Review: School-based Mental Health Literacy Interventions To Promote Help-Seeking – A Systematic Review

Background:

School-based mental health literacy interventions aim to prevent mental disorders and promote mental wellbeing through improving the knowledge and understanding of mental health, mental disorders, and reducing stigma. Evidence suggests that good mental health literacy helps young people recognise mental health difficulties in themselves and in others, and seek help for mental health problems. Improved helpseeking can allow for early intervention, which prevents the progression of mental disorders and ultimately reduces the burden of mental disorders. The aim of this review is to identify and synthesise evidence on the effectiveness of school-based mental health literacy interventions in improving help-seeking outcomes. Methods: We searched MEDLINE, Embase, PsycINFO, ERIC, Child Development and Adolescent Studies, British Education Index and ASSIA (June 2020). Additional searches were conducted a year later to identify any new publications (June 2021). We included randomised controlled trials (RCTs) assessing the effectiveness or costeffectiveness of school-based interventions to improve help-seeking outcomes for children and young people aged 4–18 years. Included studies were critically appraised.

Results:

We identified 11 studies investigating help-seeking outcomes of school-based mental health literacy interventions including a total of 7066 participants from 66 secondary schools. Overall, there is no strong evidence for the effectiveness of school-based mental health literacy interventions in improving help-seeking outcomes, including general attitudes towards help-seeking, personal intentions to seek help, knowledge of when and how to seek help for mental disorders, confidence to seek help, and actual help-seeking behaviours. None of the studies investigated the costeffectiveness of the interventions. 

Conclusion:

The lack of standardised measures with established reliability and validity for help-seeking outcomes, and the incomprehensive consideration of the multi-faceted concepts of MH literacy and MH stigma have contributed to the scarcity of evidence for the effectiveness. Future research should focus on developing standardised measurement tools and including economic evaluations to understand pragmatic and financial aspects of school-based mental health literacy interventions.

Key Practitioner Message

• Research suggests that improving MH literacy may improve outcomes for those with mental disorders through improving help-seeking and the utilisation of MH services, hence school-based mental health literacy interventions have great potential to close treatment gaps especially in underserved populations.
•  Although school-based interventions are a viable option for solving the problem of low MH literacy and the presence of stigmatising attitudes and behaviours towards mental disorders, these do not seem to translate into real world impact in terms of MH service utilisation.
• Our findings suggest that school-based interventions should address self-stigma alongside public stigma to effectively improve help-seeking, as self-stigma is more closely associated with help-seeking. Interventions should also incorporate specific elements regarding knowledge and skills transfer that is practical for helpseeking.
• Economic evaluations should be conducted in future studies to understand the pragmatic and financial aspects of the interventions, which is important for bridging the gap between research and service provision.