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    Nov 2008
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    IWK Health Centre · Psychiatry
    Halifax, Canada
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    Objective: This study evaluated the effectiveness of a school-based mental health literacy intervention for adolescents on knowledge and stigma. Method: A total of 24 high schools and 534 students in the regional area of Ottawa, Ontario, Canada participated in this randomized controlled trial. Schools were randomly assigned to either the curriculum or control condition. The curriculum was integrated into the province's grade 11 and 12 "Healthy Living" courses and was delivered by teachers. Changes in mental health knowledge and stigma were measured using pre- and posttest questionnaires. Descriptive analyses were conducted to provide sample characteristics, and multilevel modeling was used to examine study outcomes. Results: For the curriculum condition, there was a significant change in stigma scores over time (p = .001), with positive attitudes toward mental illness increasing from pre to post. There was also a significant change in knowledge scores over time (p < .001), with knowledge scores increasing from pre to post. No significant changes in knowledge or stigma were found for participants in the control condition. A meaningful relationship was found whereby increases in knowledge significantly predicted increases in positive attitudes toward mental health (p < .001). Conclusion: This is the first large randomized controlled trial to demonstrate the effectiveness in mental health literacy of an integrated, manualized mental health educational resource for high school students on knowledge and stigma. Findings also support the applicability by teachers and suggest the potential for broad-based implementation of the educational curriculum in high schools. Replication and further studies are warranted. Clinical trial registration information-Impact of a Mental Health Curriculum for High School Students on Knowledge and Stigma; http://clinicaltrials.gov/; NCT02561780.
    Addressing youth mental health in secondary schools has received greater attention globally in the past decade. It is essential that educators, mental health experts, researchers, and other related service providers understand the most current research findings to inform policy making, and identify priority areas for the development of future interventions and research strategies. This review describes literature during the past year on school-based mental health programs addressing mental health promotion, prevention, early identification and intervention/treatment. In contrast to the abundance of school-based mental health programs, the evidence of program effectiveness, safety and cost-effectiveness in this area is somewhat insufficient, mostly due to the lack of rigorous research designs, the heterogeneity of school environments, and the complexities of interventions that require multisector collaboration. Although the opportunity in school mental health is substantial, much yet needs to be done to develop and evaluate interventions that can be proven to be effective, safe and cost-effective. Mental health literacy may be an appropriate start that will help to set the foundation for mental health promotion, prevention and intervention.
    Background Enhancement of mental health literacy for youth is a focus of increasing interest for mental health professionals and educators alike. Schools are an ideal site for addressing mental health literacy in young people. Currently, there is limited evidence regarding the impact of curriculum-based interventions within high school settings. We examined the effect of a high-school mental health curriculum (The Guide) in enhancing mental health literacy in Canadian schools.Methods We conducted a secondary analysis on surveys of students who participated in a classroom mental health course taught by their usual teachers. Evaluation of students¿ mental health literacy (knowledge/attitudes) was completed before and after classroom implementation and at 2-month follow-up. We used paired-samples t-tests and Cohen¿s d value to determine the significance and impact of change.ResultsThere were 265 students who completed all surveys. Students¿ knowledge significantly improved between pre- and post-tests (p¿<¿0.001; d¿=¿0.90) and was maintained at follow-up (p¿<¿0.001; d¿=¿0.73). Similarly, attitude significantly improved between pre- and post-tests (p¿<¿0.001; d¿=¿0.25) and was significantly higher at follow-up than base-line (p¿<¿0.007; d¿=¿0.18)Conclusions The Guide, applied by usual teachers in usual classroom curriculum, may help improve student knowledge and attitudes regarding mental health. This is the first study to demonstrate the positive impact of a curriculum-based mental health literacy program in a Canadian high school population.
