Educational interventions to promote adolescents’ mental health: A scoping review

Abstract

Background:

Adolescents often experience discomfort due to individual experiences and the influence of their environment. This discomfort sometimes leads to mental health problems. Education is pivotal in promoting adolescents’ mental health through dedicated prevention interventions and through everyday educational practice, both at school and in the community.

Objective:

To develop an overview of the types of educational interventions aimed at promoting the mental health of adolescents and young adults, providing helpful guidance and insights to teachers/educators.

Methods:

We conducted a scoping review developed through searches in the CINAHL, Eric, PsycINFO and PubMed databases. We summarised data using descriptive analysis, grouping educational interventions category according to their goals and purposes.

Results:

Of the initial 704 articles identified, 19 met the study inclusion criteria. Consistent with Dewey’s educational theory, most of the interventions reported in the selected studies can be viewed as genuine ‘educational’ interventions, in that they involved experiential and interactive activities such as discussion groups, role-play and art-based activities. Fewer interventions involved less participatory and more ‘information-based’ activities, such as lessons. However, in many interventions, the role of teachers/educators in promoting young people’s mental health was underestimated; indeed, in only a few cases were they the providers/co-providers of the activities described, and rarely was there continuity/alignment between the interventions and everyday school activities.

Conclusions:

Conducting a greater number of formal/informal educational interventions to promote adolescents’ mental health is imperative, especially in the current socio-historical context, but this enterprise must acknowledge, value and support the important role of teachers/educators as leaders and participants in this endeavour.

Keywords

Adolescent discomfort educational intervention mental health promotion scoping review young people

In many Western cultural contexts, the experience of ‘unease’ and/or discomfort is becoming increasingly common in adolescents and young adults (Bauman, 2000; Simmons and Smyth, 2016; Xie et al., 2014), and current global and local socio-economic conditions, especially those linked to the COVID-19 pandemic, are adding complexity to the already difficult task of charting a way forward in such a challenging environment (Hafstad et al., 2021).

It is commonly agreed that the growing experience of discomfort among adolescents/young adults depends not only on individual characteristics, but also on the interaction between the individual and the environment in which the young person ‘learns’ how to live (Marmot et al., 2008; World Health Organisation (WHO), 2014b). Like many researchers (Bauman, 2000; Benasayag and Schmit, 2003; Ehrenberg, 2000; Palmieri, 2012), we consider discomfort to be a social problem and not just an individual one, with the experience of discomfort being a ‘learned condition’. Increasingly, young people interiorise experiences of uneasiness within their family/social context (Palmieri, 2012). Since discomfort can be a ‘learned condition’, it must also be addressed by educational interventions, along with psychological and social support.

While it is commonly agreed that education matters strongly with respect to mental health promotion (WHO, 2004), we wonder how many of the contemporary interventions that are said to be ‘educational’ can be understood as such, or are in fact more focused on information/instruction regarding mental health and access to related services. What makes the difference between an informative/instructional approach and an educational one, is ‘experience’. To explain this more fully, we turn to the work of the philosopher and educational reformer, John Dewey (1859–1952). According to Dewey (1938), ‘there is an intimate and necessary relation between the processes of actual experience and education’ (p. 19). Teachers and educators can gently direct young people’s experience, using the physical and social surroundings to create worthwhile educational experiences (Dewey, 1938). The challenge for educators is to become intimately acquainted with the context in which the person is embedded–and its physical, relational and historical characteristics, so that these can be used as educational resources. Dewey (1938) assigned a pivotal role to the interaction between students and educators, and between peers, as part of education (p. 29), such that both experience and interaction become pointers to the intrinsic value of education.

The influence of Dewey’s educational theory can be seen in changes and developments in school-related educational methods, such as the linking together of theory and practice (Díaz, 2020). We share Morris’ (2015) view that the same approach can be used to promote mental well-being in schools. He writes, ‘we should be teaching the students how to be well, how to do well-being [. . .] we have to get the students to experience it’ (p.14), rather than lecturing them about the importance of mental health and wellbeing. Therefore, in recognition of the relevance of multi-professional approaches to promoting mental health (with some mental health promotion interventions being based on individual/group counselling led by psychologists and/or psychiatrists), we consider a mental health promotion intervention to be ‘truly educative’ only when it is based on experience. To be effective in promoting mental health, educational interventions should actively involve young people in meaningful experiences, foster protective factors, and develop competences that will support them in the transition to adulthood.

