School mental health in India: The present scenario and future directions’

Introduction

India is home to one-fifth of the world’s adolescents and is confronting a pressing need to address the challenge of mental health problems among school-going children. With the increasing prevalence of anxiety, depression, substance use, and behavioral disorders in children, school-based mental health programs (SBMHPs) have become instrumental to primary prevention and early intervention.

Objective

This article aims to review the national and state-level school-based mental health initiatives in India, with a focus on their theoretical frameworks, and thematic categorization, along with identifying barriers in implementation, and providing actionable recommendations for the future.

Methods

A comprehensive literature search following the PRISMA guidelines was undertaken to ensure a structured approach. Given the broad scope of “school mental health programs in India,” we aimed to perform a scoping review of both academic and grey literature. Sources that described, reviewed, or evaluated a school-based mental health initiative in India were included in the review, ultimately relying on 150 sources.

Discussion

Various theoretical models exist, like Bronfenbrenner’s ecosystem theory, Maslow’s need hierarchy, the health promotion viewpoint of the World Health Organization, Social-Emotional Learning Framework, and newer constructs like the PERMA and the Act-Belong-Commit models, based on which the operationalization of school mental health initiatives in India can be visualized. Further, such initiatives can also be grouped based on their key themes like, Curriculum-Based Life Skills and Social-Emotional Learning (SEL) Programs, Teachers’ training and capacity-building programs, Direct Counselling and Referral Services, Stigma reduction and awareness-enhancing programs, Holistic well-being and health-promotion in schools, Peer support and community engagement programs, Special needs and disability support in schools, and Digital and technology-based interventions. Several school-based mental health initiatives are currently operational in India, both at the national and individual state levels, including both Government and non-Government initiatives. A few such notable initiatives include the National Education Policy 2020, Rashtriya Kishore Swasthya Karyakram, Adolescent Education Program, National and District Mental Health Programmes, and Ayushman Bharat, supported by state-specific models in various Indian states, which prioritize integration of mental health into education. These initiatives range from teacher intervention, appointing school counsellors, and resilience training, to digital platforms and mobile health units.

Conclusion

Though there are several school-based mental health programs in India, implementation is hampered by factors like stigma, workforce shortage, data fragmentation, absence of standardized monitoring framework, and infrastructure gaps. Practical solutions, include teacher education, cross-system collaboration, parental support, cultural adaptation and judicious use of digital and technology-based interventions for more effective implementation of such programs.