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This article was downloaded by: [University of Prince Edward Island] On: 24 November 2014, At: 05:30 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Advances in School Mental Health Promotion Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/rasm20 Advancing School Mental Health Promotion Globally Mark D. Weist & Michael Murray Published online: 22 Dec 2011. To cite this article: Mark D. Weist & Michael Murray (2008) Advancing School Mental Health Promotion Globally, Advances in School Mental Health Promotion, 1:sup1, 2-12, DOI: 10.1080/1754730X.2008.9715740 To link to this article: http://dx.doi.org/10.1080/1754730X.2008.9715740 PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions

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Page 1: Advancing School Mental Health Promotion Globally

This article was downloaded by: [University of Prince Edward Island]On: 24 November 2014, At: 05:30Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House,37-41 Mortimer Street, London W1T 3JH, UK

Advances in School Mental Health PromotionPublication details, including instructions for authors and subscription information:http://www.tandfonline.com/loi/rasm20

Advancing School Mental Health Promotion GloballyMark D. Weist & Michael MurrayPublished online: 22 Dec 2011.

To cite this article: Mark D. Weist & Michael Murray (2008) Advancing School Mental Health Promotion Globally, Advances inSchool Mental Health Promotion, 1:sup1, 2-12, DOI: 10.1080/1754730X.2008.9715740

To link to this article: http://dx.doi.org/10.1080/1754730X.2008.9715740

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) containedin the publications on our platform. However, Taylor & Francis, our agents, and our licensors make norepresentations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose ofthe Content. Any opinions and views expressed in this publication are the opinions and views of the authors,and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be reliedupon and should be independently verified with primary sources of information. Taylor and Francis shall not beliable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilitieswhatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out ofthe use of the Content.

This article may be used for research, teaching, and private study purposes. Any substantial or systematicreproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in anyform to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions

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2 Advances in School Mental Health Promotion INAUGURAL ISSUE - October 2007 © The Clifford Beers Foundation & University of Maryland

FF EE AA TT UU RR EE

Key words: children; young people; schools; global;school mental health promotion

Introduction

With enthusiasm, we (M Murray and M Weist) bringyou this new journal, Advances in School MentalHealth Promotion. The journal is a product of ourcollaboration over the past eight years as part ofbroader efforts to build a global mental health pro-motion agenda. Within this larger agenda, promotingthe mental health and school success of children andadolescents, from pre-school through secondary edu-cation and transition to adulthood, is an area of criticalemphasis. In this introductory article, we define schoolmental health promotion, discuss its key themes,

review reasons for its growth, discuss challenges beingencountered, present strategies and ideas for thegrowth of the field, and discuss the role of this newjournal in moving forward training, practice, researchand policy.

School mental health promotion defined

We build our definition of school mental health promotion

Mark D. Weist1

Center for School Mental Health,University of Maryland

School of Medicine

Michael Murray

The Clifford Beers Foundation

Advancing SchoolMental HealthPromotion Globally

This article introduces the new journal Advances in

School Mental Health Promotion. Following definitions of

key concepts, critical themes associated with high-quality

school mental health promotion are reviewed. Reasons

for the growth of the field, along with evidence of

progress in a number of developed nations, are presented.

We then discuss challenges being encountered, including

those related to high variability in experience across

communities, states and nations, stigma and marginaliza-

tion, funding and resource limitations, language barriers,

the limited focus on school-wide promotion, universal

prevention, social and emotional learning and climate, a

significant research to practice gap, training and workforce

concerns, and issues around youth, family and other

stakeholder involvement. Each of these areas includes

critical opportunities for the advancement of training,

practice, research and policy, building interconnections

between these realms, and development of collaborative

research agendas within and across countries. We conclude

with a review of global initiatives and opportunities

related to school mental health promotion and briefly

describe the articles in this inaugural issue.

AA BB SS TT RR AA CC TT

1Supported by cooperative agreement U45 MC 00174-10-0 from the Office ofAdolescent Health, Maternal and Child Health Bureau (Title V, SocialSecurity Act), Health Resources and Services Administration. Also supportedby grant 1R01MH71015-01A1 from the National Institute of Mental Health.We extend our considerable appreciation to Aya Ghunney, Nancy Lever,Peter Paulus, Monique Vulin-Reynolds, Louise Rowling, and Sharon Stephanfor help in developing this article. We also extend our sincere thanks toColin Reed, Janet Simons, Marjorie Forster, Tony Bibbo, and Neal Gallico forcritical guidance and assistance in developing this new journal.