These interventions should be delivered by professionals skilled in the development of specialised educational approaches, most usually teachers and educators (Whitley et al., 2013). Such professionals can promote mental health not only by leading and participating in dedicated projects, but by also ‘embedding’ mental health promotion strategies in their everyday practices, in schools and within the community (Mazzer and Rickwood, 2014; White and LaBelle, 2019).

Although many studies in the available literature report on interventions aimed at promoting mental health in the young, only a few of them have compared the methods used in different contexts. Furthermore, to our knowledge, no studies have analysed these interventions with the specific intent of identifying their ‘educational’ characteristics, in particular using a Deweyan lens. Therefore, the purpose of this scoping study was to examine the available literature to construct an overview of the types of educational interventions aimed at promoting the mental health of adolescents and young adults, highlighting and analysing their characteristics, modes of implementation and the professionals involved. By shedding light on these interventions with particular attention being given to the role of teachers and educators, we hope to provide insight that can help educational practitioners consciously and actively ‘embed’ mental health in their everyday practices.

Materials and methods

This scoping review was developed in line with the approach advocated by Arksey and O’Malley (2005). This involved defining the research question, identifying all relevant studies, study selection, interpreting and synthesising, and summarising and reporting the results.

Defining the research question

Our research question was as follows: what is known from the existing literature, about educational interventions for mental health promotion in adolescents and young adults?”

Identifying relevant studies

The literature search was undertaken using the CINAHL, Eric, PsycINFO and PubMed databases from the date of inception to March 2020. The main search terms utilised were adolescent, young adult, mental health promotion, school, community, educator, social worker, teacher, best practice, intervention, and strategy. Each word was searched individually (capturing synonyms and the data bases’ thesaurus terms) and was combined with an ‘OR’ criterion to create a construct search term. Finally, the construct search terms were combined with an ‘AND’ criterion. References were exported to Mendeley software and duplicates were removed.

Study selection

The review was limited to studies that

Had been published in English or Italian since 2010;

Discussed interventions/projects for mental health promotion and/or primary prevention of discomfort among adolescents and young adults (aged 10–24 years) (WHO, 2014a), in and out of school (at home; in the community; in meeting places etc); and

Had full text access.

The exclusion criteria for studies were as follows:

Psychological and psychiatric interventions described as such by the authors or implied (e.g. interventions that involved ‘mindfulness’, or individual interventions based on psychological counselling);

Examples of secondary and/or tertiary prevention (e.g. interventions specifically aimed at young people at risk of suicide);

Studies of individuals less than 10 years and more than 24 years of age (WHO, 2014a).

Interpreting and synthesising

After a full-text review of the included articles, relevant information was extracted and placed in a table. The information included author(s), year of publication, journal of publication, country of the study, aim(s) of the study, study design, evaluation instruments and intervention details.

With respect to the ‘intervention’ (i.e. the focus of this scoping review), other specific features were documented, including its purpose, intervention tools/activities, the recipients of the intervention, the setting, the providers of intervention and the timing and frequency of intervention.

Summarising and reporting

Studies were subjected to descriptive analysis, which involved grouping interventions together according to their purpose and frequency using an inductive approach. Data were reported in schematic and narrative forms to clarify the extent and nature of the existing literature. Recommendations were generated according to the analysis of key findings and gaps identified in the literature.

Results

The search strategy identified 704 citations between 2010 and 2020. Following the removal of duplicates and citations based on the inclusion/exclusion criteria, a total of 19 studies proved eligible for inclusion in the review (see Figure 1).

Figure 1.

Flowchart for literature selection.

Characteristics of included studies

The majority of the 19 studies included in this review were conducted in Europe and most were published in health care journals. These were mainly characterised by quantitative research designs and the use of validated assessment tools (pre-post RCT/controlled study design; questionnaires and scales). The objectives of most of the studies concerned the evaluation of the effectiveness of a proposed educational intervention (see online supplemental table).

Characteristics of the interventions

The analysis allowed the identification of 8 categories relating to the objectives of the educational interventions and 9 intervention activities/tools (educational strategies aimed at achieving these objectives) (see Figure 2).

Figure. 2.

Frequency (n, %) of categories and of the intervention activities/tools.

Forty-seven units (the specific objectives of the interventions) were identified, then grouped into 8 categories. For each category, specific objectives (units) were identified in relation to risk or protective factors, together with the activities/tools to achieve those objectives (Table 1).

