Search results for: mental health stigma

Authors: Johnnie Hay

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New Zealand is well known for its natural beauty, diversity of people but also for its strong focus on mental health through the provision of a vast network of psycho-social support services. South African-trained psychologists often make New Zealand their new home when emigrating - as it is relatively simple to slot into the well-established mental health system. South Africa is bigger in size, population, GDP and probably people diversity than New Zealand but struggles to provide adequate educational and psychological support services to schools. This is mainly due to budgetary pressures brought about by the imperative to first ensure that the approximately 13 million learners all have a teacher in front of their classes and at an average ratio of not more than 40 learners per class. In this paper, perspectives on educational and psychological support in New Zealand and South African schools will be shared. Through basic qualitative research encompassing semi-structured interviews with two South African educational psychologists who returned from New Zealand, supplemented by document analysis, the New Zealand situation will be scrutinized. South African perspectives will be obtained through a number of semi-structured interviews and questionnaires administered by education support services specialists working in district-based support teams in three provinces of the country. This research is in process, but preliminary findings indicate large disparities between the two countries' emphasis, funding, post provisioning and structure regarding educational and psychological support services.

Keywords: educational psychological support services, support for learners experiencing special needs, education support services, diverse learner population

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Authors: Abdirahim Mohamed, Sarita Rana Chhetri, Michael Sleath, Nadia Saleem

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Rationale: Internet usage has been very much integrated into our daily lives. Internet usage within a neurodevelopmental disorder population is also on the increase. Nevertheless, there is very little empirical research on how this population virtually protect themselves; along with how their parents can keep them safe online. This topic was an ever-growing concern to the parents within our services and in many cases would add to the stresses and mental health of parents. This ignited an idea within our team to conduct research to explore the perceived online risks within this population and how they keep themselves safe. In conjunction, we also explored how parents and caregivers monitor and safeguard their young people to the potential threats online. Our hypothesis was that the perceived risks will heavily outnumber the safeguarding measures implemented by this population. Method: Within the Coventry and Warwickshire NHS Partnership Trust Child and Adolescent Mental Health Service (CAMHS), we distributed qualitative questionnaires to all the clinical bases (N=80). Questions explored topics such as daily internet usage, safeguarding measures, and perceived threats. The researchers requested for all CAMHS clinicians to identify participants. Participants in this study were accessing CAMHS for neurodevelopmental specific interventions. Results: The data were analysed using both Excel and SPSS. Within SPSS, a MANOVA was conducted and found a significant difference between safeguarding measures and perceived online risks within responses (p ≤ 0.5). This supports our hypothesis that participants in this population are well versed in the safeguarding issues of the internet; however, struggle to implement appropriate preventative measures. Data were also screened using Excel and found that all parents and carers stated they 'monitored their child’s internet use'. Conclusion: Data suggest that parents/carers may require more specific intervention to equip them with preventative measures due to the clear discrepancy between perceived risks and safeguarding measures. More research may also need to be conducted around this area to determine appropriate methodology to explore this topic further.

Keywords: Internet, health , how safe are we , internet health check

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Authors: Rosanna M. Rooney, Sharinaz Hassan, Maryanne McDevitt, Jacob D. Peckover, Robert T. Kane

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Anxiety and depression are the most common mental health problems experienced by Australian children and adolescents. Research into youth mental health points to the importance of considering emotional competence, parental influence on the child’s emotional development, and the fact that cognitions are still developing in childhood when designing and implementing positive psychology interventions. Additionally, research into such interventions has suggested the inclusion of a coaching component aimed at supporting those implementing the intervention enhances the effects of the intervention itself. In light of these findings and given the burden of anxiety and depression in the longer term, it is necessary to enhance the Aussie Optimism Positive Thinking Skills program and evaluate its efficacy in terms of children’s mental health outcomes. It was expected that the enhancement of the emotional and cognitive aspects of the Aussie Optimism Positive Thinking Skills program, the addition of coaching, and the inclusion of a parent manual would lead to significant prevention effects in internalizing problems at post-test, 6- and 18-months after the completion of the intervention. 502 students (9-11 years old) were randomly assigned to the intervention group (n = 347) or control group (n = 155). At each time point (baseline, post-test, 6-month follow-up, and 18-month follow-up), students completed a battery of self-report measures. The ten intervention sessions making up the enhanced Aussie Optimism Positive Thinking Skills program were run weekly. At post-test and 6-month follow-up, the intervention group reported significantly lower depression than the control group, with no group differences at the 18-month follow-up. The intervention group reported significantly lower anxiety than the control group only at the 6-month follow-up, with no group differences in the post-test or at the 18-month follow-up. Results suggest that the enhanced Aussie Optimism Positive Thinking Skills program can reduce depressive and anxious symptoms in the short term and highlight the importance of universally implemented positive psychology interventions.

Keywords: positive psychology, emotional competence, internalizing symptoms, universal implementation

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Authors: Clare Victoria Martin

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With reports of increased mental health problems and a lack of proactive, consistent well-being initiatives, well-being is a topical issue in the workplace, as well as a wider public health concern. Additionally, workplace well-being is closely linked to performance, both from a business perspective and in psychological research. Businesses are therefore becoming increasingly motivated to promote well-being, yet there are still barriers, including a lack of evidence-based workplace interventions, issues with measuring effectiveness and problems creating lasting cultural change. This review aimed to collate workplace well-being research to propose a comprehensive new model for delivering evidence-based workplace well-being training with a real potential for lasting impact. Method: A narrative review was conducted to meta-synthesise relevant research. Thematic analysis was then adopted as a systematic method of identifying key themes from the review to lead to practical recommendations. Interventions focusing on strengths, psychological capital, mindfulness and positivity (SPMP) dominated the research in this area, suggesting benefits of incorporating all four into training. However, to avoid a ‘quick fix’ mentality, the concept of training ‘well-being ambassadors’ as a preventative counterpart to mental health ‘first aiders’ was proposed alongside a new ‘REST and RISE’ model: well-being interventions should be ‘relatable’, ‘enjoyable’, ‘sociable’ and ‘trackable’ (REST) in order to increase ‘resilience’, ‘innovation’, ‘strengths’ and ‘engagement’ (RISE). If the REST principles are applied to interventions focusing on SPMP, research suggests individuals will RISE. Future research should empirically test this new well-being ambassador programme and REST/RISE model in an applied setting.

