Adolescent mental health: A systematic review on the effectiveness of school-based interventions
This major report reviews the latest evidence on school-based mental health interventions, providing a comprehensive and up-to-date picture of what works, for whom and under what circumstances in relation to interventions that enhance mental health, prevent mental health difficulties and prevent behavioural difficulties.
The latest prevalence data for England on young people’s mental health shows that approximately one in seven young people aged 11–19 experience at least one mental disorder. According to recent NHS data and our own research, the Covid-19 pandemic and resulting lockdowns have led to a worsening of teenagers’ mental health.
Mental health difficulties during adolescence can have lifelong effects, impacting on a range of adult outcomes including employment, the ability to establish and maintain healthy relationships, and general health and wellbeing. Schools are in a unique position to deliver mental health support to all children and young people without some of the common barriers that affect similar interventions offered outside of schools.
Taking steps to prevent and address children and teens’ mental health difficulties early provides a solid base for academic achievement, which goes hand-in-hand with mental health and wellbeing. Preventing and tackling mental health difficulties early on in a school setting can also reduce pressure on other public services, where it becomes more difficult and more expensive to adequately support people who need help.
Exploring the evidence on what works
Our major report on adolescent mental health is the most significant UK review of the evidence on supporting positive mental health in schools for at least a decade, and the first to focus squarely on what works in secondary schools to support pupils’ wellbeing during their critical teenage years. Drawing on evidence from 34 systematic reviews published since 2010 together with 97 primary studies published over the past three years, this evidence review provides a comprehensive and up-to-date summary of what works, for whom and under what circumstances.
The report sets out the evidence on the effectiveness of interventions for:
- Promotion: Interventions to enhance mental health and wellbeing including social and emotional learning interventions, positive psychology interventions, mindfulness-based interventions, positive youth development interventions, and mental health literacy interventions.
- Prevention: Interventions to prevent mental health difficulties including anxiety and depression prevention interventions, and suicide prevention interventions.
- Behaviour: Interventions to prevent behavioural difficulties including aggression and violence prevention interventions, bullying prevention interventions, and sexual violence prevention interventions.
The evidence in each of these three areas is explored in terms of:
- What works: Setting out the effectiveness of school-based mental health and behavioural interventions implemented for young people aged between 12 –18 based on UK and international studies, and the strength of that evidence.
- For whom: Establishing the characteristics (such as age, gender, ethnicity or socioeconomic status) of young people who experience the largest impact from school-based mental health interventions.
- Under what circumstances: Identifying the settings or conditions in which programmes have been shown to be effective.
Summary of key findings
- Universal social and emotional learning (SEL) interventions have good evidence of enhancing young people’s social and emotional skills and reducing symptoms of depression and anxiety in the short term.
- There is good evidence that universal and targeted cognitive behavioural therapy (CBT) interventions are effective in reducing internalising symptoms in young people.
- There is limited evidence on the effectiveness of school-based interventions designed to prevent suicide and self-harm.
- Violence prevention interventions have been shown to have a small but positive effect on aggressive behaviour in the short term.
- Bullying prevention interventions are effective in reducing the frequency of traditional and cyberbullying victimisation and perpetration.
- There is promising evidence on the effectiveness of interventions designed to reduce sexual violence and harassment when delivered to young people at risk of experiencing sexual violence.
- The impact of depression and anxiety prevention interventions and violence prevention interventions tends be stronger when they are targeted at young people with elevated but subclinical symptoms.
- In addition to reducing mental health and behavioural difficulties it is essential to support the development of social, emotional and behavioural competencies at a universal level.
- There are a limited number of interventions which report evidence of improving mental health and behavioural outcomes among diverse groups and an even smaller number of and an even smaller number of interventions specifically designed for and evaluated with minority ethnic groups. Findings from these studies do, however, suggest promising impact on mental health and behavioural outcomes when delivered at both universal and targeted level.
- Universal interventions can be effectively delivered by teachers; however, there is no evidence that teacher-delivered interventions are effective in addressing the needs of students with symptoms of depression or anxiety.
- High-quality programme implementation is critical to achieving positive outcomes.