Table 1.

Description of units, grouped in categories, and of intervention activities/tools.

Categories (objectives of the interventions)	Units (specific objectives of the interventions)		Activities/Tools (to achieve the objectives of the interventions)
Categories (objectives of the interventions)	In reference to protective factors	In reference to risk factors
Promote literacy on health and mental health	1.1) Promote literacy/Increase awareness on mental health (Balaji et al., 2011; Bannink et al., 2014; Lindow et al., 2020; Vella et al., 2018; Wasserman et al., 2018). 1.2) Provide information on mental health aid resources (Lindow et al., 2020; Lubman et al., 2016; Wasserman et al., 2018). 1.3) Deepen the topic of (cyber)bullying (Kosic, 2018).	1.4) Promote literacy/To increase awareness on risky behaviours (alcohol and drug use, smoking, unsafe sex) (Bannink et al., 2014; Lubman et al., 2016).	a. Lessons/workshop (Balaji et al., 2011; Bannink et al., 2014; Lindow et al., 2020; Vella et al., 2018; Wasserman et al., 2018). b. Group activities/leisure activities/sports activities (Balaji et al., 2011; Kosic, 2018; Lubman et al., 2016). c. Role plays (Kosic, 2018; Lindow et al., 2020; Wasserman et al., 2018). d. Art-based activities (media; movie; street performances) (Balaji et al., 2011; Kosic, 2018). e. Information brochures/posters (Lindow et al., 2020; Wasserman et al., 2018). f. Discussion groups (Kosic, 2018). g. Information activities via web (Bannink et al., 2014). h. Lessons/workshop via web (Vella et al., 2018).
Learning to ask/give help	2.1) Promote the attitude to ask/give help about mental health (Bohleber et al., 2016; Lindow et al., 2020; Lubman et al., 2016; Vella et al., 2018; Wasserman et al., 2018). 2.2) Develop social support behaviour (Balaji et al., 2011; McMullen and McMullen, 2018; Vella et al., 2018). 2.3) Getting self-help advice (Lindow et al., 2020; Wasserman et al., 2018).	2.4) Promote the attitude to ask/give help about mental health problem (Lubman et al., 2016).	a. Lessons/workshop (Balaji et al., 2011; Lindow et al., 2020; McMullen and McMullen, 2018; Vella et al., 2018; Wasserman et al., 2018). i. Discussion groups via web/App (Bohleber et al., 2016; Vella et al., 2018). e. Information brochures/posters (Lindow et al., 2020; Wasserman et al., 2018). c. Role plays (Lindow et al., 2020; Wasserman et al., 2018). d. Art-based activities (pictures) (Bohleber et al., 2016). f. Discussion groups (McMullen and McMullen, 2018). b. Group activities/leisure activities/sports activities (Lubman et al., 2016). g. Information activities via web (Bohleber et al., 2016). h. Lessons/workshop via web (Vella et al., 2018).
Promote overall well-being	3.1) Increase resilience (Frazier et al., 2015; McAllister et al., 2017, 2018; McMullen and McMullen, 2018; Srikala and Kishore, 2010; Vella et al., 2018). 3.2) Improve life-skills (McMullen and McMullen, 2018; Schwager et al., 2019). 3.3) Develop relaxation techniques (Bjørnsen et al., 2018). 3.4) Promote well-being (McAllister et al., 2017, 2018). 3.5) Promote well-being sleep (Bjørnsen et al., 2018).		f. Discussion groups (Bjørnsen et al., 2018; McMullen and McMullen, 2018; Schwager et al., 2019).b. Group activities/leisure activities/sports activities (Frazier et al., 2015; McAllister et al., 2017, 2018).d. Art-based activities (movie; songs; storytelling)(McAllister et al., 2017, 2018).a. Lessons/workshop (McMullen and McMullen, 2018; Vella et al., 2018).e. Information brochures/posters (Schwager et al., 2019).h. Lessons/workshop via web (Vella et al., 2018).c. Role plays (Vella et al., 2018).