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from a definition of mental health by the World HealthOrganization (WHO, 2001) that emphasizes it as apositive attribute:

a state of well-being in which the individualrealizes his or her own abilities, can cope withthe normal stresses of life, can work produc-tively and fruitfully, and is able to make acontribution to his or her community (p1).

People have problems with their physical health, andproblems with their mental health. These problems donot make either of them a negative concept.

Our definition of school mental health promotionalso builds on a definition of mental health promotionby Hosman and Jané-Llopis (1999).

Mental health promotion activities imply thecreation of individual, social and environ-mental conditions that enable optimal psycho-logical and psychophysiological development.Such initiatives involve individuals in theprocess of achieving positive mental health,enhancing quality of life and narrowing thegap in health expectancy between countriesand groups. It is an enabling process, done by,with and for the people. Prevention of mentaldisorders can be considered one of the aimsand outcomes of a broader mental healthpromotion strategy. (p.31)

Building on these concepts, we define school mentalhealth promotion as:

Providing a full continuum of mental healthpromotion programs and services in schools,including enhancing environments, broadlytraining and promoting social and emotionallearning and life skills, preventing emotionaland behavioral problems, identifying andintervening in these problems early on, andproviding intervention for established problems.School mental health promotion programsshould be available to all students, includingthose in general and special education, indiverse educational settings, and should reflecta shared agenda – with families and youngpeople, school and community partners activelyinvolved in building, continuously improving,and expanding them.

Please note that in this definition school mental healthpromotion is the overarching concept, with all efforts –from environmental enhancement to intervention forserious problems – subsumed under it.

Key themes

Quality is a central construct in school mental health(SMH) promotion, with many facets, including:

an inclusive approach reaching out to andassisting all interested young people and families,and purposefully overcoming barriers to pro-motion and interventionbuilding programs in ways that are responsiveto student, school and community needs, whilebuilding on strengthsfocusing on reducing barriers to student learningthrough programs that are student- and family-friendly and are based on evidence of whatworksproactively involving all interested stakeholdersin all aspects of program development,improvement and growthemphasizing and providing support for systematicquality assessment and improvement andcontinuous student- and program-level evaluationensuring the full promotion to interventioncontinuumhiring the right staff, who receive the right trainingand ongoing coaching and support for high-quality promotion and interventionensuring that all efforts are sensitive to the fullrange of developmental, cultural/ethnic, andpersonal differences in studentsbuilding interdisciplinary relationships in schools,and strong teams and coordinating mecha-nismsbuilding strong connections between programsand resources within the school with programsand resources in other community settings(Weist et al, 2005a; see Jané-Llopis & Barry,2005 for a discussion of high-quality SMHpromotion).

In addition to this strong emphasis on quality, schoolmental health promotion should reflect a purposefulattempt to build a new paradigm in the way mentalhealth is promoted in children and adolescents. Thepriorities should be environmental improvement and

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the health of populations of children and adolescents,not solely limited efforts to treat ‘psychopathology’ (apejorative term) in select individuals (Rowling & Weist,2004). Purposeful and strong efforts are needed tobreak down disciplinary silos (such as psychology vs.education vs. social work vs. nursing), as the work inschools is inherently interdisciplinary (Flaherty et al,1998; Rappaport et al, 2003; Waxman et al, 1999).Similar system silos (for example mental health vs.education vs. health vs. juvenile services vs. child wel-fare) need to be broken down, as all of these systemsserve young people in the schools. The many barriersassociated with passive bureaucracies that wait forchildren and families to come should be dismantled,toward proactive, flexible, and minimally bureaucraticapproaches to putting helpful and science-based pro-grams and people in front of children and adolescents– those in need, those at risk, and those doing well(Association for Supervision and CurriculumDevelopment, 2007; Weist, 1997).