Keywords: performance, positive psychology, thriving, workplace well-being

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Authors: Patricia L. Fontanilla, David Nordstokke

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Introduction: Today’s children and youth face increasing social and behavioural challenges, leading to delays in social development and greater mental health needs. Early adolescents (aged 9 to 14) are experiencing a rise in mental health symptoms and diagnoses. This study examines the impact of HEROES, a social-emotional learning (SEL) program, on resilience and academic outcomes in early adolescents. The HEROES program is designed to enhance resilience the ability to adapt and thrive in the face of adversity, equipping youth to navigate developmental transitions and challenges. This study’s objective was to evaluate the program’s long-term effectiveness by measuring changes in resilience and academic resilience across 10 months. Methodology: This study collected data from 21 middle school students (grades 7 to 9) in a rural Canadian school. Quantitative data were gathered at four intervals: pre-intervention, post-intervention, and at 2- and 4-month follow-ups. Data were analyzed with linear mixed models (LMM). Results: Findings showed statistically significant increases in academic resilience over time and significant increases in resilience from pre-intervention to 2 and 4 months later. Limitations included a small sample size, which may affect generalizability. Conclusion: The HEROES program demonstrates promise in increasing resilience and academic resilience among early adolescents through SEL skill development.

Keywords: academic resilience, early adolescence, resilience, SEL, social-emotional learning program

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Authors: Stela Doncheva

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Postpartum distress, encompassing depressive symptoms, obsessions, and anxiety, remains a subject of significant scientific interest due to its prevalence among individuals giving birth. This critical and transformative period presents a multitude of factors that impact women's health. On the one hand, variables such as social support, satisfaction in romantic relationships, shared newborn care, and birth satisfaction directly affect the mental well-being of new mothers. On the other hand, the interplay of hormonal changes, personality characteristics, emotional difficulties, and the profound life adjustments experienced by mothers can profoundly influence their self-esteem and overall physical and emotional well-being. This paper extensively explores the factors of alexithymia, social support, partners' support, and birth satisfaction to gain deeper insights into their impact on postpartum distress. Utilizing a qualitative survey consisting of six self-reflective questionnaires, this study collects valuable data regarding the individual postpartum experiences of Bulgarian mothers. The primary objective is to enrich our understanding of the complex factors involved in the development of postpartum distress during this crucial period. The results shed light on the intricate nature of the problem and highlight the significant influence of bio-psycho-social elements. By contributing to the existing knowledge in the field, this research provides valuable implications for the development of interventions and support systems tailored to the unique needs of mothers in the postpartum period. Ultimately, this study aims to improve the overall well-being of new mothers and promote optimal maternal health during the postpartum journey.

Keywords: maternal mental health, postpartum distress, postpartum depression, postnatal mothers

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Authors: Maria Do Carmo Baracho De Alencar, Marciene Campos Fialho, Maria Do Carmo Vitório Ramos

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The subjects affected by Repetitive Strain Injury/Work Related Musculoskeletal Disorder (RSI/WRMSD) face an everyday life marked by pain, feelings of worthlessness and incapacity caused by the disease, and aggravated often because of discrimination society. Aim: To investigate the experiences and feelings of workers affected by RSI/WRMSD in removal from work situations and to understand the repercussions on mental health. Methods: Clinical records of workers were consulted, opened from July 1, 2014, to July 1, 2015, at the Reference Center for Worker's Health, in Santos city-SP. Selection of workers affected by RSI /WRMSD and who had experienced the removal from work situation due to the disease, and invitation to participate in the study. Semi-structured and individual interviews were carried out based on a pre-elaborated script, and for thematic content analysis. Results: Of a total of 502 medical records, 157 were selected, and of these, 18 workers participated in the interviews, both gender, most of them with low education level, aged between 35 and 56 years, and from different professions. Diseases affected several physical body regions and some workers had more than one body region affected by chronic pain. In the testimonies emerged the psychic suffering by the process of illness at work, fear of dismissal, invisibility of pain, in medical expertise attendance, by the incapacity to perform tasks that were easily achievable, with feelings of uselessness, revolt, and injustice, among others. Conclusion: The workers need to be readapted to new life situations, and the study promotes reflections on the need for more interdisciplinary actions and of the Psychology to the workers affected by RSI/ WRMSD.

Keywords: repetitive strain injury, cumulative trauma disorder, absence from work, mental health, occupational health

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Authors: Ines Vieira, Luisa Faria

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Globally, half of all mental disorders begin by age 14 and the current gap of poorly addressed adolescent mental health has future consequences in adulthood. Schoolwork pressure to achieve good performance in secondary education might lead to lower levels of life satisfaction in youth and individual emotional competencies are crucial in this life stage. The present study aimed to determine how mindfulness relates to school achievements and well-being in adolescence and whether such a relationship might be mediated by emotional intelligence. We also studied the moderation interaction effects of gender and the involvement in non-curricular activities. A sample of 597 Portuguese adolescents aged 15 to 17 years old (N=597; 292 girls; 298 boys), enrolled in secondary education completed self-report measures of mindfulness (CAMM), emotional intelligence (TEIQue-ASF) and well-being (SWLS) in their Portuguese versions. Using SPSS and AMOS, the results were obtained through path analyses and multiple linear regression. A Confirmatory Factor Analysis was also conducted. The correlation coefficients reported a positive and statistically significant relationship between mindfulness, emotional intelligence and well-being. Regression analysis indicated that mindfulness reduced its influence on well-being and on school results when emotional intelligence was added to the model. Overall, our results provided further evidence supporting the development of robust hypotheses by perceiving the relevance of mindfulness and individual emotional competencies to school achievements and well-being in a way of improving adolescents’ health, wellness, and school success.

Keywords: mindfulness, emotional intelligence, well-being, adolescence, school

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Authors: Tasha L. Golden

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Girls in the U.S. juvenile justice system are most often arrested for truancy, drug use, or running from home, all of which are symptoms of abuse. In fact, some have called this 'The Sexual Abuse to Prison Pipeline.' Such abuse has consequences for girls' health, education, employment, and parenting, often resulting in significant health disparities. Yet when arrested, girls rarely encounter services designed to meet their unique needs. Instead, they are expected to cope with a system that was historically designed for males. In fact, even literature advocating for increased gender equity frequently fails to include girls’ voices and firsthand accounts. In response to these combined injustices, public health researchers launched a trauma-informed creative writing intervention in a southern juvenile detention facility. The program was designed to improve the health of detained girls, while also establishing innovative methods of both data collection and social justice advocacy. Girls’ poems and letters were collected and coded, adding rich qualitative data to traditional survey responses. In addition, as part of the intervention, these poems are regularly published by international literary publisher Sarabande Books—and distributed to judges, city leaders, attorneys, state representatives, and more. By utilizing a creative medium, girls generated substantial civic engagement with their concerns—thus expanding their influence and improving policy advocacy efforts. Researchers hypothesized that having access to their communities and policy makers would provide its own health benefits for incarcerated girls: cultivating self-esteem, locus of control, and a sense of leadership. This paper discusses the establishment of this intervention, examines findings from its evaluation, and includes several girls’ poems as exemplars. Grounded in social science regarding expressive writing, stigma, muted group theory, and health promotion, the paper theorizes about the application of arts-based advocacy efforts to other social justice endeavors.

