Assistant Professor

Department of Psychology

Vasant Kanya Mahavidyalaya, BHU

Varanasi  U.P., India 

Research Scholar

Department of Psychology

Vasant Kanya Mahavidyalaya, BHU

Varanasi, U.P., India

The Subject of mental health, which encompasses a multitude of aspects in human life has been the centre of academic curiosity for a long time. Mental health promotion is given recognition as an aspect of Healthy Schools through the National Healthy Schools Award scheme established by the Health Development Agency (Dfee, 1999). There is a rising global concern regarding mental disorders among children and adolescents. By implementing evidence-based intervention, schools have been leading the way in promoting positive mental health and overall well-being. The primary goal of this chapter is to evaluate the present evidence-based research on interventions focused on promoting mental health in schools and assess the reported effectiveness to pinpoint the intervention that can support prevailing policy and guarantee the efficient allocation of limited resources.

The authors globally assessed the current state of knowledge on school mental health promotion interventions. Major databases, MEDLINE, EMBASE, Web of Science index Medicus, PubMed, Springer, ResearchGate, and Google Scholar were explored for relevant research.

Studies found that Gratitude, Resilience, Self-esteem, and positive affect significantly correlate with the psychological well-being and mental health of adolescents. The chapter discusses the inter-relationship of these variables and examines the intervention programs currently available for mental health promotion within schools.

Mental Health Promotion Intervention in School

On a global scale, approximately 10-20% of children and young people go through a mental disorder (Kieling C, et al., 2008) and this is increasing (Key, 2017). Moreover, statistical approximations indicate that around half of the adult population affected by disorders encountered them during their early teenage years (Kessler R, Berglund O, Demler R, Jin R, Walters E (2005). To tackle this issue, it is crucial to focus on promoting and preventing behaviours, particularly within educational institutions as they provide an ideal setting for such efforts due to the significant amount of time young individuals spend in that environment (Sturgeon S., 2007).

According to the WHO’s definition, mental illness prevention involves decreasing the incidence, prevalence, and recurrence of these disorders. To prevent the development of disorders, it is beneficial to target high-risk groups through the implementation of prevention strategies. On the other hand, it should be emphasized that while there is a differentiation, it is crucial to acknowledge that the separation is not as strict when considering younger populations due to their ongoing skill development (Barnes J., (1998) and the potential preventive impact of well-being-focused skill enhancement. (Sroufe A, Rutter M (1984)

Schools play an influential role in the lives of young individuals, creating environments that can enhance their mental health and counteract the detrimental impacts of various societal elements. On the other hand, some people view schools as substantial sources of worry, distress, and unhappiness (Dogra N., 2010), When focusing on promotion, careful consideration must be given to the educational environment as a space that enables the development of rights of agency, security, and personal freedom in young people. It is important to acknowledge any possible constraints embedded within this context.

Schools must provide a continuum of intervention programs for effective promotion of mental health. In their article, Weist and Murray (Weist MD, Murray M., 2007) stated that the emphasis of these programs should be on promoting social and emotional learning, fostering competence for every student, and engaging young individuals, educational institutions, and communities. According to the authors, quality holds centrality and multiple factors require consideration.

An inclusive approach towards mental health promotion should be taken by the schools. This can be done by instilling some practices in the schools. some of them may choose to follow.

1.     Develop initiatives that cater to the individual needs of students, schools, and communities, fostering strong connections among available resources.

2.     Evidence-based programmes must be focused on reducing barriers to student learning.

3.     Highlight the role of systematic quality assessment and improvement and provide additional support.

4.     Ensure staff are engaged and supported

5.     Make sure that the actions taken are considerate of the developmental and diversity aspects affecting students.

6.     Foster collaborative connections in educational institutions, resilient alliances and efficient coordination systems.

