affective development of children and young people. It will then propose an evidence-based, multilevel, and school-based approach to mental health promotion, focusing on health promotion, prevention, and targeted interventions involving the whole school community in collaboration with the parents, the local community, and external support services. The final section presents a number of recommendations for the application of the model in actual practice.