A framework for national-level prevention initiatives in Indian schools: A risk reduction approach

India's mental health policies predominantly prioritize treatment and rehabilitation. While acknowledging the significance of youth well-being, the initiatives undertaken are fragmented, lacking comprehensive data on reach and utilization. Mounting evidence supports the preventability of mental illnesses, highlighting the cost-effectiveness of prevention initiatives, particularly within school-based programs. This paper aims to delineate a preventive framework centered on schools, employing the six-step OrigAMI (Origins of Adult Mental Illnesses) model. This model targets modifiable risk factors to stop the development of mental illnesses. Each step of this model is dissected and examined within the context of the school environment, elucidating the unique and influential role that educational institutions can undertake in preventive initiatives in India. In the initial step, the paper identifies modifiable risk factors in children and adolescents that can be addressed within the school environment. The second and third steps involve pinpointing the target demographic and utilizing data from comprehensive reviews of mental health initiatives. The fourth and fifth steps delineate the workforce structure, advocating for task shifting to non-specialists, engaging school stakeholders and parents, and establishing a systematic workforce framework. The final step delves into policy implications, exploring the potential to reduce the prevalence of mental illness by focusing on risk factors with a high Population Attributable Fraction. This section also contrasts the proposed approach in terms of expenditure against the current budget allocations. The paper culminates with a recommendation to integrate these preventive programs into existing healthcare policies, positioning schools as central to these prevention efforts. The integration of prevention programs into healthcare policies aims to reduce prevalence rates and alleviate the burden on the healthcare system.