    Objective: To investigate whether the significant and substantive findings from a previous study of youth mental health literacy (MHL) could be replicated using the same methods in another population. Method: We examined the impact of a curriculum resource, the Mental Health and High School Curriculum Guide (The Guide), taught by usual classroom teachers on students’ knowledge and attitudes related to mental health and mental illness in Canadian secondary schools. Survey data were collected before, immediately after, and 2 months after implementation of The Guide by teachers in usual classroom teaching. We conducted paired-sample t tests and calculated the Cohen d value to determine outcomes and impact of the curriculum resource application. Results: One hundred fourteen students were matched for analysis of knowledge data and 112 students were matched for analysis of attitude data at pre-intervention, post-intervention, and 2-month follow-up time periods. Following classroom exposure to the curriculum resource, students’ knowledge scores increased significantly and substantively, compared with baseline (P < 0.001, d = 1.11), and this was maintained at 2-month follow-up (P < 0.001, d = 0.91). Similar findings for attitude improvement were found (P < 0.001, d = 0.66), and this improvement was maintained at 2-month follow-up (P < 0.001, d = 0.52). Conclusions: These findings corroborate those from a previous study conducted in a different location. Taken together these results suggest a simple but effective approach to improving MHL in young people by embedding a classroom resource, delivered by usual classroom teachers in usual school settings.
    Background: This is a report on the outcomes of a training program for community clinic healthcare providers in identification, diagnosis, and treatment of adolescent Depression in Tanzania using a training cascade model. Methods: Lead trainers adapted a Canadian certified adolescent Depression program for use in Tanzania to train clinic healthcare providers in the identification, diagnosis, and treatment of Depression in young people. As part of this training program, the knowledge, attitudes, and a number of other outcomes pertaining to healthcare providers and healthcare practice were assessed. Results: The program significantly, substantially, and sustainably improved provider knowledge and confidence. Further, healthcare providers' personal help-seeking efficacy also significantly increased as well as the clinicians' reported number of adolescent patients identified, diagnosed, and treated for Depression. Conclusion: To our knowledge, this is the first study reporting positive outcomes of a training program addressing adolescent Depression in Tanzanian community clinics. These results suggest that the application of this training cascade approach may be a feasible model for developing the capacity of healthcare providers to address youth Depression in a low-income, low-resource setting.
    Aims Stigma of mental illness is a significant barrier to receiving mental health care. However, measurement tools evaluating stigma of mental illness have not been systematically assessed for their quality. We conducted a systematic review to critically appraise the methodological quality of studies assessing psychometrics of stigma measurement tools and determined the level of evidence of overall quality of psychometric properties of included tools. Methods We searched PubMed, PsycINFO, EMBASE, CINAHL, the Cochrane Library and ERIC databases for eligible studies. We conducted risk-of-bias analysis with the Consensus-based Standards for the Selection of Health Measurement Instruments checklist, rating studies as excellent, good, fair or poor. We further rated the level of evidence of the overall quality of psychometric properties, combining the study quality and quality of each psychometric property, as: strong, moderate, limited, conflicting or unknown. Results We identified 117 studies evaluating psychometric properties of 101 tools. The quality of specific studies varied, with ratings of: excellent ( n = 5); good (mostly on internal consistency ( n = 67)); fair (mostly on structural validity, n = 89 and construct validity, n = 85); and poor (mostly on internal consistency, n = 36). The overall quality of psychometric properties also varied from: strong (mostly content validity, n = 3), moderate (mostly internal consistency, n = 55), limited (mostly structural validity, n = 55 and construct validity, n = 46), conflicting (mostly test–retest reliability, n = 9) and unknown (mostly internal consistency, n = 36). Conclusions We identified 12 tools demonstrating limited evidence or above for (+, ++, +++) all their properties, 69 tools reaching these levels of evidence for some of their properties, and 20 tools that did not meet the minimum level of evidence for all of their properties. We note that further research on stigma tool development is needed to ensure appropriate application.
    Background: Mental health literacy is important to improve help-seeking behaviors. However, the quality of mental health help-seeking tools remains unknown. Aims: We conducted a systematic review to appraise the quality of such tools. Methods: We searched databases for English publications addressing psychometrics of help-seeking tools. We included help-seeking tools addressing mental health in general and tools on four mental disorders: anxiety, depression, attention deficit hyperactivity disorder (ADHD) and schizophrenia. We determined the methodological quality of studies as “excellent”, “good”, “fair”, or “indeterminate”. We ranked the level of evidence of each measurement property as “strong”, “moderate”, “limited”, “conflicting” or “unknown”. Results: We found 12 help-seeking tools in 24 studies that assessed related psychometrics. The methodological quality of included studies ranged from “poor” to “excellent” with four studies on the content validity, structural validity or internal consistency demonstrating “excellent” quality. Three tools demonstrated overall strong evidence (content or structural validity); eight tools demonstrated moderate evidence (internal consistency, structural or construct validity); and eight tools demonstrated limited evidence (reliability, construct validity or internal consistency). Conclusions: We recommend the application of tools with strong or moderate evidence for their psychometric properties. Future research may focus on the generalizability of the tools across diverse settings.