There should be a move away from expert modelsthat rely exclusively on people with advanced degreeswho convey expertise in limited consultation and thenmove on, toward collaborative, non-hierarchicalapproaches that empower all who work in schools tobe promoters of mental health for students, families,and staff (Power et al, 2003; Waxman et al, 1999;Weare, 2000). Young people, families, teachers, schooland community leaders, policy makers, business leaders,and faith leaders should be genuinely involved in allaspects of program development, continuousenhancement and growth (Andis et al, 2002; Lever etal, 2003).

As high-quality programs and services, adhering tothese principles, begin to achieve outcomes, findingsand experiences – quantitative and qualitative – shouldbe purposefully connected to systematic efforts to buildadvocacy, improve policy, and extend resources toenable the spread of SMH promotion to more schools(Weist et al, 2005b). Strategies to promote publicinvolvement in the school mental health promotionagenda are critical, helping this agenda rise to signifi-cant policy actions in communities, since it is aboutyoung people, helping them to do well in school, andhelping them to go on to become productive citizens(Andis et al, 2002).

All of this work involves recruiting, training, andempowering those who will promote mental health inschools, improving the quality of promotion and inter-vention, further building a systematic research agenda,

and promoting policy improvement and resourceenhancement, with specific linkage between each ofthese realms. Articles in this journal will reflect thesethemes.

Reasons for growth

There are many reasons for the growth of the schoolmental health promotion field. First, there is increasingrecognition that children and adolescents with mentalhealth needs generally do not receive services toaddress these needs in traditional outpatient or privatesettings, and that in most countries, the mental healthsystem is essentially a non-system (U.S. Department ofHealth and Human Services [DHHS], 1999; U.S. PublicHealth Service, 2000; President’s New FreedomCommission [PNFC], 2003; World Health Organization,2004). This recognition is combined with recognitionthat schools are already the de facto deliverers ofmental health services for children (Rones & Hoagwood,2000), yet are often poorly equipped and supportedto handle this responsibility (Adelman & Taylor, 2000).

As mental health promotion and intervention effortsbuild in schools, the most universal natural setting forchildren, many of the barriers that constrain the deliveryof services to them in other settings are removed.When these services are done well, as presented inthe above, there is an emerging literature showingthat outcomes valued by families, schools and com-munities can be achieved. For example, empiricallysupported mental health promotion in schools hasbeen associated with improved emotional and behavioralfunctioning (Botvin, 2000; Greenberg et al, 1999;Horner & Sugai, 2000), academic achievement (Knoff& Batsche, 1995), and cost savings, for examplethrough reduced referrals to special education (Brunset al, 2004).

In reporting on the evidence for mental health pro-motion efforts in schools, Stewart-Brown of the WorldHealth Organization, Europe (2006) stated:

… school-based programmes that promote men-tal health are effective, particularly if developedand implemented using approaches common tothe health promoting schools approach: involve-ment of the whole school, changes to the schoolpsychosocial environment, personal skill devel-opment, involvement of parents and the widercommunity, and implementation over a longperiod of time (p16).

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Related to these recognitions, a number of developednations are prioritizing the SMH promotion agendathrough reports and funded initiatives. In the U.S.,there is a clear federal commitment to school mentalhealth, as found in the President’s New FreedomCommission report (2003), which includes as one of19 recommendations ‘to expand and improve schoolmental health programs’ (Recommendation 4.2, alsosee www.mentalhealthcommission.gov). Since 1995,the Health Resources and Services Administration, withco-funding from the Substance Abuse and MentalHealth Services Administration (SAMHSA) through2001 has funded two national centers to support theadvancement of school mental at the University ofMaryland (http://csmh.umaryland.edu) and theUniversity of California, Los Angeles (http://smhp.psych.ucla.edu). Since 1999, a group of federal agenciesled by SAMHSA has funded the Safe Schools HealthyStudents initiative, which has supported the delivery ofSMH services in over 240 U.S. communities (Furlonget al, 2003; U.S. Department of Education, U.S.Department of Health and Human Services, & U.S.Department of Justice, 2006). The Centers for DiseaseControl and Prevention’s (CDC) Division of Adolescentand School Health (DASH) is currently supporting 23state agencies in implementing coordinated schoolhealth programs, which in recent years have placedadditional emphasis on SMH promotion (NationalCenter for Chronic Disease Prevention and HealthPromotion, 2007).

