Mental health in adolescence: the role of schools-based social emotional teaching

The World Health Organization has defined mental health as a state of well-being in which every individual realizes their own potential, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to their community (World Health Organisation, 2022). What would it take to create a world where this aspiration of mental health for all is realised? We suggest that it requires a paradigm shift, towards a multifaceted strategy that prioritizes prevention and health promotion, as well as treatment (Patel et al., 2018). Universal approaches that target the underlying determinants of health in the whole population have the potential to reduce the prevalence and burden of ill health and ensure more of the population enjoy healthy life expectancy (Rose, 1992/2008). There are compelling reasons to focus prevention in childhood and adolescence, because it is a period of significant developmental change and where the precursors for mental ill health in adulthood first appear (Sawyer et al., 2012; Natividad et al., 2023; Jung, 2021). A promising approach to mental health promotion in adolescence is school-based social-emotional learning (SEL). Universal schools-based interventions “(a) have the potential to contribute to adaptive coping/resilience across an array of experiences and settings, (b) are positively framed and provided independent of risk status, and therefore non-stigmatizing, and (c) may reduce or prevent multiple behaviour problems that are predicted by shared or common risk factors” (Greenberg & Abenavoli, 2017). Individual studies, systematic reviews and meta-analyses suggest SEL programmes are promising, but consistently note heterogeneity, limitations in study design as well as inadequate attention to diversity, accessibility and implementation, plus call for adequately powered and rigorously designed trials (Beukema et al., 2022; Dray et al., 2017; Dunning et al., 2022). We recently published the MYRIAD study, a cluster randomized controlled trial (85 schools, 8376 adolescents, aged 11–16) of a teacher-led, school-based mindfulness training intervention compared with established best practice (Kuyken et al., 2022a). This study suggested no superiority of the intervention over current good practice on our student mental health outcomes. Our study is not an outlier; a number of adequately powered and designed studies have failed to demonstrate the effectiveness of school-based mental health interventions, ranging from mental health literacy education for teachers to cognitive-behavioural therapy and mindfulness training (Andrews et al., 2022; Kidger et al., 2021; Stallard et al., 2013). We argue that these studies can teach us a great deal in terms of intervention development, research, and implementation.