Develop awareness to themselves and others	4.1) Increase self-awareness (Kosic, 2018; Mfidi et al., 2018; Mohammadzadeh et al., 2019).4.2) Increase self-esteem (Bjørnsen et al., 2018; Schwager et al., 2019; Srikala and Kishore, 2010).4.3) Develop of one’s own strengths (Kosic, 2018; McAllister et al., 2017, 2018).4.4) Promote awareness of one’s own body image (Bjørnsen et al., 2018).4.5) Increase awareness of one’s own limits (Bjørnsen et al., 2018).4.6) Increase awareness of one’s own weaknesses (Kosic, 2018).		f. Discussion groups (Bjørnsen et al., 2018; Kosic, 2018; Mfidi et al., 2018; Mohammadzadeh et al., 2019; Schwager et al., 2019).b. Group activities/leisure activities/sports activities (Kosic, 2018; McAllister et al., 2017, 2018; Mfidi et al., 2018; Mohammadzadeh et al., 2019).d. Art-based activities (performing drama, drawing, media; movie; songs; storytelling)(Kosic, 2018; McAllister et al., 2017, 2018; Mohammadzadeh et al., 2019).c. Role plays (Kosic, 2018; Mohammadzadeh et al., 2019).e. Information brochures/posters (Schwager et al., 2019).a. Lessons/workshop (Mfidi et al., 2018).
Understanding the importance of relationships with others	5.1) Work on meeting the need to belong (Mfidi et al., 2018).5.2) Increase social awareness (Mfidi et al., 2018).5.3) Promote social integration and tolerance (Schwager et al., 2019).		f. Discussion groups (Mfidi et al., 2018; Schwager et al., 2019).b. Group activities/leisure activities/sports activities (Mfidi et al., 2018).e. Information brochures/posters (Schwager et al., 2019).a. Lessons/workshop (Mfidi et al., 2018).
Develop social and interpersonal skills	6.1) Improve communication skills (Kosic, 2018; Frazier et al., 2015; McMullen and McMullen, 2018; Mohammadzadeh et al., 2019; Veltro et al., 2015a, 2015b).6.2) Build social relationships (Kosic, 2018; McAllister et al., 2017, 2018; Mfidi et al., 2018).6.3) Work on assertiveness (Kosic, 2018; Mfidi et al., 2018; Veltro et al., 2015a, 2015b).6.4) Work on intra-and interpersonal relationship (Balaji et al., 2011; Mohammadzadeh et al., 2019).6.5) Implement peer-to-peer support (Bohleber et al., 2016; Lindow et al., 2020; Wasserman et al., 2018).6.6) Develop prosocial strategies (McAllister et al., 2017, 2018).6.7) Improve skills of cooperation (Veltro et al., 2015a, 2015b).6.8) Improve skills of negotiation (Veltro et al., 2015a, 2015b).	6.9) Develop ability to face/to manage conflicts (Kosic, 2018; Mfidi et al., 2018).	a. Lessons/workshop (Balaji et al., 2011; Lindow et al., 2020; McMullen and McMullen, 2018; Mfidi et al., 2018; Veltro et al., 2015a, 2015b; Wasserman et al., 2018).f. Discussion groups (Kosic, 2018; McMullen and McMullen, 2018; Mfidi et al., 2018; Mohammadzadeh et al., 2019; Veltro et al., 2015a, 2015b).b. Group activities/leisure activities/sports activities (Frazier et al., 2015; Kosic, 2018; McAllister et al., 2017, 2018; Mfidi et al., 2018; Mohammadzadeh et al., 2019).c. Role plays (Kosic, 2018; Lindow et al., 2020; Mohammadzadeh et al., 2019; Veltro et al., 2015a, 2015b; Wasserman et al., 2018).d. Art-based activities (performing drama, drawing, media; movie; pictures; songs; storytelling)(Bohleber et al., 2016; Kosic, 2018; McAllister et al., 2017, 2018; Mohammadzadeh et al., 2019).e. Information brochures/posters (Lindow et al., 2020; Wasserman et al., 2018).i. Discussion groups via web/App (Bohleber et al., 2016).g. Information activities via web (Bohleber et al., 2016).