More recently, the U.S. Department of Educationhas been funding states and localities to build infra-structure for the ‘integration of mental health inschools’, and DASH is also funding state and localeducation agencies to build capacity for effectiveSMH. Further, 12 states have made an explicit commitmentto build the SMH agenda (www.sharedwork.org), andmovements related to school-wide positive behaviorsupport (www.pbis.org) and social and emotionallearning in children in schools are growing rapidly(www.casel.org), with support from the federal govern-ment (see Anglin, 2003 for a review of U.S. support ofSMH, and Robinson, 2004 and Weist et al, 2003 forbooks on SMH based largely on the U.S. experience).

There are a number of initiatives in Australiareceiving governmental support. For example,beyondblue is a national initiative of the state and territorialgovernments that works in partnership with schools,health services, workplaces, universities, media andcommunity organizations to raise awareness and

reduce stigma related to depression. The initiative alsosupports people with depression by providing themwith resources and treatment options, and by encour-aging relevant research (www.beyondblue.org.au/index.aspx?link_id). MindMatters is a nationalresource and professional development programfunded by the Commonwealth Department of Healthand Aging to support Australia secondary schools. Theprogram takes a whole-school approach in promotingthe emotional and social well-being of all members ofthe school community. MindMatters is being imple-mented broadly throughout Australia, 71% of allsecondary schools reporting use of the program.MindMatters is being adopted in other countries, over80,000 people receiving professional developmenttraining on the program (http://cms.curriculum.edu.au/mindmatters/about/about.htm; Hazell, 2006; Mason,2007).

In Canada, Take Action is a school-based initiativeof Ontario’s Ministry of Children and Youth Serviceswhich supports school communities in providing infor-mation and building awareness about tobacco, alco-hol and substance use, risk reduction and health/mental health promotion. The program provides studentswith grade-appropriate lessons which provide afoundation for students to learn decision-making andproblem-solving skills and to make healthy choices inlife. A new component, Take Action in SecondarySchools, has been added, providing educators with areference guide to address and prevent substance use(www.ophea.net/takeactionoverview.cfm).

In England, Social and Emotional Aspects of Learningfor Secondary Schools (Secondary SEAL) takes a whole-school approach to promoting social and emotionallearning that aims, when fully implemented, to involveall members of the school and focus on all aspects ofschool life, including school plans, strategies, policies,teaching and learning, behavior support and staffdevelopment to support social and emotional learning.The program uses a broad five-fold categorization ofsocial and emotional aspects of learning: self-awareness,managing feelings, motivation, empathy and socialskills. These skills also contribute to a more positiveschool climate and promote staff effectiveness andwell-being. Secondary SEAL effectively links with othernational school-based initiatives. The program wasdevised by the Department for Children, Schools andFamilies (www.dcsf.gov.uk/), was successfully piloted in60 schools in 2006, and will be offered to all schoolsby 2011 (http://bandapilot.org.uk/secondary/resources/

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welcome_page/sns_ssealguidance0004307.pdf). In Ireland, Social Personal and Health Education

is an approved part of the school curriculum whichsupports the personal development, health and well-being of young people and helps them create andmaintain supportive relationships. It was originallyintroduced in junior cycle and post-primary schools,and in 2000 the process began of expanding it to allschools. The program aims to promote self-esteemand self-confidence in students. Students are givenstrategies to make healthy, responsible decisions andare given the opportunity for discussion and reflection(www.sphe.ie/info.htm).

In New Zealand, the Mentally Healthy Schoolsinitiative takes a whole-school approach to addressingthe mental health concerns of school communities. Itobtains curriculum support from the Mental HealthMatters program (a health education curriculum). Theinitiative has three main domains: the health curricu-lum, school climate and the relationship betweenschool and home. The initiative acknowledges thatschools must address both individual learning throughthe health curriculum and the broader environment inwhich students learn (www.mentalhealth.org.nz/page.php?123)

The above are a sample of increasing activities indeveloped nations to promote student health andmental health in schools, not an exhaustive review ofall that is going on. In addition to these efforts withincountries, there are a number of networks of countriesthat are pursuing the promotion of mental health inschools. For example, the European Network ofHealth Promoting Schools includes more than 40member nations. It was formed as a partnershipbetween the Council of Europe, the EuropeanCommission and the World Health Organization(WHO) Regional Office for Europe to promote healthin schools. The network connects the policy and practiceof the health-promoting school to the health andeducation sectors. Though the main focus of the programis the student, it also aims to work at school, nationaland international levels. A settings approach to healthserves as the basis for the health-promoting school.The approach maintains that creating a positiveschool environment will enable students to makehealthy choices in all areas of life and improve theirability to learn. This will in turn reap benefits for theentire population with regard to health and prosperity,by reducing societal inequalities (www. euro.who.int/ENHPS; Gray et al, 2006).