Weist and Murray (Weist MD, Murray M., 2007), through their research, found that to instigate change, there needs to be widespread involvement and training across various stakeholders within the education system to provoke a culture shift. The successful promotion of mental health programs in schools is believed to require the involvement of multiple individuals, a trend also observed in various other Western countries. (e.g. (Nielsen L, et al., (2015). Additionally, fostering collaborations between the health and educational realms can facilitate significant involvement and enduring transformation. A comprehensive strategy in the entire school acknowledges the significance of fostering a healthy mindset by actively involving students, families, and staff, and considering the influence of both local and government policies. (Graetz B, et al., 2008). Adoption of this strategy proposes that educational institutions should take on mental health and well-being challenges through their behaviour guidelines, curriculum planning, provision of care and support to students, inclusion of staff members, and active involvement of parents. Schools all over the world have implemented this approach through the adoption of social and emotional programs. For instance, the Collaborative for Academic, Social, and Emotional Learning in the USA, Kids Matter in Australia, and Social and Emotional Aspects of Learning in the UK. (SEAL, DCSF, 2010)).

When implemented, this has been found to support not only positive mental health, but also enhance academic achievement (Public Health England (2015). Although this approach has its benefits as highlighted, it is crucial to recognize that there are obstacles associated with implementing the whole-school approach promoted by various authors. (e.g. Rowling L (2009). May be undermined by: deficiency in necessary support (concerning staff’s readiness or financial provision), To ensure clarity, operationalization, and consistency in terminology used, it is essential to also take into account the conceptualization of mental health and illness., To ensure proper support and guidance, it is crucial to have staff members who are adequately trained. and, involving young individuals in the process of promoting positive mental health is essential. Furthermore, when it comes to recognizing the importance of sustainable multi-sector partnerships in promoting mental health, there is little information available about the specific individuals and stakeholders who should be included or what particular responsibilities they should undertake. Perhaps, it would be fitting to involve the broader community by incorporating both families and also young individuals with their teachers.

The main obstacle to achieving effective mental health promotion lies in the fact that many school-based interventions, which have been documented, are generally short-term and lack sufficient long-term monitoring. Furthermore, it was common practice to assess them immediately or shortly after the intervention. Nonetheless, an increasing amount of evidence indicates the existence of certain long-term effects that are now coming to light; moreover, it is noteworthy that although these effects gradually dwindle over time, they can continue to be substantial. (Weare K, Nind M (2011). Sometimes, the lack of consistent, rigorous, and faithful implementation of the overall program as well as the absence of support for teachers administering it has often been linked to the finding of fewer advantages in certain whole-school approaches pertaining to mental health promotion. (Kimber B, Sandell S, Bremberg S (2008). (Michelle O’Reilly, 2018)

Resilience and Mental Health

The extensive discussion regarding the theoretical correlation between disorder and good health has focused on somatic health, encompassing treatment and prophylaxis. However, a significant lack of attention has been given to these issues concerning mental health within both one-dimensional (biological, psychological, or sociocultural) and multi-dimensional (biopsychosocial) models of psychopathology. (Adler, et. all 2009) In spite of the fact that language related to physical ailments such as trauma and stress is now widely used in mental health research and clinical practice, other affirmative concepts like immune prevention (Cooreman, Leroux-Roels, & Paulij, 2001) and sanitation (Yazdanbakhsh, Kremsner, & van Ree, 2002) are gaining importance. They have yet to be considered, despite their potential significance in mental health matters. It is only in recent years that the concept of an immunity model regarding mental well-being has gained recognition, highlighting resilience as something more than simply the lack of disorder (Bonanno, 2004). Identifying intrinsic and acquired clinical, biological, and environmental attributes that preserve mental well-being in the presence of risk factors is integral to this approach, as highlighted in studies conducted by Hoge, Austin, and Pollack (2007) as well as Patel and Goodman (2007). Up until recently, the conceptualization has predominantly focused on mono-causal models, which means that biomedical, psychological, or sociocultural domains of resilience have been considered separately without any efforts to bring them together under a comprehensive theoretical framework.