    All around the world, partnerships among schools and other youth-serving systems are promoting more comprehensive school-based mental health services. This article describes the development of international networks for school mental health (SMH) including the International Alliance for Child and Adolescent Mental Health and Schools (INTERCAMHS) and the more recent School Mental Health International Leadership Exchange (SMHILE). In conjunction with World Conferences on Mental Health Promotion, SMHILE has held pre-conference and planning meetings and has identified five critical themes for the advancement of global SMH: 1) Cross-sector collaboration in building systems of care; 2) meaningful youth and family engagement; 3) workforce development and mental health literacy; 4) implementation of evidence-based practices; and 5) ongoing monitoring and quality assurance. In this article we provide general background on SMH in four nations, two showing strong progress (the United States and Canada), one showing moderate progress (Norway), and one beginning the work (Liberia). Following general background for each country, actions in relation to the SMHILE themes are reviewed. The article concludes with plans and ideas for future global collaboration towards advancement of the SMH field.
    little research is available. Schools are an ideal location in which to address mental health literacy. A Canadian school-based mental health literacy resource was adapted for application in sub-Saharan Africa called the African Guide (AG). The AG is a classroom ready curriculum resource addressing all aspects of mental health literacy. Herein we provide teacher reported activity impacts and MHL outcomes from the implementation of the AG in Tanzania. Following training, survey data addressing teacher reported AG impact and MHL outcomes was collected at three time points over a one year period. Over a period of one year, 32 teachers from 29 different schools reported that over: 4,600 students were taught MHL; 150 peer teachers were trained on the AG; 390 students approached teachers with a mental health concern; 450 students were referred to previously trained community care providers for diagnosis and treatment of Depression; and most students were considered to have demonstrated improved or very much improved knowledge, attitudes and help-seeking efficacy, with similar outcomes reported for teachers. Results of this study demonstrate a substantial positive impact on MHL related activities and outcomes for both students and teachers using the AG resource in Tanzania. Taken together with previously published research on enhancing MHL in both Malawi and Tanzania, if replicated in another setting, these results will provide additional support for the scale up of this intervention across sub-Saharan Africa.
    Mental health literacy is fundamental to improving knowledge about mental health, decreasing stigma, and, therefore, enhancing help-seeking behaviors. The purpose of this cohort study is to evaluate the impact of a mental health literacy program on preservice teachers’ knowledge, attitudes, and help-seeking efficacy. Sixty preservice teachers in a Canadian university participated in a professional development day and completed a survey of their mental health knowledge, attitudes toward mental illness, and help-seeking efficacy. Compared with baseline data, results demonstrated significant and substantial improvements on all three outcomes immediately following the session and after 3 months. Provision of mental health literacy education among preservice teachers may be an effective approach to help them better address student mental health needs in their future teaching career.
    Mental health literacy (MHL) encompasses four components: understanding how to obtain and maintain good mental health, understanding mental illness and treatment, reducing stigma, and promoting help-seeking efficacy. MHL is foundational to mental health promotion, early identification/prevention and intervention.We have created a "School Friendly" MHL intervention, Mental Health and High School Curriculum Guide (the Guide), for secondary school students and teachers, designed to be embedded into the existing school curriculum. A number of cross-sectional studies and a randomized-controlled trial were undertaken to investigate its impact on knowledge, attitudes, and help-seeking efficacy among students (grades 9 and 10) and teachers in Canadian schools and other international educational jurisdictions. We also obtained feedback from educators who taught the Guide with regards to the content, lesson plans, and format of the Guide for its future revisions.All studies showed significant improvements of knowledge and attitudes among both students and teachers, as well as enhanced help-seeking efficacy among students as a result of delivering the Guide embedded into the school curriculum. Further, the impact of these changes was sustained at three-month follow-up. Teacher feedback demonstrated that they enjoyed teaching the Guide and they considered it to be a better approach to addressing youth mental health compared to other school-based interventions.The Guide may be a "School Friendly" approach to improving both student and teacher MHL, and building the foundation needed for improving mental health outcomes for young people.