Improve cognitive skills	7.1) Develop problem-solving skills (Frazier et al., 2015; Kosic, 2018; McMullen and McMullen, 2018; Mohammadzadeh et al., 2019; Veltro et al., 2015a, 2015b).7.2) Develop responsible decision making skills (Bjørnsen et al., 2018; Kosic, 2018; McMullen and McMullen, 2018; Mfidi et al., 2018).7.3) Develop ability to face challenges (McAllister et al., 2017, 2018).7.4) Develop coping strategies (Mohammadzadeh et al., 2019; Srikala and Kishore, 2010).7.5) Develop creative thinking ability (Kosic, 2018; Mohammadzadeh et al., 2019).7.6) Develop critical thinking ability (Kosic, 2018; Mohammadzadeh et al., 2019).7.7) Promote the ability to set realistic and challenging goals (Veltro et al., 2015a, 2015b).	7.8) Develop ability to face/to manage crisis situations (Lindow et al., 2020; Wasserman et al., 2018).	f. Discussion groups (Bjørnsen et al., 2018; Kosic, 2018; McMullen and McMullen, 2018; Mohammadzadeh et al., 2019; Veltro et al., 2015a, 2015b).b. Group activities/leisure activities/sports activities (Frazier et al., 2015; Kosic, 2018; McAllister et al., 2017, 2018; Mohammadzadeh et al., 2019).a. Lessons/workshop (McMullen and McMullen, 2018; Mfidi et al., 2018; Veltro et al., 2015a, 2015b).c. Role plays (Frazier et al., 2015; Kosic, 2018; Mohammadzadeh et al., 2019; Veltro et al., 2015a, 2015b).d. Art-based activities (performing drama, drawing, media; movie; songs; storytelling)(Kosic, 2018; McAllister et al., 2017, 2018; Mohammadzadeh et al., 2019).
Work on/manage emotions (one’s own and others)	8.1) Work on emotion (Bjørnsen et al., 2018; Frazier et al., 2015; Kosic, 2018; Schwager et al., 2019).8.2) Work on self-regulation (Kosic, 2018; Mfidi et al., 2018; Veltro et al., 2015a, 2015b).8.3) Work on empathy (Kosic, 2018; Mohammadzadeh et al., 2019).	8.4) Develop ability to face/to manage stress (Bjørnsen et al., 2018; Bohleber et al., 2016; Kosic, 2018; Lindow et al., 2020; Wasserman et al., 2018).8.5) Develop ability to face/to manage depression (Lindow et al., 2020; Schwager et al., 2019; Wasserman et al., 2018).8.6) Develop ability to face/to manage anger and aggressive behavioural (Veltro et al., 2015a, 2015b).8.7) Develop ability to manage suicidal thoughts (Lindow et al., 2020; Wasserman et al., 2018).8.8) Develop ability to face/to manage anxiety (Schwager et al., 2019).8.9) Develop ability to face/to manage negative emotions (McMullen and McMullen, 2018).	f. Discussion groups (Bjørnsen et al., 2018; Kosic, 2018; Mfidi et al., 2018; McMullen and McMullen, 2018; Mohammadzadeh et al., 2019; Schwager et al., 2019; Veltro et al., 2015a, 2015b).c. Role plays (Frazier et al., 2015; Kosic, 2018; Lindow et al., 2020; Mohammadzadeh et al., 2019; Veltro et al., 2015a, 2015b; Wasserman et al., 2018).a. Lessons/workshop (Lindow et al., 2020; McMullen and McMullen, 2018; Mfidi et al., 2018; Veltro et al., 2015a, 2015b; Wasserman et al., 2018).b. Group activities/leisure activities/sports activities (Frazier et al., 2015; Kosic, 2018; Mfidi et al., 2018; Mohammadzadeh et al., 2019).d. Art-based activities (performing drama, drawing, media; movie; pictures)(Bohleber et al., 2016; Kosic, 2018; Mohammadzadeh et al., 2019).e. Information brochures/posters (Lindow et al., 2020; Schwager et al., 2019; Wasserman et al., 2018).i. Discussion groups via web/App (Bohleber et al., 2016).g. Information activities via web (Bohleber et al., 2016).h. Lessons/workshop via web(Vella et al., 2018).