Resilience can provide a shield against different mental health disorders, such as depression and anxiety, while the concept of health encompasses not only being free from illness and disability but also experiencing joy and well-being. In the modern era, increasing importance is being given to recognizing the positive dimensions of overall well-being, enabling people to utilize their unique abilities as a protective barrier against mental afflictions. (Ryff CD, Singer B, 1996, Robbins BD., 2008).

The assessment of mental health encompasses elements such as intellectual, emotional and spiritual development, positive self-perception, a sense of dignity and physical health, in addition to interpersonal harmony. (Manwell LA, et al. 2015, Bhugra D, et al. 2013).

Common mental disorders, like anxiety and depression, will become the most common diseases by 2030 (more than cardiovascular diseases and car accidents) (Honikman S., 2012).

If one successfully manages stress, one can improve their capacity to adapt and overcome the requirements and difficulties one faces (Maciejewski PK, Prigerson HG, Mazure CM., 2000). Resilience refers to an individual’s capacity for adapting and coping with various stressors including injuries, threats, tragedies, interpersonal conflicts alongside family troubles as well as financial struggles and occupational challenges while effectively managing medical and health problems to counteract the negative repercussions of stress (Basim HN, Cetin F., 2011, Wagnild GM, Young HM., 1993). According to Bonanno (2004), resilience can be defined as the process of reverting to one’s normal functioning and persisting in effectively managing stress (Bonanno GA. Loss, 2004).

The process, capacity, or outcome in which individuals succeed in adaptation despite challenges and threats is known as resilience, as defined by Masten et al (1990). By focusing on the process of adaptation, coping aims at acquiring a set of skills, whereas resilience denotes the successful outcome obtained through their utilization. Some coping skills may not be positive and might not lead to a positive outcome; they occasionally fail because resilience quickly facilitates effective recovery, which some researchers refer to as mental resilience. (Davydov DM., et al., 2010, Tugade MM, Fredrickson BL., 2004).

Consequently, comprehending resilience becomes significant for formulating interventions aimed at preventing and/or managing common mental disorders like anxiety, depression, and stress reactions, whose impact varies greatly depending on individual and cultural factors (Connor & Zhang, 2006). Even so, despite benefiting from empirical research efforts, obstacles arising from deficiencies in its central terminology have restricted the mental health protection approaches potential for further conceptual development. More recently, it has been proposed by Masten (2007) that a wide-ranging systems approach, which focuses on the resilience and adaptability of dynamic systems in response to significant disturbances, could be exceptionally important. The biopsychosocial framework of resilience posits that there are multiple mechanisms at play, both internal and external to an organism, that provide protection against disturbances, akin to the intricate model used for maintaining somatic health. (Dmitry M. Davydov)

Resilience and Mental Health in School

This study's discoveries demonstrated that the association between resilience and mental well-being was comparatively weaker among school and university students as opposed to other populations, potentially owing to the unique difficulties encountered during this phase of existence. This finding was inconsistent with that of the other studies reporting a high correlation (r = 0.58) between mental health and resilience among students (Rajabi S, Assareh M, Keshvari F., 2014). Good mental health is crucial for the educational success of students at both schools and universities. Although the difficulties experienced throughout this phase might undermine their emotional well-being, the strength of resilience equips them to employ their skills effectively amidst challenges, leading them towards triumphant outcomes and personal growth. Furthermore, it empowers individuals to utilize these challenges as a means to strengthen themselves despite the presence of risk factors. (Akbarzadeh D, et al., 2014, Delaram M, et al., 2012).

In their study, Dray et al (2014) uncovered significant evidence supporting the effectiveness of resilience-based interventions in reducing mental health problems. (Dray J, et al., 2014). In general, resilience grants individuals the ability to harness obstacles as stepping stones towards growth and enhancement by leveraging time, energy, and available resources. (Kotze M, Nel P, 2013).

As one describes the association between resilience and mental health, it becomes evident that resilient individuals employ numerous individuals, social, and contextual (protective) aspects to moderate or diminish stressful situations. (Vanderbilt-Adriance E, Shaw DS., 2008).

