Learning Together for Mental Health: Rapid systematic review of reviews of school-level interventions to promote mental health and wellbeing.

Abstract

Background: The high prevalence of mental health disorders among adolescents point to the need for interventions that prevent or minimise harms from these. Schools are the ideal setting for such interventions, given almost all children can be reached. We adapted a whole-school health intervention to target mental health. As part of this research, we aimed to provide schools with a report on mental health needs among their students and a menu of evidence-based actions that schools could take to address these needs. Given the multiple existing systematic reviews in this area, the actions to be included in the menu were informed by a rapid systematic review of reviews.

Aims: To identify effective school-level or simple interventions to address student needs across various domains of mental health in secondary schools or an equivalent phase, which have been identified in existing systematic reviews.

Methods: We undertook a rapid systematic review of reviews. In January 2022, we searched three databases [PubMed, PsycInfo^® (American Psychological Association, Washington, DC, USA) and Cochrane Library] for systematic reviews of mental health interventions in the domains of: antisocial behaviour, anxiety, body image, depressive symptoms, digital health, eating problems, emotional issues, general well-being, lesbian, gay, bisexual, trans, questioning and other (LGBTQ+) inclusion, mental health first aid, physical activity for mental health, positive mental health, self-harm, student voice and substance use. Eligible for inclusion were systematic reviews of randomised trials or quasi-experimental studies evaluating school-based interventions among secondary school- or equivalent-aged children. We retrieved 95 reviews, of which 41 were eligible for the present review. We defined effective intervention strategies as those identified as being effective in an eligible study in any review.

Results: We identified a number of effective school-level or simple school interventions for addressing mental health in the above domains. Nine intervention focus areas were identified: (1) positive mental health and promotion of healthy development (five intervention strategies identified); (2) mental health literacy and awareness (six strategies); (3) LGBTQ+ mental health (two strategies); (4) mental health first aid (one strategy); (5) peer mentoring (two strategies); (6) support for transition from primary to secondary school (one strategy); (7) body image and body confidence (one strategy); (8) creative arts activities (one strategy); (9) physical activity (seven strategies) and (10) increasing access to nature (one strategy). Altogether, 27 strategies were identified.

Conclusions and limitations: This rapid review identified 27 evidence-based school-level strategies that were used to inform the development of a menu of evidence-based whole-school actions, which were simple and inexpensive to implement in schools. This menu was piloted in a feasibility study, the results of which are reported elsewhere. Our findings were limited by a lack of quality assessment and single screening of abstracts.

Future work: If Learning Together for Mental Health is demonstrated as feasible to implement and acceptable to teachers and students, a phase III cluster randomised trial will be conducted to evaluate the effectiveness of the intervention.

Funding: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR131594.