Focus of interventions

In most cases, the interventions were directed towards adolescents/young people between 10 and 21 years of age (n = 16; 84%) (Bannink et al., 2014; Bohleber et al., 2016; Bjørnsen et al., 2018; Kosic, 2018; Lindow et al., 2020; Lubman et al., 2016; McAllister et al., 2017, 2018; McMullen and McMullen, 2018; Mfidi et al., 2018; Mohammadzadeh et al., 2019; Schwager et al., 2019; Srikala and Kishore, 2010; Veltro et al., 2015a, 2015b; Wasserman et al., 2018). A few, however, were intended for young adults (aged 22–24 years) (Balaji et al., 2011), family members (Frazier et al., 2015; Vella et al., 2018) and/or sports coaches (n = 3; 16%) (Vella et al., 2018). In a very few cases, the interventions were aimed towards very specific populations: adolescents living in orphanages (Mohammadzadeh et al., 2019), male adolescents (Vella et al., 2018), adolescents looking for a first job (Bohleber et al., 2016) and African American adolescents and families (Frazier et al., 2015).

Setting

The interventions described in the studies mainly took place in schools (n = 8; 42%) (Bjørnsen et al., 2018; Lindow et al., 2020; Lubman et al., 2016; McAllister et al., 2018; McMullen and McMullen, 2018; Schwager et al., 2019; Srikala and Kishore, 2010; Wasserman et al., 2018); and to a lesser extent both in and out of school (at home; in the community; in meeting places) (n = 5; 26%) (Balaji et al., 2011; Kosic, 2018; Mfidi et al., 2018; Veltro et al., 2015a, 2015b) in out of school settings (orphanages; parks) (n = 2; 11%) (Frazier et al., 2015; Mohammadzadeh et al., 2019), on the Web (n = 2; 11%) (Bannink et al., 2014; Bohleber et al., 2016), via ‘blended’ learning (online and in person at a sports club) (n = 1; 5%) (Vella et al., 2018). In one case, this information was not reported (McAllister et al., 2017). Among the studies where the intervention took place at school (n = 13; 68%), 5 (38%) reported that the intervention had been conducted during ordinary school lessons (Kosic, 2018; Schwager et al., 2019; Srikala and Kishore, 2010; Veltro et al., 2015a, 2015b).

Providers

The intervention providers were in most cases (n = 7; 37%) professionals who worked outside the immediate context of the intervention such as instructors (Lindow et al., 2020; Wasserman et al., 2018); facilitators (McAllister et al., 2017); psychologists, social workers and peers (Balaji et al., 2011; Bohleber et al., 2016); qualified volunteers and psychologists (Vella et al., 2018); and mental health professionals and facilitators (Frazier et al., 2015).

In five cases (26%), the interventions were delivered both by internal and external professionals: teachers, psychologists and peers (Veltro et al., 2015a, 2015b); teachers, psychologists and other experts (Kosic, 2018); school health personnel and mental health professionals (McAllister et al., 2018); and teachers and facilitators (Lubman et al., 2016).

In yet other studies (n = 4; 21%), the interventions were provided by professionals within the school: teachers (McMullen and McMullen, 2018; Schwager et al., 2019; Srikala and Kishore, 2010) and school health personnel (Bjørnsen et al., 2018). Finally, in three cases (16%) (Bannink et al., 2014; Mfidi et al., 2018; Mohammadzadeh et al., 2019), provider data were not reported.

Among the studies in which providers were specified (n = 16; 84%), some authors reported provider-specific training without clarifying the amount of time invested in such training d (n = 5; 31%) (Balaji et al., 2011; Frazier et al., 2015; Schwager et al., 2019; Srikala and Kishore, 2010; Vella et al., 2018). Others reported provider-specific training while also clarifying the length of training (from 2 to 3 days) (n = 4; 25%) (McAllister et al., 2018; McMullen and McMullen, 2018; Veltro et al., 2015a, 2015b).

Timing and frequency of intervention

The timing and frequency of interventions were not clearly reported by most of the studies. In the few studies (n = 4; 21%) which reported this data, interventions were either low-frequency, spread in a long period of time (between 12 and 24 one-hour sessions, once a week, in a 6–12 month period) (Srikala and Kishore, 2010; Veltro et al., 2015a, 2015b) or medium-frequency, spread in a shorter period of time (twenty 90-minute sessions, twice a week, in a 3-month period) (Frazier et al., 2015).

Discussion

Five main findings emerged from the review, offering insight and suggestions for future practice.

Identified interventions tend to promote the wellbeing of young people and protective factors rather than focus on risk factors

Promoting the wellbeing of adolescents, rather than tackling risk factors, is in line with international recommendations on mental health promotion (Centre for Economic Performance’s Mental Health Policy Group, 2012; De Santi et al., 2008; EU, 2020; WHO, 2002). The former approach is related to the more general aims of education of children/young people in general, such as learning to appreciate interpersonal relationships, to recognise and value emotions, to achieve self-awareness and to acknowledge others, and to develop dialogue and respect (Iori, 2006, 2009; Massa, 2000; Van Manen, 2016). Other more psychologically focused studies aim to develop other typical goals of education for children and young people, such as cognitive skills, problem solving and decision-making (Fook and Gardner, 2007).

