Are school-based mental health programs working as hoped?
Summary:
Analysis of 83,000 youth across 22 countries suggests current mental health programs in schools may benefit some students more than others.
The mental health of young Canadians continues to be a pressing concern. Trends mapped by the Canadian Institute for Health Information show that one in five people are diagnosed with a mental illness by age 25, 70 per cent of whom had symptoms before adulthood.
As schools play a role in supporting student mental health, many offer programs to all students, known as “universal” initiatives. A new study led by researchers at The Hospital for Sick Children (SickKids) combed through evidence to gauge how effective they’ve been.
Published in JAACAP Open, their review found that current universal school-based programs had modest effects, with benefits mostly seen among students already experiencing symptoms such as anxiety and depression.
Here, Dr. Daphne Korczak, Senior Scientist in Neurosciences & Mental Health and SickKids Staff Psychiatrist reflects on what they discovered and what we can take away from it, along with first author and Research Associate, Dr. Kimberley Tsujimoto.
Inside the study
Why was this analysis so important to undertake?
Daphne Korczak (DK): As the demand for youth mental health services has increased, there has been rising interest in providing mental health programming in community settings. Schools have emerged as a place of considerable interest for universal programs, and we’ve also seen an increase in the types of mental health curricula that schools have been incorporating.
We wanted to understand whether these programs were effective and, if so, which types of programs and for which students. Our hope was to be able to provide guidance for educators interested in implementing mental health curricula or programs, to help them select the format and target the age or grade most likely to be beneficial for their students.
Kimberley Tsujimoto (KT): Most evaluations have focused up to now on what are called “internalizing symptoms,” emotional distress that is experienced inward, like feelings of sadness, depression or anxiety. Few have examined effects on mental health problems that manifest as “externalizing behaviours,” or symptoms that are observed more outwardly, such as aggression and impulsivity — which are growing in incidence in schools.
What trends are you seeing as it relates to mental health among young Canadians?
DK: We are seeing worsening trends that predated the pandemic but seem accelerated by it. Back in 2022, our study showed that more than two in three Canadian kids reported declining mental health during COVID as compared to before the pandemic, and that these levels have persisted in the years since. Our findings are also consistent with those of other Canadian researchers, who have found that Ontario students have increasingly experienced moderate to serious psychological distress over the last two decades.
KT: When we have more than one in three students rating their own mental health as “fair” or “poor,” there’s an urgent need to support them and help schools find ways to improve their outcomes as well.
DK: For us as scientists, that also means obtaining as accurate a picture as possible. Our approach allowed us to evaluate the type of programs being offered, who was leading them, and information about the students receiving them — such as their grade, sex and mental health symptoms.
What are the most important takeaways?
DK: Overall, we found that universal school-based mental health programs have modest benefits for internalizing symptoms and didn’t show clear benefits for externalizing behaviours. Programs were more likely to be helpful if they were grounded in cognitive behavioural therapy (CBT), if they were delivered by mental health professionals (versus teachers), and for children with higher internalizing symptoms before the program started.
KT: Right now, current programs appear to be best suited for students who are experiencing higher levels of sadness or worry, or who are already starting to experience internalizing symptoms, rather than for all students.
What do the findings mean for schools and families?
KT: Supporting the mental health of young students is essential but different programs may need different goals. Most programs we found use clinically-informed frameworks for significant symptoms, making them ideal for targeted intervention for specific people. While they are still beneficial for kids without such symptoms, these might be best continued as "tier-2" or specialized programs.
DK: Our study suggests that we need to think a bit more carefully about what might be helpful — and what classroom teachers can deliver — with respect to mental health promotion for all students. For example, it may be helpful to evaluate programs that increase mental health literacy, encourage protective factors like school engagement, or address risk factors such as screen use or learning difficulties as ways to support overall mental health and well-being.
Other programs, like those we reviewed, may be better targeted to students who’ve started to experience symptoms. What’s needed may be a combination of these approaches within schools, so students can access what is most relevant to them.
KT: For parents, we know how important these programs can be, delivered at no cost in an environment their children know well. Our study shows that school-based initiatives can make a difference in supporting kids’ mental health, but that their implementation may need to be re-imagined to reflect the diverse needs of all students. Some of this is already happening, as we came across examples of unique programs, and there may be much to learn from them as we move forward.