Challenges

In spite of the support and progress described for theabove nations, the work is at a very early stage andmany challenges are being confronted. In the U.S.,where there is clear and growing support for SMH,progress is very patchy; some communities embracethis agenda and others maintain the status quo of lim-ited school mental health programs and services(PNFC, 2003; Teich et al, this issue). Even in commu-nities showing some commitment to SMH, interventionservices are generally limited, evidence-based prac-tices are too rarely implemented, and school-widemental health promotion, climate enhancement, andprevention remain relatively rare (Evans & Weist,2004; Kutash et al, 2006; Foster et al, 2005; Weist etal, 2005; Teich et al, this issue).

Federalism in the United States (U.S. GeneralAccounting Office, 2001) creates a strong emphasis onlocal control of schools, with site-based management.This means that even in one small community the pic-ture of school mental health promotion could look verydifferent from one school to the next, depending onschool leadership and other factors, such as the stu-dent body. Some school principals will embrace theSMH agenda, while many others will not, believing, forexample, that schools are for learning and not seeingthe connection between school mental health promo-tion and learning (Paternite, 2004). A prevailing prob-lem is stigma, often about all things related to mentalhealth, which may result in avoidance or minimizationof student mental health issues (WHO, 2001, 2004).Thus a considerable challenge in many schools is toconvince school leadership that the SMH agenda isworthy of strong support. And, given the fluidity ofschool environments, with frequent changes in leader-ship, how can this commitment be sustained?

Language is very important, and language differ-ences are significant in this emerging field. There is alack of agreement on terms; ‘school mental health’,1

‘school-based mental health’, ‘school behavioralhealth’, and ‘social and emotional learning’ are all inactive use in the U.S. Similarly, terms used by some todescribe SMH services, such as ‘clinic-based’, ‘pull-out’ intervention, and ‘co-located’ services clearlyhave negative connotations. There are related concernsabout labeling students with terms like ‘emotional

1 For a number of reasons, including the earlier review of definitions andconcepts, we believe that ‘school mental health promotion’ is the mostappropriate term for the work involved; hence the name of this journal.

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disturbance’ and ‘psychiatric diagnosis’, and manyhave argued for strong caution in using these termsand ‘medicalizing’ the field (Paternite, 2004; Rowling& Weist, 2004). However, these labels are often necessaryfor students to receive services, a clear tension.

Consistent with the factors outlined above, literaturefocusing on U.S. school mental health programs suggeststhat they are often marginalized and struggle for funding(Evans et al, 2003; Teich et al, this issue). Many SMHinitiatives are reliant on fee-for-service fundingmechanisms, which are highly bureaucratic and oftenburdensome to clinicians who operate with limitedadministrative support. Over-reliance on these mecha-nisms may directly militate against evidence-basedpractices (Evans et al, 2003; Evans & Weist, 2004). AsSMH initiatives bring accessible mental health servicesto young people in schools, it is a real challenge toattempt to meet the unaddressed mental health needsof young people with insufficient staff and resources.Scattered, unsupported services usually do not achieveoutcomes (Weisz, 2004), and so advocacy will stall.This creates a ‘Catch 22’ in communities that arecommitted to this agenda; they desire to expand servicesbut are unable to do so without proof that they actuallyachieve desired outcomes (Wandersman, 2003).

A related set of challenges is associated with the biasin health and mental health systems to ‘treat’ people withdisorders, and the general failure to prioritize and funduniversal prevention, social and emotional learningprograms and school climate enhancement,2 in spite of agrowing knowledge base on their importance for a rangeof positive student and school outcomes (Collaborative forAcademic, Social and Emotional Learning, 2003; Durlak& Wells, 1997, 1998; Elias et al, 1997; WingspreadDeclaration on School Connections, 2004).