    Background: Mental health literacy (MHL) is foundational for mental health promotion, prevention, stigma reduction, and care; School supported information pertaining to MHL in sub-Saharan Africa is extremely limited, including in Tanzania. Successful application of a school MHL curriculum resource may be an effective way to increase teacher MHL and therefore help to improve mental health outcomes for students. Methods: Secondary school teachers in Tanzania were trained on the African Guide (AG) a school MHL curriculum resource culturally adapted from a Canadian MHL resource (The Guide) for use in Africa. Teacher training workshops on the classroom application of the AG were used to evaluate its impact on mental health literacy in a sample of Tanzanian Secondary school teachers. Pre-post training assessment of participant knowledge and attitudes was conducted. Help-seeking efficacy for teachers themselves and their interventions for students, friends, family members and peers were determined. Results: Paired t test (n = 37) results demonstrate highly significant improvements in teacher's overall knowledge (p < 0.001; d = 1.14), including mental health knowledge, (p < 0.001; d = 1.14) and curriculum specific knowledge (p < 0.01; d = 0.63). Teachers' stigma against mental illness decreased significantly following the training (p < 0.001; d = 0.61). Independent t tests comparing the paired sample against unpaired sample also demonstrated significant differences between the groups for teacher's overall knowledge (p < 0.001). Teachers also reported high rates (greater than ¾ of the sample) of positive help-seeking efficacy for themselves as well as for their students, friends, family members and peers. As a result of the training, the number of students teachers identified for potential mental health care totaled over 200. Conclusions: These positive results, when taken together with other research, suggest that the use of a classroom-based resource (the AG) that integrates MHL into existing school curriculum through training teachers may be an effective and sustainable way to increase the MHL (improved knowledge, decreased stigma and positive help-seeking efficacy) of teachers in Tanzania. As this study replicated the results of a previous intervention in Malawi, consideration could be given to scaling up this intervention in both countries and applying this resource and approach in other countries in East Africa.
    Background Mental health literacy has received great attention recently to improve mental health knowledge, decrease stigma and enhance help-seeking behaviors. We conducted a systematic review to critically appraise the qualities of studies evaluating the measurement properties of mental health knowledge tools and the quality of included measurement properties. Methods We searched PubMed, PsycINFO, EMBASE, CINAHL, the Cochrane Library, and ERIC for studies addressing psychometrics of mental health knowledge tools and published in English. We applied the COSMIN checklist to assess the methodological quality of each study as “excellent”, “good”, “fair”, or “indeterminate”. We ranked the level of evidence of the overall quality of each measurement property across studies as “strong”, “moderate”, “limited”, “conflicting”, or “unknown”. Results We identified 16 mental health knowledge tools in 17 studies, addressing reliability, validity, responsiveness or measurement errors. The methodological quality of included studies ranged from “poor” to “excellent” including 6 studies addressing the content validity, internal consistency or structural validity demonstrating “excellent” quality. We found strong evidence of the content validity or internal consistency of 6 tools; moderate evidence of the internal consistency, the content validity or the reliability of 8 tools; and limited evidence of the reliability, the structural validity, the criterion validity, or the construct validity of 12 tools. Conclusions Both the methodological qualities of included studies and the overall evidence of measurement properties are mixed. Based on the current evidence, we recommend that researchers consider using tools with measurement properties of strong or moderate evidence that also reached the threshold for positive ratings according to COSMIN checklist.
    Suicide in young people is a significant health concern, with numerous community- and school-based interventions promising to prevent suicide currently being applied across Canada. Before widespread application of any one of these, it is essential to determine its effectiveness and safety. We systematically reviewed the global literature on one of the most common community suicide prevention interventions in Canada and summarized data on 2 commonly applied school-based suicide prevention programmes. None of these has demonstrated effectiveness in preventing youth suicide or safety in application. Concurrently with their widespread distribution in Canada, the suicide rate in young women has increased—the first time in over 3 decades. Policy and regulatory implications of these findings are discussed.