Most of the objectives of the interventions and educational activities described here focused on the development of life skills (Table 1). Few had a focus on specific mental health problems but aimed instead to empower young people in the development of wellbeing and, more generally, life competencies.

Identified interventions largely involve experiential activities and aim to promote the participation of the young people involved

Most of the activities aimed at promoting mental health reported in the selected studies involved student-centred/experiential activities such as discussion groups, activities/sports activities, role-play, and art-based activities (drawing, acting, watching movies, playing songs, storytelling, using media, photos, street performances) (Cahnman-Taylor and Siegesmund, 2017; Hannigan et al., 2019). Those activities reflect the typical experiences promoted by educators both outside and inside school.

Nevertheless, in selected studies, we also found less participatory and more information-based activities such as lessons, which reflect the didactic model that has often characterised educational interventions for health and wellbeing in general. Such an approach is commonly used in schools to prevent problems such as bullying, violence, substance abuse (De Santi et al., 2008; Yeager and Dahl, 2017). The theory of change underlying many of these interventions comes [from behavioural decision-making theories [. . .], which propose that increasing knowledge of health risks, skills for achieving health goals, and awareness of societal values regarding healthy behaviour will lead to positive behaviour change (Yeager and Dahl, 2017). Their success has however been shown to be limited.

With respect to the aims of the educational interventions described in selected papers, and the activities carried out to achieve them, there was generally a high degree of alignment between goals and educational activities. However, in some published studies, aims and educational activities were less well aligned (see Table 1). For example, aims and activities seemed well aligned in efforts ‘to promote health and mental health literacy’ (see Table 1: category 1), but this was not the case in relation to the aim of ‘learning to ask for and offer help’ (see Table 1: category 2). We can be informed about how and to whom to ask for help but to promote our mental health, we also need to learn to recognise our emotions and to describe what we are feeling. This is not something that can be effectively learned through formal lessons and requires a more experiential approach in a protected and familiar learning environment.

Interventions ‘to promote awareness of one’s own body image’ and ‘to increase awareness of one’s limits’ (see Table 1: units 4.4, 4.5) were addressed through discussion groups without any experiential activity. We find this limiting. In line with Dewey (1938), and other scholars (Massa, 2000; Morris, 2015), we believe that experience is fundamental to learning and educational processes and adolescents require opportunities to recognise, foster and manage emotions by activating them in simulated and protected situations, to later reflect on their experience. Morris (2015) reminds us:

Suppose someone is teaching cognitive skills (such as those on resilience). In that case, the teacher has to get the students practicing them and applying them in real-life situations: it is no good just talking about it or handing over a worksheet. (p. 14)

Similarly, it is only by ‘experiencing’ one’s own body (i.e. through sport activities, dance, drama etc.) that a young person can learn to know it, to become aware of its limits, and to recognise themselves in their own body through processes that are crucial to developing one’s own identity (Hosseini and Padhy, 2021; Merleau-Ponty, 1945). Such activities should take place in a ‘safe’ space in which the individuals can experiment without encountering the risks of ‘real’ life (Gordon, 1992; Massa, 2000), where emotions, ideas and even the individual’s own body may be mocked or belittled.

Most of the interventions are carried out in person

Only a very few of the identified mental health promotion activities were web-based. This may be related to the fact that while web-based interventions can promote the dissemination of information, in-person experiential activities are better suited to helping adolescents build relationships, value emotions, achieve self-awareness and recognise/show respect to others.

Most identified interventions were delivered in schools, but only rarely with teachers providers or co-providers

Even if the majority of the interventions were delivered at school, the providers were mostly other professionals (e.g. psychologists) and only more rarely teachers. Moreover, only a few published interventions were carried out as part of daily school activities, and even fewer took place in the community, and involved other stakeholders. Nevertheless, it is widely agreed that intervening where the discomfort arises, and involving diverse stakeholders, is crucial to success (Cefai and Cooper, 2017; Levine, 2003; Whitley et al., 2013).