A significant challenge is a large research to practicegap. While there are at least 40 evidence-based inter-ventions that could be implemented in schools (Centerfor School Mental Health Assistance, 2002), theseinterventions may be somewhat cumbersome toimplement, require significant infrastructure supportthat usually does not exist, may engender clinicianresistance, and are often in need of some degree ofmodification for application in a particular school site(Grasczyk et al, 2003; Kutash et al, 2006; Evans &Weist, 2004; Flaspohler et al, 2006; Ringeisen et al,2003). This realization is leading to an important line

of research which is seeking to build implementationsupport for effective SMH practices (Fixsen et al,2005), including supported use of manualizedapproaches and of more flexible modular strategies(Chorpita et al, 2004; Chorpita, 2006), and empha-sizing positive relationships with students, protectivefactor enhancement and risk and stress factor reduction(Weist et al, 1999).

A daunting issue encountered in the U.S. and othernations pertains to the SMH workforce. Many commu-nities lack enough mental health professionals, andthe ratio of school-employed mental health profes-sionals to students is commonly significantly belowrecommended levels (Paternite et al, 2006). Mentalhealth professionals may receive little training inevidence-based practices, and in child and adoles-cent mental health unproven approaches continue tobe commonly used (Evans & Weist, 2004; Hoagwoodet al, 2007; Institute of Medicine, 2001; Kutash et al,2006; Schaeffer et al, 2005). Discipline-related turf andtension remain common, fueled partly by professionalorganizations which promote their discipline and holdconferences for their members (Flaherty et al, 1998;Rappoport et al, 2003). There are relatively few inter-disciplinary training events, and interdisciplinary train-ing at the pre-service level is extremely rare (Paterniteet al, 2006). These realities are inconsistent with thework in schools, where the work is inherently interdis-ciplinary and where, in reality, the boundaries areblurring as social workers, counselors, psychologists,and nurses (and in some cases teachers) may bedoing very similar work.

Similarly, significant involvement of young peopleand families and other school and community stake-holders in planning, implementing, and continuouslyimproving SMH services is an important aspiration forthe field, consistent with the movement toward truesystems of care (Stroul & Friedman, 1996; Leaf et al,2003). Yet tokenism (marginally involving stakehold-ers, for example to achieve a grant requirement) con-tinues to prevail (Bickham et al, 1998; Lowie et al,2003). An important agenda for research and policyis on how to best engage young people and familiesand other invested people meaningfully in this work,and to gauge the incremental benefit of such stake-holder involvement.

All of these challenges point to many areas in needof research and knowledge development in thisemerging field, and we hope this journal can be aresource for the same. We acknowledge that much of

2 On a positive note, this trend is beginning to change, some U.S. states(such as Illinois, Ohio) enhancing funding for these programs and makingthem legislative priorities.

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the above refers to the U.S. experience. There appearsto be no literature comparing SMH experiences in theU.S. with those of other developed nations. And,importantly, there is very little information on schoolmental health in less developed nations. Articles com-paring SMH themes across nations and focusing onunder-developed nations will receive special priority.

Moving forward

The above emphasizes that school mental healthpromotion is an emerging field, gathering significantmomentum in some countries, but with considerablevariability in these countries, and probably with limitedor non-existent status in the rest, especially in under-developed nations. There is a clear need for a globalassessment of the status of these efforts, along withdocumentation of lessons learnt and effective practicesin advancing training, practice, research and policyagendas, and in connecting these agendas together.The International Alliance for Child and AdolescentMental Health and Schools (Intercamhs) emerged inthe early 2000s as a small consortium of people fromaround 10 countries with a strong interest in schoolmental health promotion, and has since grown to over300 people from 30 countries. Intercamhs hasengaged in a number of actions to advance a globalschool mental health agenda, including presenting onthis theme at a number of international meetings,assisting under-developed nations in building a focuson schools, and promoting networking and collabora-tion by interested people within and across countries(www.intercamhs.org).

In addition, along with other international organi-zations, Intercamhs is participating in the GlobalConsortium to Advance Promotion and Prevention inMental Health (GCAPP). GCAPP is an internationalnetwork of organizations that serves as a global forumfor information exchange, discussion and mutual supportin planning and implementing shared actions to promotemental health through partnership/collaborative working.It does this by building capacity for informationexchange and by providing other assistance servicesfor researchers, policy makers, advocates, practitionersand consumers across the globe. GCAPP is a catalyst,creating synergy across international organizationsand borders to expand the capacity for developing,disseminating and implementing culturally tailored,effective interventions.