Self- esteem and Mental Health

Self-esteem is determined by an individual’s personal perception of themselves, which can sway towards positivity or negativity. Thus, self-esteem serves as the evaluative element when it comes to one’s self-concept. (Gecas and Burke, 1995). The level of self-esteem in a person depends on their overall perception of personal worth, acceptance, and adequacy. (Crocker & Major, 1989)

There exists notable evidence indicating that practising gratitude can enhance self-esteem levels, thus making a substantial contribution to improved overall well-being. (Lin, 2015).

The development of a favourable self-image plays a vital role in preserving an individual’s mental, emotional, and social equilibrium throughout their lifetime. [(Macdonald, 1994), Self-esteem has connections to a large spectrum of mental disorders and social difficulties; these include internalizing issues like depression, suicidal tendencies, eating disorders, and anxiety; as well as externalizing issues like violence and substance abuse.

Self-esteem is not solely recognized as an essential aspect of mental well-being, but also as a shielding element that enhances overall health and fosters constructive social conduct by safeguarding against adverse influences. Active efforts towards promoting healthy functioning are apparent in all aspects of life, including achievements, success, satisfaction, and the ability to manage illnesses like cancer and heart disease. On the other hand, the presence of an unstable self-concept coupled with low levels of self-regard could act as crucial catalysts fuelling the prevalence of numerous psychological afflictions and societal problems like depression, anorexia nervosa, bulimia nervosa, anxiety disorders, violent behaviour patterns among individuals alongside substance misuse or engaging in high-risk activities. The outcome of these conditions is twofold: the experience of intense suffering for individuals, as well as an immense problem imposed on society. It will be demonstrated that prospective studies emphasize low self-esteem as a risk factor and positive self-esteem as a protective factor. In the context of health promotion, it is vital to highlight the significant impact of self-esteem on both physical and mental health, thus emphasizing its importance for mental health promotion. Health promotion focuses on empowering individuals to enhance their own well-being and gain better control over their health. (WHO, 1986).

Identity development sources of self-esteem

Erikson (1968) developed a theoretical framework that highlighted the changing nature of self-esteem during different stages of psychosocial development in individuals. According to Erikson's perspective, individuals remain preoccupied with their self-esteem and self-concept while going through the process of identity crystallization. The lack of a successful negotiation keeps the individual in a state of perplexity, with no understanding of their true self. The presence of identity difficulties, such as an ambiguous identity, a dispersed identity, and a lack of firm commitments in life (classified as the foreclosure identity status among adolescents), can lead to various complications. The combination of individuals classified as foreclosed, who have made future commitments without experiencing the crises of determining their true preferences, along with low self-esteem, can be attributed as the root cause for numerous mental and social problems. (Marcia et al., 1993).

Self-esteem development in childhood and adolescence is contingent upon a diverse array of intra-individual and social determinants. The key determinants of self-esteem include obtaining approval and backing, especially from parents and peers, as well as possessing a sense of competence in domains that hold importance. [for a review, see (Harter, 1999)]. Attachment and unwavering support from parents are crucial factors in one’s self-development. As individuals develop positive self-esteem, they become more capable of internalizing the positive perception others reciprocally have of them.

Self- esteem and Mental Health in School

Many studies have reported the correlation between self-esteem and academic achievement. (Marsh and Yeung, et al.,1997) During the crucial years of early childhood development, research indicates that fostering positive self-esteem can significantly boost children’s confidence levels and academic achievements at school (Coopersmith, 1967). Furthermore, it has been noted that positive self-esteem acts as a strong predictor of academic success, particularly in reading abilities. (Markus and Nurius, 1986). A longitudinal research study among elementary school students reveals that those with elevated levels of self-esteem exhibit superior cognitive aptitudes. (Adams, 1996). Moreover, investigations have indicated that the assessment of core self-evaluations during both childhood and early adulthood has a significant connection to job satisfaction in middle age. (Judge et al., 2000).