Keywords: advocacy, public health, social justice, women’s health

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Authors: Hana Ashique, Florence Onabanjo

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Objectives: Research on drug abuse education in secondary schools has highlighted the discrepancy between drug policies and practice. Drug abuse is closely associated with child mental health, and with increasing drug overdose deaths in the UK, approximately doubling in the last 30 years, it becomes important to revolutionise drug abuse education. Medical professionals from the University of Nottingham piloted a drug abuse workshop at a state school in Nottingham for children between the age of 14-15 years. An interactive and educational approach was implemented, which explained addiction from a medical perspective. The workshop aimed to debunk medical beliefs children harboured about drugs and to support children in making informed drug choices. Methods: The sample group consisted of six cohorts of 30 children from year 10. The workshop was delivered in three segments to each cohort. In the first segment, the children were introduced to the physiological mechanisms behind drug dependence and reward pathways. The second segment consisted of interactive discussions between the children and medical professionals. This also involved conversations between the children about their perspectives on drug abuse, thereby co-creating knowledge. The third segment used art to incorporate storytelling from the perspective of a year ten child. This exercise investigated the causes that led children to abuse drugs. A feedback questionnaire was distributed among the children to analyse the impact of the workshop. Results: The children answered eight questions. 56% agreed/strongly agreed that they found being taught by medical professionals effective. 50% disagreed, strongly disagreed, or felt neutral that they had received sufficient education about drug abuse previously. Notably, 20% agreed that they feel more likely to ask for help from a medical professional or organisation if they need it. Conclusion: The results highlighted the relevance of medical professionals to function as peer educators in drug abuse education to secondary school children. This would build trust between children and the medical profession within the community. However, a minority proportion of children showed keenness to seek support from medical professionals or organisations for their mental health if they needed it. This exposed the anxiety children have in coming forward to seek professional help. In order to work towards a child-centred approach, educational policies and practices need to align. Similar workshops and research may need to be conducted to expose different perspectives toward drug abuse education.

Keywords: adolescent mental health, evidence-based teaching, drug abuse awareness, medical professional led workshops

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Authors: Andrew Shugyo Daijo Bonnici

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Core-Self Intelligence (CSI) is an absolutely still, non-verbal, non-cerebral intelligence. Our still core-self intelligence is felt at our body's center point of gravity, just an inch below our navel, deep within our lower abdomen. The still sub-quantum depth of core-Self remains untouched by the conditioning influences of family, society, culture, religion, and spiritual views that shape our personalities and ego-self identities. As core-Self intelligence is inborn and unconditioned, it exists within all human beings regardless of age, race, color, creed, mental acuity, or national origin. Our core-self intelligence functions as a wise and compassionate guide that advances our health and well-being, our mental clarity and emotional resiliency, our fearless peace and behavioral wisdom, and our ever-deepening compassion for self and others. Although our core-Self, with its absolutely still non-judgmental intelligence, operates far beneath the functioning of our ego-self identity and our thinking mind, it effectively coexists with our passing thoughts, all of our figuring and thinking, our logical and rational way of knowing, the ebb and flow of our feelings, and the natural or triggered emergence of our emotions. When we allow our whole inner somatic awareness to gently sink into the intelligent center point of gravity within our lower abdomen, the felt arising of our core- Self’s inborn stillness has a serene and relaxing effect on our ego-self and thinking mind. It naturally slows down the speedy passage of our involuntary thoughts, diminishes our ego-self's defensive and reactive functioning, and decreases narcissistic reflections on I, me, and mine. All of these healthy cognitive benefits advance our innate wisdom and compassion, facilitate our personal and interpersonal growth, and liberate the ever-fresh wonder and curiosity of our beginner's heartmind. In conclusion, by studying, exploring, and researching our core-Self intelligence, psychologists and psychotherapists can unlock new avenues for advancing the farther reaches of our mental, emotional, and spiritual health and well-being, our innate behavioral wisdom and boundless empathy, our lucid compassion for self and others, and our unwavering confidence in the still guiding light of our core-Self that exists at the abdominal center point of all human beings.

Keywords: intelligence, transpersonal, beginner’s heartmind, compassionate wisdom

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Authors: Winnie Kung, Xinhua Liu, Debbie Huang, Patricia Kim, Keon Kim, Xiaoran Wang, Lawrence Yang

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Considerable Asian Americans were exposed to the World Trade Center attack due to the proximity of the site to Chinatown and a sizeable number of South Asians working in the collapsed and damaged buildings nearby. Few studies focused on Asians in examining the disaster’s mental health impact, and even less longitudinal studies were reported beyond the first couple of years after the event. Based on the World Trade Center Health Registry, this study examined the trajectory of PTSD of individuals directly exposed to the attack from 2-3 to 5-6 years after the attack, comparing Asians against the non-Hispanic White group. Participants included 2,431 Asians and 31,455 Whites. Trajectories were delineated into the resilient, chronic, delayed-onset and remitted groups using PTSD checklist cut-off score at 44 at the 2 waves. Logistic regression analyses were conducted to compare the poorer trajectories against the resilient as a reference group, using predictors of baseline sociodemographic, exposure to the disaster, lower respiratory symptoms and previous depression/anxiety disorder diagnosis, and recruitment source as the control variable. Asians had significant lower socioeconomic status in terms of income, education and employment status compared to Whites. Over 3/4 of participants from both races were resilient, though slightly less for Asians than Whites (76.5% vs 79.8%). Asians had a higher proportion with chronic PTSD (8.6% vs 7.4%) and remission (5.9% vs 3.4%) than Whites. A considerable proportion of participants had delayed-onset in both races (9.1% Asians vs 9.4% Whites). The distribution of trajectories differed significantly by race (p<0.0001) with Asians faring poorer. For Asians, in the chronic vs resilient group, significant protective factors included age >65, annual household income >$50,000, and never married vs married/cohabiting; risk factors were direct disaster exposure, job loss due to 9/11, lost someone, and tangible loss; lower respiratory symptoms and previous mental disorder diagnoses. Similar protective and risk factors were noted for the delayed-onset group, except education being protective; and being an immigrant a risk. Between the 2 comparisons, the chronic group was more vulnerable than the delayed-onset as expected. It should also be noted that in both comparisons, Asians’ current employment status had no significant impact on their PTSD trajectory. Comparing between Asians against Whites, the direction of the relationships between the predictors and the PTSD trajectories were mostly the same, although more factors were significant for Whites than for Asians. A few factors showed significant racial difference: Higher risk for lower respiratory symptoms for Whites than Asians, higher risk for pre-9/11 mental disorder diagnosis for Asians than Whites, and immigrant a risk factor for the remitted vs resilient groups for Whites but not for Asians. Over 17% Asians still suffered from PTSD 5-6 years after the WTC attack signified its persistent impact which incurred substantial human, social and economic costs. The more disadvantaged socioeconomic status of Asians rendered them more vulnerable in their mental health trajectories relative to Whites. Together with their well-documented low tendency to seek mental health help, outreach effort to this population is needed to ensure follow-up treatment and prevention.