    Background: Mental health literacy has received increasing attention as a useful strategy to promote early identification of mental disorders, reduce stigma and enhance help-seeking behaviors. However, despite the abundance of research on mental health literacy interventions, there is the absence of evaluations of current available mental health literacy measures and related psychometrics. We conducted a scoping review to bridge the gap. Methods: We searched PubMed, PsycINFO, Embase, CINAHL, Cochrane Library, and ERIC for relevant studies. We only focused on quantitative studies and English publications, however, we didn't limit study participants, locations, or publication dates. We excluded non-English studies, and did not check the grey literature (non peer-reviewed publications or documents of any type) and therefore may have missed some eligible measures. Results: We located 401 studies that include 69 knowledge measures (14 validated), 111 stigma measures (65 validated), and 35 help-seeking related measures (10 validated). Knowledge measures mainly investigated the ability of illness identification, and factual knowledge of mental disorders such as terminology, etiology, diagnosis, prognosis, and consequences. Stigma measures include those focused on stigma against mental illness or the mentally ill; self-stigma ; experienced stigma; and stigma against mental health treatment and help-seeking. Help-seeking measures included those of help-seeking attitudes, intentions to seek help, and actual help-seeking behaviors. Conclusions: Our review provides a compendium of available mental health literacy measures to facilitate applying existing measures or developing new measures. It also provides a solid database for future research on systematically assessing the quality of the included measures.
    Objectives: The transition from high school to college or university is an important time to enhance mental health literacy for young people. This study evaluated the second edition of a resource entitled Transitions, a comprehensive life-skills resource with embedded mental health information available in book, e-book and iPhone app formats for post-secondary students. Design: In this cross-sectional/one-off study, students' opinions about the impact of the resource were gained through in-person and online surveying. Methods: The survey took place on a local university campus in Canada. Frequencies of responses and sex differences in answers were analysed using Predictive Analytics Software (PASW) 17. In total, 82 students from a large, Canadian research university completed the survey. Results: Reading Transitions (2nd edition) improved student knowledge about and decreased stigma towards mental health and mental illness and increased help-seeking efficacy. There were sex differences in response regarding discussion of the resource with others and help-seeking intentions. Conclusion: Given the positive results of this study conducted at a single university, the resource could potentially be valuable in other post-secondary settings as well.
    Introduction: Youth suicide is highly related to mental disorders. While communities and schools are marketed to with a plethora of suicide prevention programs, they often lack the capacity to choose evidence-based programs. Methods: We conducted a systematic review of two youth suicide prevention programs to help determine if the quality of evidence available justifies their wide spread dissemination. We searched Medline, PsycINFO, EMBASE, CINAHL, the Cochrane Library, Campbell Collaboration SPECTR database, SocIndex, Sociological Abstracts, Social Services Abstracts, ERIC, Social Work Abstracts, Research Library, and Web of Science, for relevant studies. We included studies/systematic reviews/meta-analysis that evaluated the effectiveness, cost-effectiveness, and/or safety of Signs of Suicide (SOS) and Yellow Ribbon (YR) suicide prevention programs that target adolescents. We applied the Office of Justice Program What Works Repository (OJP-R) to evaluate the quality of the included studies as effective, effective with reservation, promising, inconclusive evidence, insufficient evidence, and ineffective. Two SOS studies were ranked as “inconclusive evidence” based on the OJP-R. One SOS study was ranked as having “insufficient evidence” on OJP-R. The YR study was ranked as “ineffective” using OJP-R. We only included studies in peer-reviewed journals in English and therefore may have missed reports in grey literature or non-English publications. Results: We cannot recommend that schools and communities implement either the SOS or YR suicide prevention programs. Purchasers of these programs should be aware that there is no evidence that their use prevents suicide. Conclusions: Academics and organizations should not overstate the positive impacts of suicide prevention interventions when the evidence is lacking.
    "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." Copyright © 2015 Elsevier Inc. All rights reserved.
    Background The adolescent years (here, ages 12 to 24) are a critical period for the onset of mental disorders, when approximately 70% of all lifetime mental disorders can be diagnosed (O'Connell, Boat, Warner, et al., 2009; Kessler, Berglund, Demler, Jin, Merikangas, & Walters, 2005). Mental health problems or mental disorders, if unrecognized and untreated, can lead to substantial negative personal, social, and civil consequences, including school drop-out/incompletion (Breslau, Miller, Joanie Chung, & Schweitzer, 2011; Kessler, Foster, Saunders, & Stang, 1995), poor social relationships (Bhatia, 2007; Shochet, Dadds, Ham, & Montague, 2006), less robust vocational success, justice system contact, early mortality (including suicide), and a high burden of disability (O'Connell et al., 2009; World Health Organization, 2004). While severe mental disorders (such as psychosis) do onset in adolescence (American Psychiatric Association, 2013) most, especially emotional/mood disturbances, are mild or moderate in intensity (Kessler et al. 2012). Substantial evidence for successful treatment of mental disorders in young people exists and positive outcomes may be enhanced if evidence-based treatment is provided early in the course of illness (Rutter et al., 2008). Thus, early identification and early effective interventions, support, and ongoing care for youth developing a mental disorder is needed. This may not only advance positive treatment outcomes, but also may help facilitate healthy psychosocial development (Kutcher, 2011; Waddell, Offord, Shepherd, Hua, & McEwan, 2002). Since most youth attend school, schools are an obvious venue through which to address their health and mental health needs. Promoting physical health and applying public health interventions, such as vaccinations, in schools has long been supported by international organizations, such as the World Health Organization (WHO), United Nations Educational, Scientific, and Cultural Organization (UNESCO), and United Nations International Children's Emergency Fund (UNICEF) (WHO Regional Office for Europe, 1996). More recently, school mental health has received international attention.