School dropout

Identity diffusion may lead to dropping out of the educational system, indicating rebellion or antisocial behaviour. The identity status of adolescents is dependent on their decisions to make firm commitments in life. Adolescents labelled as undecided have yet to ponder identity dilemmas or, if they have contemplated them, have not made any definitive commitments for the future. According to Muha (Muha, 1991), self-image and self-esteem play a crucial role in the competent functioning of individuals during childhood and adolescence; however, inadequate self-esteem can result in difficulties in social functioning and eventual school abandonment. The wider community, as well as the individual involved, could face considerable social consequences due to these problem behaviours. The dropout rate of students at risk has been significantly decreased by various prevention programs. (Alice, 1993; Andrews, 1999). Dropout prevention programs place significant emphasis on self-esteem as a critical component.

Gratitude Intervention promoting mental health

According to Emmons, McCollough, and Tsang (2003), the concept of Gratitude finds its roots in the Latin term Gratia, encompassing elements of grace, gratefulness, and graciousness. The thought emanating from this Latin source refers to compassion, goodwill, token, and the loveliness of giving and receiving (Pruyser, 1976 P69). The acknowledgement of gratitude arises from understanding that an individual, at personal expense, deliberately yielded a beneficial result for us. Hence, gratitude provides a means for individuals to tap into their natural inclination to acknowledge and savour the regular events and experiences of daily life (Brayant, 1989; Langston, 1994, Snyder, 2011).

One’s personal and relational well-being is significantly improved through gratitude, making it a remarkable human strength that could potentially benefit society as a whole. The evidence concerning the connections of dispositional gratitude appears to endorse this perspective. In its essence, gratitude is the inherent inclination to acknowledge and respond positively (through expressions of appreciation and thankfulness) to the benevolent actions of others, which play a significant role in generating positive experiences and outcomes for oneself. Findings from various research indicate individual discrepancies in gratitude. Experimentally fostering gratitude through intervention suggests that it is a typically pleasant occurrence that correlates with emotional, physical, and relational health (Emmons, 2008).

Gratitude Fostering Mental Health

The presence of gratitude is significantly linked to decreased instances of mental health issues such as anxiety, depression, phobias, substance dependency, and post-traumatic stress disorder (PTSD; refer to Wood et al, 2010, for a comprehensive overview). Gratitude is thought to contribute to mental well-being through its effects on positive reframing and positive emotion, according to Lambert et al. (2012), while also influencing how individuals interpret the events occurring in their lives, as explored by Wood et al. (2010). The research conducted by Krejtz et al in 2016 suggests that practising gratitude can result in reduced daily stress levels, ultimately benefiting overall mental health.

Although commonly viewed as a dispositional quality, there is research evidence supporting the idea that gratitude can be encouraged. (Davis et al., 2016; Seligman et al., 2005; Wood et al., 2010). Encouraging gratitude regularly involves participants engaging in brief activities like listing things they are grateful for, journaling, or expressing appreciation to someone. Significant relationships have been observed in high-risk samples suffering from PTSD between gratitude and lower depression levels, adaptive personality traits, positive social connections, as well as improved physical health resulting from such interventions. (Davis et al., 2016; Wood et al., 2010). The examination of gratitude as it pertains to parental stress has predominantly centred around children with disabilities or emotional and behavioural difficulties who are being provided care.  (Kim-Godwin, 2020).

Parents' well-being and hope were enhanced by a gratitude intervention from the initial assessment to the end of the course. (Martin et al., 2019), and A different study revealed that implementing a gratitude journal practice resulted in decreased levels of stress, depression, somatic symptoms, and systolic pressure. (Kim-Godwin, 2020). Although there is substantial evidence supporting the positive impact of gratitude on mental well-being, very few studies have focused on investigating how gratitude affects the mental health of mothers, specifically. Furthermore, there has been a complete lack of research exploring the role of gratitude in the mental well-being of single mothers.

Adolescent populations can greatly benefit from gratitude interventions, as these interventions can promote engagement in self-improvement behaviours tailored towards long-term goals rather than immediate rewards. In a recent set of studies involving Filipino high school and university students, connections were discovered between gratitude and motivation, as well as self-reported and teacher-reported engagement. (King & Datu, 2018).