Keywords: PTSD, Asian Americans, World Trade Center Attack, racial differences

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Authors: Vasoontara Yiengprugsawan, Sam-ang Seubsman

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As Thais live longer, caregivers will become even more important to social and healthcare systems. Commonly reported in many low and middle‐income countries in Asia, formal social welfare services to support caregivers are lacking and informal family support will be required for all levels of care. In 2005, 87,151 open‐university adults were recruited to the Thai Cohort Study, with the majority aged between 25 and 39 years, and residing nationwide. At the 4‐year follow up in 2009 (n=60569) and the 8‐year follow‐up in 2013 (n=42785), prospective cohort participants were asked if they provide care for chronically ill, disabled, or frail family members. Among Thai cohort members reporting between 2009 and 2013, approximately 56% were not caregivers in either year, 24.5% reported providing care in 2009 only, 8.6% in 2013 only, and 10.6% reported providing care at both time points. Caregivers in the cohort reported providing financial support, help with shopping, emotional support, and assist with daily activities. Kessler 6 psychological distress scale, measured in both 2009 and 2013, was used as the primary outcome of a relationship between caregiving status and mental health. Using multivariate logistic regression, our 4‐year longitudinal findings revealed that cohort members who reported providing care at both time points were 1.4 to 1.6 times more likely to report high psychological distress than non‐caregivers, after accounting for potential covariates. With increasing needs for informal care provided by family members, the future health and social welfare system will need to provide adequate support to caregivers (e.g., respite care, clinical support and information for the family, and awareness of mental health among caregivers).

Keywords: family caregivers, psychological distress, prospective cohort, longitudinal study, Thailand

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Authors: M. Walmsley, S. Elmatarri, S. Mannion

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Introduction: Self-inflicted injury is a recognised cause of major trauma in adults and is an independent indicator of a reduced functional outcome compared to non-intentional major trauma. There is little literature available on the inpatient mental health (MH) management of this vulnerable group. A retrospective review was conducted of inpatient MH management of major trauma patients admitted to a UK regional Major Trauma Centre (MTC). Their outcomes were compared to all major trauma patients. This group of patients required multiple MH interventions whilst on the Major Trauma Ward (MTW) and a had worse functional outcome compared to non-intentional trauma. Method: The national TARN (Trauma Audit and Research Network) database was used to identify patients admitted to a regional MTC over a 2-year period from June 2018 to July 2020. Patients with an ISS (Injury Severity Score) of greater than 15 with a mechanism of either self-harm or high-risk behavior were included for further analysis. Inpatient medical notes were reviewed for MH interventions on the MTW. Further outcomes, including mortality, length of stay (LOS) and Glasgow Outcome Score (GOS) were compared with all major trauma patients for the same time period. Results: A total of 60 patients were identified in the time period and of those, 27 spent time on the MTW. A total of 23 (85%) had a prior MH diagnosis, with 11 (41%) under the care of secondary MH services. Adequate inpatient records for review were available for 24 patients. During their inpatient stay, 8 (33%) were reviewed on the ward by the inpatient MH team. There were 10 interventions required for 6 (25%) patients on the MTW including, sections under the Mental Health Act, transfer to specialist MH facility, pharmacological sedation and security being called to the MTW. When compared to all major trauma patients, those admitted due to self-harm or high-risk behavior had a statistically significantly higher ISS (31.43 vs 24.22, p=0.0001) and LOS (23.51d vs 16.06d, p=0.002). Functional outcomes using the GOS were reduced in this group of patients, GOS 5 (low disability) (51.66% vs. 61.01%) and they additionally had a higher level of mortality, GOS 1 (15.00% vs 11.67%). Discussion: Intentional self-harm is a recognised cause of major trauma in adults and this patient group sustains more severe injuries, requiring a longer hospital stay with worse outcomes compared to all major trauma patients. Inpatient MH interventions are required for a significant proportion of these patients and therefore, there needs to be a close relationship with MH services. There is limited available evidence for how this patient group is best managed as an inpatient to aid their recovery and further work is needed on how outcomes in this vulnerable group can be improved.

Keywords: adult major trauma, attempted suicide, self-inflicted major trauma, inpatient management

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Authors: Paul Narh Doku

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The relationship between parental HIV/AIDS status or death and child mental health is well known, although the role of child maltreatment as a confounder or mediator in this relationship remains uncertain. This study examined the potential path mechanism through child maltreatment mediating the link between HIV/AIDS family dysfunction trajectories and psychosocial problems. A cross-sectional survey was conducted in the Lower Manya Municipal Assembly of Ghana. A questionnaire which consisted of the Strengths and Difficulties Questionnaire (SDQ), Social and Health Assessment (SAHA), Rosenberg Self-Esteem Scale (RSES), and the Conflict Tactics Scale (CTS) was completed by 291 adolescents. Controlling for relevant sociodemographic confounders, mediation analyses using linear regression were fitted to examine whether the association between family dysfunction and psychosocial problems is mediated by child maltreatment. The results indicate that, among adolescents, child maltreatment fully mediated the association between being orphaned by AIDS and self-esteem, delinquency and risky behaviours, and peer problems. Similarly, child maltreatment fully mediated the association between living with an HIV/AIDS-infected parent and self-esteem, delinquency and risky behaviours, depression/emotional problems, and peer problems. Partial mediation was found for hyperactivity. Child maltreatment mediates the association between the family dysfunction trajectories of parental HIV/AIDS or death and psychosocial problems among adolescents. This implies that efforts to address child maltreatment among families affected by HIV/AIDS may be helpful in the prevention of psychosocial problems among these children, thus enhancing their well-being. The findings, therefore, underscore the need for comprehensive psychosocial interventions that address both the unique negative exposures of HIV/AIDS and maltreatment for children affected by HIV.

