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Scoping review: Potential harm from school-based group mental health interventions
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Abstract
A growing body of evidence demonstrates that school-based mental health interventions have negative outcomes in at least some young people and thus are potentially harmful for these individuals. In this scoping review, we map out the empirical evidence relating to this phenomenon. We review three specific areas: the types of potential harms reported in school-based mental health interventions; the subgroups of children and adolescents at heightened risk of experiencing potential harm from school-based interventions; and the proposed explanations for these potential harms.
... Beyond the university context, there is some scepticism surrounding the usefulness of these sorts of awareness efforts (Arie, 2017;Foulkes & Stringaris, 2023). A growing body of empirical research indicates that teaching young people about mental health leads some individuals to report more, not fewer, symptoms (Foulkes & Stringaris, 2023;Guzman Holst et al., 2024), and that the delivery of public health campaigns more broadly can have unintended negative effects (Bonell et al., 2015). The 'prevalence inflation hypothesis' (Foulkes & Andrews, 2023) posits that awareness efforts may be "an additional factor contributing to the recent rise in mental health problems" by serving to increase reporting through improving recognition (Najman et al., 2021), and also through over-interpretation of psychological distress symptoms (Conrad & Slodden, 2013;Haslam et al., 2020) which cyclically increases the effort and funding put into awareness efforts (Foulkes & Andrews, 2023). ...
... In future research, it would be valuable to examine opinions in students with varying levels of mental health problems, from those who report no difficulties to those who have clinically significant symptoms and/or a clinical diagnosis, given that university-wide awareness efforts are, by design, delivered to the whole student population regardless of need. Given suggestions within the literature that universal mental health interventions might have iatrogenic effects to those already experiencing symptoms, it would be pertinent to investigate the effect of these efforts upon those that are already vulnerable (Foulkes & Stringaris, 2023;Guzman Holst et al., 2024;Montero-Marin et al., 2022). ...
Mental health problems are common amongst UK undergraduate students. In response, many universities have put considerable effort into raising awareness about student mental health problems and avenues of support, for example via workshops, posters, email newsletters and social media posts. Nonetheless, reported rates of mental health problems in students have continued to rise. Despite the ubiquity of awareness efforts, there has been limited research assessing students’ attitudes towards and experience of these initiatives. To address this, in this study, N=15 undergraduate students (aged 18 to 24) from thirteen UK universities were interviewed in depth to explore their attitudes towards the mental health awareness efforts of their respective universities. Using reflexive thematic analysis, three themes were generated: (1) University life directly contradicts university mental health awareness efforts; (2) University mental health awareness efforts are perceived as disingenuous and inadequate; and (3) Students don't want awareness – they want accessible help and supportive communities. These themes highlight the frustration students feel towards what they see as misguided efforts from their universities, and the structural problems at university that make living a mentally healthy life difficult. Simultaneously, the findings highlight the elements of mental health support that students value. The findings of this study have important implications for the designing and implementing of universities’ efforts to improve and support student mental health, while also adding constructively to the wider societal conversation critiquing the impact of mental health awareness efforts.
... This included an increase in internalising symptoms, a decrease in prosocial behaviour and a decrease in parental relationship quality. Around half of these negative outcomes were found within subgroup analyses: for example, being younger, experiencing deprivation or having mental health problems at baseline were all associated with worse outcomes (Guzman Holst et al., 2024). ...
There is an urgent need to improve mental health outcomes among young people. One approach taken to address this problem has been the design and delivery of universal school‐based prevention, based on therapeutic models such as CBT and mindfulness. Such interventions are delivered to groups of young people, irrespective of risk or need. However, in this commentary, we argue that the initial appeal of universal interventions has not been supported by the evidence: universal school‐based prevention is less effective than targeted approaches, often leads to null or unsustained positive effects, has the potential to elicit negative effects and is not well liked by young people themselves. In addition, many young people in each classroom already meet the criteria for a mental disorder, meaning that prevention approaches may not be appropriate or effective for this group. In this commentary, we respond to Birrell et al.'s (2025) paper by arguing that the field should move away from universal prevention and instead invest our limited resources in the refinement and dissemination of interventions with a stronger evidence base, such as one‐to‐one, targeted and indirect approaches.
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