To enhance the level of happiness among Muslims, a study compares the effects of an Islamic-based expressive gratitude strategy with a Western-based expressive gratitude strategy. As part of the study, participants are subjected to three different experimental exercise conditions. First, the Western-based gratitude exercise in which the participants will be asked to identify previously unappreciated aspects of their life, for which they are thankful. Second, the Islamic-based gratitude exercise, in which the participants will be asked to notice how fortunate Allah makes them at present in all aspects of their lives, and recall all the good things in their lives at the present and the past that Allah blesses them with, for which they are grateful. Third, the life details exercise in which the participants will be asked to take notice of the ordinary details of their daily life, such as attending particular classes, and meetings, typical interactions with friends, and their typical thoughts during a day. They are required to report their grateful things or daily events for the following two weeks. and there is evidence that the GQ-6 is positively related to optimism, life satisfaction, hope, spirituality and religiousness, forgiveness, empathy and pro-social behaviour, and negatively related to depression, anxiety, materialism and envy (McCullough, 2022).

Positive affect and Mental Health

While traditional perspectives argue that positive emotions serve as markers or indicators of current health and well-being (Diener, 2000; Kahneman, 1999), the broaden-and-build theory extends this notion to suggest that positive emotions also play a role in fostering future health and well-being. (Fredrickson, 2001).

The review indicates that practising mindfulness is connected with increased positive emotions and decreased negative emotions, which in turn contributes to improved health and well-being.  (Mandal S. P., Arya Y. K., and Pandey R. (2012)

When analysing mental health, it distinguishes emotional well-being, psychological well-being, and social well-being as three significant factors. Emotional well-being involves experiencing happiness, finding interest in life, and achieving satisfaction. On the other hand, psychological well-being encompasses embracing most facets of one’s personality, adeptly managing daily responsibilities, cultivating positive relationships with others, and attaining personal contentment. Social well-being pertains to positive functioning and encompasses making a valuable contribution to society (social contribution), feeling like a vital member of a community (social integration), having faith that society is progressing towards becoming an improved environment for everyone (social actualization), and They find it logical and comprehensible that the functioning of society aligns with their understanding (social coherence).

Despite the influence of hedonic and eudaimonic traditions, which prioritize positive emotions and excellence in functioning, it is important to consider that this perspective on mental health may inadvertently exclude a significant number of shy adolescents. Those individuals who resist perceived unfairness and disparities or become disheartened after years of futile attempts, in addition to immigrants and marginalized groups who encounter rejection and bias.

The interconnectedness of mind, brain, organism, and environment emphasizes the importance of a harmonious relationship between body and mind, as one's overall experience in the world is inseparable from how their body feels in its surroundings. (Disruptions in this interaction can lead to psychotic episodes, disordered eating, self-injury, body dysmorphia, or declining physical health.) ( Galderisi S., et.al 2015)

Positive affect and Mental health in School

Children and adolescents make up almost a third (2.2 billion individuals) of the world’s population; however, they also bear the brunt of mental health problems, which affect 10–20% of them worldwide and contribute significantly to the global burden of disease. (Kieling et al., 2011). The total population in India consists of adolescents, which form approximately 20.5% of the population (UNICEF, 2011). According to Shastri (2009), approximately 10% of children between the ages of 5 and 15 have diagnosable mental health disorders, while there are up to 20 million adolescents affected by severe mental health disorders. India is becoming increasingly worried about the mental health state of teenagers. The observation made in a study revealed that flourishing, positive affect, personal well-being, physical health, social relationships, psychological well-being, and environmental health were predictors of positive mental health in adolescents. Factors that contribute to protection, such as establishing strong relationships with peers and teachers, cultivating positive self-regard, active involvement in school and community activities, acquiring communication skills and opportunities to use them effectively, recognition of contributions made and achievements attained, as well as a sense of safety are likely to play a significant role in promoting positive mental health in adolescence.

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