Keywords: child maltreatment, child abuse, mental health, psychosocial problems, domestic violence, HIV/AIDS, adolescents

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Authors: Cecilia Fagerstrom, Solve Elmstahl, Lena S. Wranker

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The conditions of increased morbidity in an aging population cause the need for family care to become more common at an advanced age. The role of family caregivers may well last for a long time but may also change over time, from being caregivers to being non-caregivers or vice versa. Although demands associated with family caring change as individuals enter into, engage with, and exit from this role, the evidence regarding the impact of family caregiving transitions on the health of older carers is still limited. This study comprised individuals (n=2294, 60+years) from the southern part of Sweden included in the project Swedish National study of Aging and Care. Caregiving transitions are discussed in the categories: enter, exit, and continuing during a six-year period. Individuals who exited caregiving during the time were older than those who continued or entered into the role of caregiving. At the six-year follow-up, caregivers who were continuing or had exited caregiving were more often worried about their own health compared to baseline. Resembling findings were not found in those who entered caregiving. Family caregiving transitions of exiting, entering or continuing had no effect on the individuals’ functional, physical and mental health expect for participants who entered in caregiving. For them, entering the role of family caregiving was associated with an improvement in physical health during the six years follow up period. Conclusion: Although the health impact of different caregiving transitions in late life does not differ, individual conditions and health at baseline are important parameters to take into consideration to improve long-term health in family caregivers.

Keywords: family caregiving, health, old age, transition

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Authors: Neeru Deep, Kimberly McAlister

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Mental health issues have been increasing worldwide for many decades, but the COVID-19 pandemic has brought mental health issues into the spotlight. Within higher education, promoting the well-being of students has dramatically increased in focus. The Northwestern State University of Louisiana opened the Center for Positivity, Well-being, and Hope using the action research process of reflecting, planning, acting, and observing. The study’s purpose is two-fold: First, it highlights how to create a collaborative team to reflect, plan, and act to develop a well-being culture in higher education institutions. Second, it investigates the efficacy of the center through Seligman’s lenses. The researchers shared their experience in the first three phases of the action research process and then applied an identical concurrent mixed methods design. A purposive sample evaluated the efficacy of the center through Seligman’s lenses. The researcher administered PERMA-Profiler Measure, the PERMA-Profiler Measure overview, the CoPWH Evaluation I, and the CoPWH Evaluation II questionnaires to collect qualitative and quantitative data. The thematic analysis for qualitative and descriptive statistics for quantitative data concluded that the center creates a well-being culture and promotes well-being in college students. In conclusion, this action research shares the successful implementation of the cyclic process of research in promoting a well-being culture in higher education with the implications for promoting a well-being culture in various educational settings, workplaces, and communities.

Keywords: action research, mixed methods research design, Seligman, well-being.

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Authors: Kevin William Taylor

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This work draws upon research in the fields of games development and mental health treatments to assess the influence that interactive entertainment has on the populous, and the potential of technology to affect areas of psychiatric assessment and treatment. It will use studies to establish the evolving direction of interactive media in the development of ‘digital self-identity,’ and how this can be incorporated into treatment to the benefit of psychiatry. It will determine that this approach will require collaborative production between developers and psychiatrists in order to ensure precise goals are met, improving the success of serious gaming for psychiatric assessment and treatment. Analysis documents the reach of video games across a growing global community of gamers, highlighting cases of the positives and negatives of video game usage. The games industry is largely oblivious to the psychological negatives, with psychiatrists encountering new conditions such as gaming addiction, which is now recognized by the World Health Organization. With an increasing amount of gamers worldwide, and an additional time per day invested in online gaming and character development, the concept of virtual identity as a means of expressing the id needs further study to ensure successful treatment. In conclusion, the assessment and treatment of game-related conditions are currently reactionary, and while some mental health professionals have begun utilizing interactive technologies to assist with the assessment and treatment of conditions, this study will determine how the success of these products can be enhanced. This will include collaboration between software developers and psychiatrists, allowing new avenues of skill-sharing in interactive design and development. Outlining how to innovate approaches to engagement will reap greater rewards in future interactive products developed for psychiatric assessment and treatment.

Keywords: virtual reality, virtual identity, interactivity, psychiatry

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Authors: Zahra Soltani Shal

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Introduction: The COVID-19 pandemic marks an extraordinary global public health crisis unseen in the last century, with its rapid spread worldwide and associated mortality burden. Healthcare resilience during a pandemic is crucial not only for continuous and safe patients care but also for control of any outbreak. Aim: The present study was conducted to discover the organizational variables effective in increasing resilience and continuing the work of nurses in critical and stressful pandemic conditions. Method: The study population is nurses working in hospitals for patients with coronavirus. Sampling was done purposefully and information was collected from 15 nurses through In-depth semi-structured interviews. The interview was conducted to analyze the data using the framework analysis method consisting of five steps and is classified in the table. Results: According to the findings through semi-structural interviews, among organizational variables, organizational commitment (Affective commitment, continuous commitment, normative commitment) has played a prominent role in nurses' resilience. Discussion: despite the non-withdrawal of nurses and their resilience, due to the negative quality of their working life, the mentioned variable has affected their level of performance and ability and leads to fatigue and physical and mental exhaustion. Implications for practice: By equipping hospitals and improving the facilities of nurses, their organizational commitment can be increased and lead to their resilience in critical situations. Supervisors and senior officials at the hospitals should be responsible for nurses' health and safety. A clear and codified program in critical situations and comprehensive management is effective in improving the quality of the work-life of nurses. Creating an empathetic and interactive environment can help promote nurses' mental health.

Keywords: organizational commitment, quality of work life, nurses resilience, pandemic, coronavirus

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Authors: Puspa Maharani, Hendy Muagiri Margono, Izzatul Fithriyah

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Contraception is a medium used to prevent conception, aimed at couples who do not want pregnancy to occur. Unintended pregnancies have a prevalence of 48% per year of the total pregnancies that occur throughout the world. Schizophrenia sufferers have a high probability of being involved in unwanted sexual relations, but are not supported by adequate knowledge and use of contraception, so they are vulnerable to experiencing unwanted pregnancies. Unwanted pregnancy can pose significant health risks for patients with schizophrenia. There are many types of contraception that can be discussed and considered for patients with schizophrenia in order to improve the quality and well- being of their lives. Choosing the right contraceptive for patients with schizophrenia requires consideration of its use by taking into account the many factors that influence it.