    The realisation that most mental disorders have their onset before the age of twenty-five has focused psychiatric research towards adolescent mental health. This book provides vivid examples of school mental health innovations from eighteen countries, addressing mental health promotion and interventions. These initiatives and innovations enable readers from different regions and disciplines to apply strategies to help students achieve and maintain mental health, enhance their learning outcomes and access services, worldwide. Through case studies of existing programs, such as the integrated system of care approach in the USA, the school-based pathway to care framework in Canada, the therapeutic school consultation approach in Turkey and the REACH model in Singapore, it highlights challenges and solutions to building initiatives, even when resources are scarce. This will be essential reading for educators, health providers, policy makers, researchers and other stakeholders engaged in helping students achieve mental health and enhance their learning outcomes.
    Adolescence is a time of significant development across all dimensions – physical, cognitive, emotional, behavioral, and social. It is also a time of significant vulnerability to life stress; negative family, peer, and neighborhood influences; and the development of mental illness, with around one in five youth showing signs of notable emotional/behavioral impairment (see Merikangas et al., 2010; Romero et al., 2014; Strang, Pruessner, & Pollack, 2011; Weist, Ginsburg, & Shafer, 1999). The school mental health (SMH) field is growing around the world (Kutcher & McLuckie, 2013; President's New Freedom Commission, 2003; Rowling & Weist, 2004; Wei & Kutcher, 2012; Weist & McDaniel, 2013; Weist, Lever, Bradshaw, & Owens, 2014), related to fundamental recognition that: (1) children, adolescents, and families usually make no or very poor connections to specialty mental health (Atkins et al., 1998; Catron, Harris, & Weiss, 1998); (2) schools are where children and youth are; and (3) many advantages accrue when education, mental health, and other youth-serving systems join together to better meet the mental health needs of students, in ways that reflect reducing and removing barriers to learning (Andis et al., 2002; Weist, 1997). National and global networks are increasingly recognizing the centrality of the SMH agenda as reflected in increasing funding, growing training opportunities, key policy initiatives, and an advancing research base that involves localities, states, regions, and countries pursuing common themes. Sadly, in some countries this agenda is receiving increased support through school shootings and the concomitant recognition of students' need for mental health services and missed opportunities for early identification and intervention (United States White House, 2013). A critically important agenda, and reflecting the public health approach (see Blau, Huang, & Mallery, 2010) is to develop a full continuum of effective promotion, prevention, early intervention, and treatment for adolescents in schools, and for this agenda to consider unique cultural, socioeconomic, and governmental factors as reflected in differences across nations. That is the purpose of this book, which we hope will spur advancements in research, practice, and policy in SMH for adolescents around the world.
    Emerging themes This rich and varied compilation of descriptions of school mental health (SMH) interventions in 18 different countries around the world raises numerous issues for our consideration, now and in the future. It is clear that SMH, which up until recently has been largely limited in its scope and development to North America, Europe, and Australia/New Zealand, is rapidly expanding and the complexities of SMH conceptualization and applications that globalization brings are considerable. It is one thing, for example, to apply theoretically sophisticated SMH approaches in settings of relative wealth and socio-political stability; it is quite another to do so in settings of severe or absolute poverty and civil unrest. It is one thing to apply SMH approaches in settings where basic literacy and numeracy are well established, and quite another to do so where these are not. It is one thing to apply SMH approaches in settings where basic health and human rights conditions are reasonable, and quite another to do so where these are not. We have much to learn from how SMH is applied in non-Western settings and those lessons should inform us everywhere (Wei and Kutcher, 2012). This monograph has provided us with a glimpse of the depth and breadth of SMH initiatives globally. As such, it is, to our knowledge, the first such compilation. And, a number of themes have clearly emerged. First, it is clear that in some jurisdictions, sophisticated frameworks have been developed to help guide the integration of schools with mental healthcare provision, as well as to address a variety of in-school mental health domains – such as mental health literacy and mental health promotion, prevention, and intervention. For example, in the United States (systems of care approach), Turkey (therapeutic school consultation), Canada (school-based integrated pathway to care approach), and Singapore (the REACH program approach), the roles of schools in enhancing access to mental healthcare delivery, integrated with existing health system structures and functions, demonstrates how SMH can be applied to this purpose. Such models may become useful templates, not in terms of the specific structures that they have identified, but in the conceptual approaches that they provide.