Above all, mental health promotion interventions should seek to involve people who are already close to the young person concerned. These may be family members, teachers/educators and others nearby, some of whom may be experiencing discomfort themselves (Aldam et al., 2019; Cefai and Cooper, 2017; De Santi et al., 2008; Ekornes et al., 2012; Jané-Llopis and Anderson, 2005; Palmieri, 2012). Several authors underline how mental health promotion programmes and interventions in school will be more effective if are part of regular school curricular activities (Greenberg, 2010; Jennings and Greenberg, 2009) and/or if they involve family and community (Adi et al., 2007; Patton et al., 2006; Weare and Markham, 2005).

Our findings are consistent with recent research which indicates that mental health is often an unfamiliar term to teachers, and is often negatively loaded (Ekornes et al., 2012). Considering that mental health issues may be seen as extraneous to the school mission, and thereby disregarding the role of teachers in mental health promotion, is quite common even among teachers themselves, especially those who think that only health care professionals should be involved in managing these issues, ideally in a health care setting (Gambacorti Passerini, 2021).

In general, considering the growing experience of discomfort in adolescents/young adults, new competences related to mental health issues are urgently required by teachers/educators. Importantly, from our perspective, teachers and other education professionals do not need in-depth training on how to deal with specific manifestations and symptoms of distress – this should be the responsibility of other professionals. What teachers and educators need is a ‘pedagogical perspective’ on the experience of distress, and the skills to promote work that values mental health issues as part of their everyday teaching.

Where data were reported, interventions did were not aligned or integrated with everyday school activities

In this scoping review, little emerges concerning the importance of continuity and alignment between the content and focus of health promotion interventions and the involvement of teachers able to incorporate the abovementioned activities into their daily teaching. Other research shows how continuity and teacher involvement are central to school-based health promotion efficacy (Cefai and Cooper, 2017; Ekornes et al., 2012). To maximise success, interventions should not be ‘one shot’ experience, but ‘embedded’ in everyday school activities, taking advantage of the regular contact that takes place between teachers/educators and adolescents (Cefai and Cooper, 2017; De Santi et al., 2008; Ekornes et al., 2012; Whitley et al., 2013). The latter spend much of the day working with teachers, who can be central figures in their lives. To further maximise the likelihood of success, future programmes and interventions should seek to promote

[a] significant shift [away] from traditional pedagogies/attitudes, toward more flexible teaching/learning approaches. This shift could help recognise those teachers who spend more time with their students on a daily basis, who can co-create positive classroom/school climate by listening and supporting them, not only in academic achievement but also in building social-emotional competencies as well. (Kosic, 2018: 78)

Study limitations

The review presented has a few limitations. First, it did not include the grey literature, and it is possible that small-scale but successful interventions in local contexts have been published in documents/papers not included in the databases used. An additional limitation derives from the fact that among the papers examined some articles did not report all the relevant information on the interventions carried on. Consequently, these data are absent in the scoping review. Finally, because scoping reviews do not require a formal quality appraisal of the research included, the rigour of the included studies has not been assessed.

Conclusions

This review reveals that a wide body of literature reports on educational approaches to promoting mental health in adolescence. Many interventions sought to adopt a genuine educational approach – aligned with Dewey’s description of what education involves, and some reported educational interventions also involved families and communities. However, the role of teachers/educators in promoting mental health as part of their daily practice in schools seems radically underestimated.

Further research is needed to understand why teachers, who are the professionals most involved in education, are so peripheral to interventions to promote mental health. Is this because teachers do not consider promoting mental health an important part of their everyday practice, or seek to do informally, or because they feel unconfident or poorly equipped to undertake the task?

Going forwards, teachers’ everyday practice may be the backbone around which to develop future interventions to promote mental health in school. Intensity, duration, frequency and continuity of intervention, alongside the involvement of a range of stakeholders, are key to the success of future actions to promote adolescents’ mental health.

Supplemental Material

sj-docx-1-hej-10.1177_00178969221105359 – Supplemental material for Educational interventions to promote adolescents’ mental health: A scoping review

Supplemental material, sj-docx-1-hej-10.1177_00178969221105359 for Educational interventions to promote adolescents’ mental health: A scoping review by Katia Daniele, Maria B Gambacorti Passerini, Cristina Palmieri and Lucia Zannini in Health Education Journal

Footnotes

Acknowledgements

We thank Annalisa Manca, who helped us edit the English in the manuscript. Her suggestions and requests of clarification improved our work in countless ways.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship and/or publication of this article.

ORCID iD

Katia Daniele

Supplemental material

Supplemental material for this article is available online.

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