Keywords: schizophrenia, contraception, pregnancy, mental health

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Authors: Bill D. Geis

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Suicide wrongful death forensic cases are the fastest rising tort in mental health law. It is estimated that suicide-related cases have accounted for 15% of U.S. malpractice claims since 2006. Most suicide-related personal injury claims fall into the legal category of “wrongful death.” Though mental health experts may be called on to address a range of forensic questions in wrongful death cases, the central consultation that most experts provide is about the negligence element—specifically, the issue of whether the clinician met the clinical standard of care in assessing, treating, and managing the deceased person’s mental health care. Standards of care, varying from U.S. state to state, are broad and address what a reasonable clinician might do in a similar circumstance. This fact leaves the issue of the suicide standard of care, in each case, up to forensic experts to put forth a reasoned estimate of what the standard of care should have been in the specific case under litigation. Because the general state guidelines for standard of care are broad, forensic experts are readily retained to provide scientific and clinical opinions about whether or not a clinician met the standard of care in their suicide assessment, treatment, and management of the case. In the past and in much of current practice, the assessment of suicide has centered on the elicitation of verbalized suicide ideation. Research in recent years, however, has indicated that the majority of persons who end their lives do not say they are suicidal at their last medical or psychiatric contact. Near-term risk assessment—that goes beyond verbalized suicide ideation—is needed. Our previous research employed structural equation modeling to predict lethal suicide risk--eight negative thought patterns (feeling like a burden on others, hopelessness, self-hatred, etc.) mediated by nine transdiagnostic clinical factors (mental torment, insomnia, substance abuse, PTSD intrusions, etc.) were combined to predict acute lethal suicide risk. This structural equation model, the Lethal Suicide Risk Pattern (LSRP), Acute model, had excellent goodness-of-fit [χ2(df) = 94.25(47)***, CFI = .98, RMSEA = .05, .90CI = .03-.06, p(RMSEA = .05) = .63. AIC = 340.25, ***p < .001.]. A further SEQ analysis was completed for this paper, adding a measure of Acute Suicide Ideation to the previous SEQ. Acceptable prediction model fit was no longer achieved [χ2(df) = 3.571, CFI > .953, RMSEA = .075, .90% CI = .065-.085, AIC = 529.550].This finding suggests that, in this additional study, immediate verbalized suicide ideation information was unhelpful in the assessment of lethal risk. The LSRP and other dynamic, near-term risk models (such as the Acute Suicide Affective Disorder Model and the Suicide Crisis Syndrome Model)—going beyond elicited suicide ideation—need to be incorporated into current clinical suicide assessment training. Without this training, the standard of care for suicide assessment is out of sync with current research—an emerging dilemma for the forensic evaluation of suicide wrongful death cases.

Keywords: forensic evaluation, standard of care, suicide, suicide assessment, wrongful death

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Authors: Michele L. Tilstra, Tiffany J. Peets

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Interprofessional collaboration in behavioral healthcare education is increasingly recognized for its value in training students to address diverse client needs. While interprofessional education (IPE) is well-documented in occupational therapy education to address physical health, limited research exists on collaboration with counselors to address mental health concerns and the psychosocial needs of individuals receiving care. Counseling education literature primarily examines the collaboration of counseling students with psychiatrists, psychologists, social workers, and marriage and family therapists. This pretest/posttest survey research study explored changes in attitudes toward interprofessional teams among 56 Master of Occupational Therapy (MOT) (n = 42) and Counseling and Human Development (CHD) (n = 14) students participating in the Counselors and Occupational Therapists Professionally Engaged in the Community (COPE) program. The COPE program was designed to strengthen the behavioral health workforce in high-need and high-demand areas. Students accepted into the COPE program were divided into small MOT/CHD groups to complete multiple interprofessional multicultural learning modules using videos, case studies, and online discussion board posts. The online modules encouraged reflection on various behavioral healthcare roles, benefits of team-based care, cultural humility, current mental health challenges, personal biases, power imbalances, and advocacy for underserved populations. Using the Student Perceptions of Interprofessional Clinical Education- Revision 2 (SPICE-R2) scale, students completed pretest and posttest surveys using a 5-point Likert scale (Strongly Agree = 5 to Strongly Disagree = 1) to evaluate their attitudes toward interprofessional teamwork and collaboration. The SPICE-R2 measured three different factors: interprofessional teamwork and team-based practice (Team), roles/responsibilities for collaborative practice (Roles), and patient outcomes from collaborative practice (Outcomes). The mean total scores for all students improved from 4.25 (pretest) to 4.43 (posttest), Team from 4.66 to 4.58, Roles from 3.88 to 4.30, and Outcomes from 4.08 to 4.36. A paired t-test analysis for the total mean scores resulted in a t-statistic of 2.54, which exceeded both one-tail and two-tail critical values, indicating statistical significance (p = .001). When the factors of the SPICE-R2 were analyzed separately, only the Roles (t Stat=4.08, p =.0001) and Outcomes (t Stat=3.13, p = .002) were statistically significant. The item ‘I understand the roles of other health professionals’ showed the most improvement from a mean score for all students of 3.76 (pretest) to 4.46 (posttest). The significant improvement in students' attitudes toward interprofessional teams suggests that the unique integration of OT and CHD students in the COPE program effectively develops a better understanding of the collaborative roles necessary for holistic client care. These results support the importance of IPE through structured, engaging interprofessional experiences. These experiences are essential for enhancing students' readiness for collaborative practice and align with accreditation standards requiring interprofessional education in OT and CHD programs to prepare practitioners for team-based care. The findings contribute to the growing body of evidence supporting the integration of IPE in behavioral healthcare curricula to improve holistic client care and encourage students to engage in collaborative practice across healthcare settings.

Keywords: behavioral healthcare, counseling education, interprofessional education, mental health education, occupational therapy education

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Authors: Hyeon-Kyo Lim, Tong-Il Jang, Yong-Hee Lee

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For an operator in a nuclear power plant, human error is one of the most dreaded factors that may result in unexpected accidents. The possibility of human errors may be low, but the risk of them would be unimaginably enormous. Thus, for accident prevention, it is quite indispensable to analyze the influence of any factors which may raise the possibility of human errors. During the past decades, not a few research results showed that performance of human operators may vary over time due to lots of factors. Among them, stress is known to be an indirect factor that may cause human errors and result in mental illness. Until now, not a few assessment tools have been developed to assess stress level of human workers. However, it still is questionable to utilize them for human performance anticipation which is related with human error possibility, because they were mainly developed from the viewpoint of mental health rather than industrial safety. Stress level of a person may go up or down with work time. In that sense, if they would be applicable in the safety aspect, they should be able to assess the variation resulted from work time at least. Therefore, this study aimed to compare their applicability for safety purpose. More than 10 kinds of work stress tools were analyzed with reference to assessment items, assessment and analysis methods, and follow-up measures which are known to close related factors with work stress. The results showed that most tools mainly focused their weights on some common organizational factors such as demands, supports, and relationships, in sequence. Their weights were broadly similar. However, they failed to recommend practical solutions. Instead, they merely advised to set up overall counterplans in PDCA cycle or risk management activities which would be far from practical human error prevention. Thus, it was concluded that application of stress assessment tools mainly developed for mental health seemed to be impractical for safety purpose with respect to human performance anticipation, and that development of a new assessment tools would be inevitable if anyone wants to assess stress level in the aspect of human performance variation and accident prevention. As a consequence, as practical counterplans, this study proposed a new scheme for assessment of work stress level of a human operator that may vary over work time which is closely related with the possibility of human errors.