    The necessity for development of mental health literacy in youth is gaining global attention with various approaches being considered worldwide. Our team in the province of Nova Scotia, Canada, has addressed this need through school curriculum embedded within usual grade nine-classroom education taught by usual, albeit trained, teachers using the Mental Health and High School Curriculum Guide. In this study, we evaluated the impact on the mental health literacy of 228 teachers who were learning how to implement the Guide in their classrooms by participating in a one-day training session, using a paired samples t test and Cohen’s effect size (d). The analysis demonstrated significant (p=0.001) and substantial (d=i.85 and d=0.5) improvements in both domains. These results are consistent with and replicate a previous study on the Guide demonstrating that an approach directed toward assisting teachers in their use of an educational resource may be a viable and easily implemented option for jurisdictions that are looking to improve mental health literacy in their schools.
    Objective: The objective of this project was to investigate the online behaviors of adolescent and adult populations with respect to mental health information seeking, and identify differences in approaches within age groups and geographical location. Method: This content analysis approach identified and mapped patterns in online conversations. The search data was able to quantify who was looking for teen mental health information, where they were looking, and what they were looking for. Additional analysis included the preferred format of information presentation and how mental health searches varied over time. Results: The results of the analysis revealed that between 2006 (baseline) to 2010, a 200% increase in online activity regarding mental health was identified. Adults were most likely to ignite (initiate) conversations online about depression, followed by: anxiety, doctors, suicide, treatments, and OCD. For teens, depression was also the most ignited topic area, followed by: anxiety, alcohol, suicide, sexting and marijuana. While adults were often seeking information about the disorders and treatment options, teens tended to discuss concerns through the use of personal stories. Conclusion: This research provides insight into how digital and social media can be used to engage both youth and adult discussions about mental health. We report substantive audience driven differences that can inform the development of targeted mental health knowledge translation methods and activities. A broader understanding of the key mental health topics of interest was garnered, in addition to how online use varied between audiences. These results have several implications for mental health knowledge translation including tactics to connect with various stakeholders.
    Background Educators can play an important role in early identification and triage of youth with mental disorders. This paper reports findings of a program evaluation of the ‘Go-To’ Educator Training in a secondary school setting. Methods Pre- and posttests were administered. ResultsParticipant mean scores on mental health competencies changed from 12 (40%) (standard deviation [SD] = 4.3) pretraining to 21 (70%) (SD = 3.3) posttraining, t(119) = 25.6, p < .0001, d = 2.3. Participant attitude mean scores improved from 49.9 (SD = 4.6) pretraining, to 51.5 (SD = 4.2), t(115) = 4.3, p < .0001, d = 0.36. Conclusions This training is a useful intervention to help educators identify youth with mental disorders and link them to appropriate services.
    Mental disorders make up close to one-third of the global burden of disease experienced during adolescence. Schools can play an important role in the promotion of positive mental health as well as an integral role in the pathways into mental health care for adolescents. In order for schools to effectively address the mental health problems of their students, educators must improve their mental health literacy. The current study examines the impact of an educator training programme designed to support educators in the delivery of a high school mental health curriculum within their classrooms, such as health class. Specifically, a paired-samples t test was used to examine the change in educators' knowledge and attitudes regarding mental health following their participation in this educator training. Eighty-three educators participated in the training, and survey data from 79 were included in the final analysis. Structured feedback on the training was obtained. Significant increases in both knowledge and attitudes scores were demonstrated. The training sessions were highly rated. Findings from this report demonstrate the potential value of mental health literacy training to improve the mental health knowledge and attitudes of educators. Improved educator knowledge and attitudes may be necessary in order for schools to provide effective mental health promotion and prevention programming.