This journal is an example of the catalytic role of

international networks such as Intercamhs and GCAPP. Together, Intercamhs and GCAPP have participated

in international and world conferences related to SMHpromotion, including meetings in Auckland, Dublin,London, Perth, Oslo and Vancouver. Upcoming meetingsof importance, in 2008, include The Fifth WorldConference on the Promotion of Mental Health andPrevention of Mental and Behavioral Disorders,Melbourne, and Towards the Future: New Frontiers forHealth Promotion, Turin.

In addition to this work, the Center for SchoolMental Health (CSMH) at the University of Maryland,a co-sponsor of this journal with the Clifford BeersFoundation, is working with the IDEA Partnership(funded by the U.S. Office of Special EducationPrograms) to build a Community of Practice on SchoolMental Health (Wenger et al, 2002). The communityincludes 12 states which have committed to advancingthe SMH agenda, and 10 practice groups that arepursuing deeper dialogue and collaboration in areasof priority for the field, for example youth involvement,family partnerships, language issues, quality andevidence-based practice, and interdisciplinary train-ing. The community interacts through a web-site,www.sharedwork.org, phone conferences and meetingsof state initiatives and practice groups, and in anannual conference on Advancing School MentalHealth sponsored by the CSMH (http://csmh.umaryland.edu). People from other countries are beginning tojoin and interact with the community, and internation-al involvement in the community is now a priority.Highly user-friendly websites such as The SchoolMental Health Connection (www.schoolmentalhealth.org)are also emerging, with helpful information on therange of SMH topics for teachers, students, familymembers, and health and mental health staff.

All of the above are promoting multi-scale learning,where connections are being made at every level –community to community, state to state, national tostate, federal to state, federal to national, nation tonation, state to international, and so on, promotingactive dialogue and collaboration, mutual support andsharing of ideas, lessons learnt, and the growth ofevidence-based and promising practices. A recentexample occurred when the Ohio Department ofMental Health contacted the CSMH for assistance indeveloping school plans to help students with themental health impacts of the pandemic flu. CSMHstaff recognized that the Maryland Department ofEducation had recently convened a task force and

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developed a report on this exact topic. Leaders fromMaryland who developed the report were connectedto leaders in Ohio preparing to work on a report, andessentially the Maryland report was adopted by Ohio,saving much effort and enhancing a state-to-statecollaboration. It is our hope that this journal willfacilitate this multi-scale learning in advancing theschool mental health promotion agenda globally.

This journal and articles in this inauguralissue

As presented on the website for this journal(www.schoolmentalhealth.co.uk), this journal emphasizeshigh-qquality and empirically supported school mentalhealth promotion efforts, outcomes valued by families,schools and community members, and policy develop-ment and advocacy, all working together and gainingstrength to enable growing numbers of schools andcommunity initiatives to remove barriers to student learn-ing and promote their school and life success.

This inaugural issue includes articles reflectingthese themes. First, Judy Teich of the Substance Abuseand Mental Health Services Administration and col-leagues present on the first-ever comprehensive surveyof school mental health in the U.S. Findings highlightthe growth of the field and the many areas in need offurther development. Louise Rowling, of the Universityof Sydney and President of Intercamhs, then reviewscritical dimensions to gaining political support forschool mental health promotion. Alexandra Hilt-Panahon and colleagues from Lehigh and LouisianaState Universities present a critical review of school-based efforts to treat depression in children and ado-lescents. This first issue closes with an article byHeather Alvarez of Ohio University on teachers’ stressand their psychosocial adjustment and functioning inthe classroom. We are pleased to be able to includethese articles on important topics for the advancementof school mental health promotion by recognizedleaders in the field.

Contact details

For further information, contact Mark D Weist, PhD,Division of Child and Adolescent Psychiatry, Center forSchool Mental Health, University of Maryland Schoolof Medicine, 737 West Lombard Street, 4th Floor,Baltimore, MD 21201, USA; [email protected], http//csmh.umaryland.edu.

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