Keywords: human error, human performance, work stress, assessment tool, time-variant, accident prevention

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Authors: Nermeen Saad Elbeltagy, Hoda Ghareeb, Hesham Adel Elsheshtawy, Nadim Hamed, Amany Ibrahim Mostafa, Sara Hazem Hassan

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Introduction: Depression is one of the most common mental health problems occurring in women during their child bearing years. Perinatal depression refers to major and minor depressive episodes that occur either during pregnancy or aer delivery. Although perinatal depression is common in developing countries, it is under-recognized in low and middle income countries making a substantial contribution to maternal and infant morbidity and mortality. About 12.5 - 42% of pregnant women and, 12 - 50% of post natal mothers in low and middle income countries such as Ethiopia had depression AIM OF THE WORK: To study prevalence, associated factors and impact of maternal perinatal depression in Alexandria. Patients and method: This study was conducted on 300 mothers at the postnatal ward in ElShatby Maternity Hospital from April 2022 unl October 2022. Females with past history of depression before pregnancy or females who receive medications inducing depression were excluded. The participants were asked to complete the questionnaire that includes the Edinburgh Postnatal Depression Scale (EPDS) as a screening test to obtain information concerning the current frame of mind at antepartum, partum and postpartum periods Results: The prevalence of perinatal depression was 22.3%. It was found that there is a significant negave moderate correlation between socioeconomic status and perinatal depression(r=-0.42). The present study revealed that about two thirds (60.7%) of postpartum women had low socioeconomic level. Also, less than one fourth (20%) of parents had high education and only one fourth (25.3%) of postpartum women were working. There was a statically significance difference between the number of previous abortions and perinatal depression (p=0.04). There was a significant moderate correlation between the amount of blood lost during delivery and an increased risk of developing postpartum depression. The prevalence of perinatal depression was high in cases of female neonates more than male ones. Conclusion: the prevalence of perinatal depression among the studied women was 22.3% of studied group. The significant factors identified in this study can be targeted to reduce the occurrence of perinatal depression among pregnant women in Alexandria through appropriate health interventions which includes perinatal depression screening, counseling, and the provision of support for pregnant women during antenatal care as well as lifestyle modification.

Keywords: mental health, depression in pregnancy, mental disorders, psychology in pregnancy

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Authors: Tris Kee

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This research investigates social sustainability factors in transitional housing projects and their impact on fostering healthy living environments that promote physical activity and social interaction for residents. Social sustainability is integral to individual health and well-being, as emphasized by Goal 11 of the 2030 Agenda for Sustainable Development, which highlights the importance of safe, affordable, and accessible transport systems, green spaces, and public spaces catering to vulnerable populations' needs. Communal spaces in urban environments are essential for fostering social sustainability, as they serve as settings for physical activities and social interactions among diverse socio-economic groups. Factors such as neighborhood social atmosphere, historical context, social disparity, and mobility can influence the relationship between existing and transitional communities. Mental health effects can be measured through housing segregation, mobility and accessibility, and housing tenure. A significant research gap exists in understanding the living environment of transitional housing in Hong Kong and the social sustainability factors affecting residents' mental and physical health. To address this gap, our study employs a mixed-methods approach combining survey questionnaires and interviews to gather both quantitative and qualitative data. This methodology will provide comprehensive insights into residents' experiences and perceptions. Our research's main contribution is identifying key social sustainability factors in transitional housing and their impact on residents' well-being, informing policy-making and the creation of inclusive, healthy living environments. By addressing this research gap, we aim to provide valuable insights for future housing projects, ultimately promoting the development of socially sustainable transitional communities.

Keywords: social sustainablity, affordable housing, transitional housing, high density housing

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Authors: Sireen Irsheid

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Despite concerted efforts to improve education attainment with progress in recent years, student achievement and attainment remain among the most significant challenges for school districts across the United States. Many scholars have argued that students who do not complete high school do not drop out of school voluntarily but are ‘pushed out’ of schools through multiple mechanisms related to structural and socioeconomic barriers, behavioral health challenges, pedagogical practices, and administrative procedures. Extant literature has shown that living in historically disadvantaged neighborhoods or attending under-resourced schools exacerbates student-level risk factors for grade retention and school pushout. Most efforts to respond to the school pushout phenomenon have focused on individual characteristics of students, with relatively little attention to addressing these multiple system-level characteristics related to perpetuating inequities. This study is built on a growing body of social justice-oriented research concerned with the systemic influences that shape the experiences and mental health challenges of young people. Specifically, this study examined how young people who have been experiencing education inequities make meaning and navigate the structural factors related to neighborhood and school disinvestment and access to resources and supports, and their risk for school pushout. Furthermore, schools as political, cultural, and ideologically reproductive spaces often serve as sites of resistance and can support students who are impacted by educational inequity. Study findings provide education, neighborhood, school psychology, social work practice, and policy considerations.

Keywords: education policy, mental health, school prison nexus, school pushout, structural trauma

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Authors: Sehrish Ather

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Introduction: To improve organizational achievements through the production of new knowledge, health policy and system research is the basic requirement. An aging population is always the source of the increased burden of chronic diseases, disabilities, mental illnesses, and other co-morbidities; therefore the provision of quality health care services to every group of the population should be achieved by making strong policy and system research for the betterment of health care system. Unfortunately, the whole world is lacking policies and system research for providing health care to their elderly population. Materials and Methods: A literature review of published studies on aging diseases was done, ranging from the year 2011-2018. Geriatric, population, health policy, system, and research were the key terms used for the search. Databases searched were Google Scholar, PubMed, Science Direct, Ovid, and Research Gate. Grey literature was searched from various websites, including IHME, Library of the University of Lahore, World Health Organization (Ageing and Life Course), and Personal communication with Neuro-physicians. After careful reviewing published and un-published information, it was decided to carry on with commentary. Results and discussion: Most of the published studies have highlighted the need to advocate the funders of health policy and stakeholders of healthcare system research, and it was detected as a major issue, research on policy and healthcare system to provide health care to 'geriatric population' was found as highly neglected area. Conclusion: It is concluded that physicians are more involved with the policy and system research regarding any type of diseases, but scientists and researchers of basic and social science are less likely to be involved in methods used for health policy and system research due to lack of funding and resources. Therefore ageing diseases should be considered as a priority, and comprehensive policy and system research should be initiated for diseases of the geriatric population.