    Most mental disorders often onset during the adolescent years, providing opportunities for educators, health care providers, and related stakeholders to work collaboratively in addressing adolescent mental health care needs. This report describes early implementations of various components of the School-Based Pathway to Care Model currently applied in Canada, identifies lessons learned, and suggests future directions. The School-Based Pathway to Care Model engages students, teachers, student service providers, parents/families, health care providers, and the wider community through various training programs and both formal and informal linkages between the school, community, and health providers. Preliminary evaluation of the model in whole and in part shows promising outcomes for its application in secondary schools within the wider framework of enhancing system capacity for addressing mental health needs of students. Future focus should be directed towards more rigorous research on the model and its various components.
    Aim: Conduct a systematic review for the effectiveness of school mental health literacy programs to enhance knowledge, reduce stigmatizing attitudes and improve help-seeking behaviours among youth (12-25 years of age). Methods: Reviewers independently searched PubMed, PsycINFO, Cochrane Library, CINAHL, ERIC, grey literature and reference lists of included studies. They reached a consensus on the included studies, and rated the risk of bias of each study. Studies that reported three outcomes: knowledge acquisition, stigmatizing attitudes and help-seeking behaviours; and were randomized controlled trials (RCTs), cluster RCTs, quasi-experimental studies, and controlled-before-and-after studies, were eligible. Results: This review resulted in 27 articles including 5 RCTs, 13 quasi-experimental studies, and 9 controlled-before-and-after studies. Whereas most included studies claimed school-based mental health literacy programs improve knowledge, attitudes and help-seeking behaviour, 17 studies met criteria for high risk of bias, 10 studies for moderate risk of bias, and no studies for low risk of bias. Common limitations included the lack of randomization, control for confounding factors, validated measures and report on attrition in most studies. The overall quality of the evidence for knowledge and help-seeking behaviour outcomes was very low, and low for the attitude outcome. Conclusions: Research into school-based mental health literacy is still in its infancy and there is insufficient evidence to claim for positive impact of school mental health literacy programs on knowledge improvement, attitudinal change or help-seeking behaviour. Future research should focus on methods to appropriately determine the evidence of effectiveness on school-based mental health literacy programs, considering the values of both RCTs and other research designs in this approach. Educators should consider the strengths and weaknesses of current mental health literacy programs to inform decisions regarding possible implementation.
    School mental health programs from developed countries demonstrate that both the practice and research are becoming more important to policy makers, educators, health providers, parents, and other stakeholders. Some United Nations agencies and other international organizations have begun work to advance school mental health internationally. School-based mental health programming needs to be considered as part of usual child and youth mental health policies and plans, whether those are national or other jurisdictional in nature. Currently, a paucity of evidence-based and cost effective child and youth global mental health policies/programs exist, limiting school-based mental health programs being developed, implemented, or sustained.
    Adolescence is a critical period for the promotion of mental health and the treatment of mental disorders. Schools are well-positioned to address adolescent mental health. This paper describes a school mental health model, “School-Based Pathway to Care,” for Canadian secondary schools that links schools with primary care providers and mental health services, enabling them to address youth mental health in a collaborative manner. The model highlights the fundamental role of mental health literacy, gatekeeper training, and education/health system integration in improving adolescent mental health, and enhancing learning environments and academic outcomes.
    The purpose of this paper is to provide a summary of evidence for the effectiveness and safety of commonly used crisis interventions in schools, such as critical incident stress debriefing (CISD), critical incident stress management (CISM), and psychological debriefing (PD). Two researchers independently searched relevant databases for reviews and meta-analyses in English language peer-reviewed journals using identified keywords. The database search was supplemented by hand searches of the reference lists of database-identified reviews. Selected reviews were compared and analyzed for the effectiveness of CISD/CISM/PD interventions. Research findings suggest that these interventions are ineffective and may be harmful. Evidence of effectiveness of CISD/CISM/PD interventions in schools is very limited. Given evidence of ineffectiveness and potential harm of CISD/CISM/PD interventions in adults and limited evidence of these interventions in schools, there is no compelling reason to implement CISD/CISM/PD following crisis events in schools. KeywordsCritical incident stress debriefing (CISD)-Critical incident stress management (CISM)-Psychological debriefing-Crisis intervention-School
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