Keywords: geriatric population, health care system, health policy, system research

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Authors: Renee Fabian, Jordan Davidson

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Current research on non-suicidal self-injury (NSSI) provides ample insights on best practices for caregivers and clinicians to address and reduce NSSI behavior among adolescents. However, the efficacy of evidenced-based NSSI interventions and their delivery from the perspective of adolescent patients does not receive significant attention, creating a gap between the efficacy of research-based NSSI interventions and adolescent perceptions of NSSI treatment and adolescent willingness to engage in NSSI interventions. To address the gap between practice and patient perspectives and inform more effective treatment outcomes, the current survey aims to identify major patient-reported adverse reactions to NSSI disclosures from caregivers, treating mental health clinicians, and medical professionals using a mixed methods survey of 2,500 people with a history of NSSI completed by editors at a consumer-facing health publication. Based on the analyzed results of the survey, a majority of adolescents with a history of NSSI found parents and caregivers ineffective at empathetically addressing NSSI, and a significant number of participants reported at least one treating mental health professional inadequately responded to NSSI behaviors, in addition to other findings of adverse reactions to NSSI disclosures that serve as a barrier to treatment. NSSI is a significant risk factor for future suicide attempts. Addressing patient-reported adverse reactions to NSSI disclosures in the adolescent population can remove barriers to the effectiveness of caregiver and clinician NSSI interventions and reduce the risk of NSSI-related harm and lower the risk of future suicide attempts or completions.

Keywords: adolescent self-injury, non-suicidal self-injury, patient perspectives, self-harm interventions

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Authors: Meng Wu, Atif Rahman, Eng Gee, Lim, Jeong Jin Yu, Rong Yan

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Context: The COVID-19 pandemic has had a profound impact on mental health, with increased rates of anxiety and depression observed. Social support, a critical factor in mental well-being, has also undergone significant changes during the pandemic. This study aims to explore the relationship between social support, anxiety, and depression during COVID-19, taking into account various demographic and contextual factors. Research Aim: The main objective of this study is to conduct a comprehensive systematic review and meta-analysis to examine the impact of social support on anxiety and depression during the COVID-19 pandemic. The study aims to determine the consistency of these relationships across different age groups, occupations, regions, and research paradigms. Methodology: A scoping review and meta-analytic approach were employed in this study. A search was conducted across six databases from 2020 to 2022 to identify relevant studies. The selected studies were then subjected to random effects models, with pooled correlations (r and ρ) estimated. Homogeneity was assessed using Q and I² tests. Subgroup analyses were conducted to explore variations across different demographic and contextual factors. Findings: The meta-analysis of both cross-sectional and longitudinal studies revealed significant correlations between social support, anxiety, and depression during COVID-19. The pooled correlations (ρ) indicated a negative relationship between social support and anxiety (ρ = -0.30, 95% CI = [-0.333, -0.255]) as well as depression (ρ = -0.27, 95% CI = [-0.370, -0.281]). However, further investigation is required to validate these results across different age groups, occupations, and regions. Theoretical Importance: This study emphasizes the multifaceted role of social support in mental health during the COVID-19 pandemic. It highlights the need to reevaluate and expand our understanding of social support's impact on anxiety and depression. The findings contribute to the existing literature by shedding light on the associations and complexities involved in these relationships. Data Collection and Analysis Procedures: The data collection involved an extensive search across six databases to identify relevant studies. The selected studies were then subjected to rigorous analysis using random effects models and subgroup analyses. Pooled correlations were estimated, and homogeneity was assessed using Q and I² tests. Question Addressed: This study aimed to address the question of the impact of social support on anxiety and depression during the COVID-19 pandemic. It sought to determine the consistency of these relationships across different demographic and contextual factors. Conclusion: The findings of this study highlight the significant association between social support, anxiety, and depression during the COVID-19 pandemic. However, further research is needed to validate these findings across different age groups, occupations, and regions. The study emphasizes the need for a comprehensive understanding of social support's multifaceted role in mental health and the importance of considering various contextual and demographic factors in future investigations.

Keywords: social support, anxiety, depression, COVID-19, meta-analysis

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Authors: Rhiannon Barker, Gregory Hartwell, Matt Egan, Karen Lock

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Background: Evidence suggests that mental health (MH) issues in children and young people (CYP) in the UK are on the rise. Of particular concern is data that indicates that the pandemic, together with the impact of school closures, have accentuated already pronounced inequalities; children from families on low incomes or from black and minority ethnic groups are reportedly more likely to have been adversely impacted. This study aimed to help identify specific support which may facilitate the building of a positive school climate and protect student mental health, particularly in the wake of school closures following the pandemic. It has important implications for integrated working between schools and statutory health services. Methods: The research comprised of three parts; scoping, case studies, and a stakeholder workshop to explore and consolidate results. The scoping phase included a literature review alongside interviews with a range of stakeholders from government, academia, and the third sector. Case studies were then conducted in two London state schools. Results: Our research identified how student MH was being impacted by a range of factors located at different system levels, both internal to the school and in the wider community. School climate, relating both to a shared system of beliefs and values, as well as broader factors including style of leadership, teaching, discipline, safety, and relationships -all played a role in the experience of school life and, consequently, the MH of both students and staff. Participants highlighted the importance of a whole school approach and ensuring that support for student MH was not separated from academic achievement, as well as the importance of identifying and applying universal measuring systems to establish levels of MH need. Our findings suggest that a school’s climate is influenced by the style and strength of its leadership, while this school climate - together with mechanisms put in place to respond to MH needs (both statutory and non-statutory) - plays a key role in supporting student MH. Implications: Schools in England have a responsibility to decide on the nature of MH support provided for their students, and there is no requirement for them to report centrally on the form this provision takes. The reality on the ground, as our study suggests, is that MH provision varies significantly between schools, particularly in relation to ‘lower’ levels of need which are not covered by statutory requirements. A valid concern may be that in the huge raft of possible options schools have to support CYP wellbeing, too much is left to chance. Work to support schools in rebuilding their cultures post-lockdowns must include the means to identify and promote appropriate tools and techniques to facilitate regular measurement of student MH. This will help establish both the scale of the problem and monitor the effectiveness of the response. A strong vision from a school’s leadership team that emphasises the importance of student wellbeing, running alongside (but not overshadowed by) academic attainment, should help shape a school climate to promote beneficial MH outcomes. The sector should also be provided with support to improve the consistency and efficacy of MH provision in schools across the country.

Keywords: mental health, schools, young people, whole-school culture

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