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A Scoping Review and Analysis of Mental Health

Literacy Interventions for Children and Youth

Alexandra Marinucci, Christine Grové & Kelly-Ann Allen

To cite this article: Alexandra Marinucci, Christine Grové & Kelly-Ann Allen (2023) A Scoping
Review and Analysis of Mental Health Literacy Interventions for Children and Youth, School
Psychology Review, 52:2, 144-158, DOI: 10.1080/2372966X.2021.2018918

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School Psychology Review
2023, VOL. 52, NO. 2, 144–158
https://doi.org/10.1080/2372966X.2021.2018918

A Scoping Review and Analysis of Mental Health Literacy Interventions for

Children and Youth
Alexandra Marinucci, Christine Grové, and Kelly-Ann Allen
Monash University

ABSTRACT ARTICLE HISTORY

Mental health literacy (MHL) encompasses understanding mental health and learning how to obtain Received June 7, 2021
and maintain good mental health. Increasing MHL may increase help-seeking behaviors and positive Accepted December 7, 2021
mental health. This study aimed to identify school-based MHL interventions for children/youth KEYWORDS
using a scoping review methodology following the Johanna Briggs Model. The interventions were Mental health literacy,
assessed for quality of evidence using the National Institutes of Health Study Quality Assessment intervention, children,
Tools. Six databases were searched: Scopus, APA PsycInfo, Cochrane Library, ERIC, PubMed, and youth, quality
ProQuest Psychology. Search terms included “mental health literacy,”“intervention,” and “children.”
ASSOCIATE EDITOR
The search yielded 27 studies after applying inclusion criteria. Eight of these studies were assessed Cixin Wang
as “poor” quality, twelve as “fair” quality, and seven as “good” quality. The results highlight the need
for more research to implement and evaluate interventions to sustainably and feasibly incorporate
school-based MHL interventions for children and youth into practice.

IMPACT STATEMENT
Mental health literacy interventions are needed to improve knowledge of mental health, promote
help-seeking for mental illness, and reduce stigma and negative attitudes toward mental illness.
This review identifies that more good quality research is required of school-based mental health
literacy interventions. New research is urgently needed to evaluate the feasibility and sustainability
of interventions that reduce the prevalence of mental illness for children and youth.

Mental health is not only the absence of a mental health
disorder, but includes wellbeing, recognizing one’s abilities
and difficulties, and the promotion of positive mental
health (World Health Organization [WHO], 2018). Mental
illness in youth affects core areas such as education,
achievement, relationships, and occupational success; as
such, there is a need to educate young people about mental
health to equip them with guidance and information to
inform their choices on health and wellbeing (Kessler
et al., 2005). The WHO (2018) has identified ways to pro-
mote mental health, including intervention, community
support, and promotional activities within the education
context.
Mental health literacy (MHL) represents the learning
that occurs from maintaining good mental health even in
the absence of illness symptoms; Kutcher et al. (2016) pro-
vide a clear definition:
(1) Understanding how to obtain and maintain good
mental health, (2) understanding mental disorders and
their treatments, (3) decreasing stigma related to mental
disorders, and (4) enhancing help-seeking efficacy
(knowing when, where, and how to obtain good mental
health care and developing competencies needed for self-
care) (Kutcher et al., 2016, p. 567).
The definition of MHL has evolved to be more than
symptom management and aims to empower individuals
to look after their mental health (Jorm, 2019). MHL may
have a role in preventing maladaptive self-care strategies,
such as the use of alcohol and other drugs (Cotton et al.,
2006; Furnham & Swami, 2018). Educating youth through
culturally appropriate mental health programs that aim to
increase MHL could lead to positive mental health and
better life outcomes, and potentially prevent poor health
outcomes such as substance use and suicidal risk (Franzen
et al. 2020; McNamara, 2013; Ratnayake & Hyde, 2019).
The stigma surrounding mental illness presents a bar-
rier to help-seeking behavior, however, increasing accurate
mental health knowledge could improve understanding
of mental health and reduce the stigma surrounding men-
tal illness (Clement et al., 2015; Wei et al., 2011). Though
attitudes and stigma are challenging to change, redefining
views of stigmatized groups (e.g., individuals diagnosed

CONTACT Alexandra Marinucci Alexandra.Marinucci@monash.edu Faculty of Education, Monash University, 19 Ancora Imparo Way, Clayton, VIC 3800,
Australia.
Supplemental data for this article can be accessed online at http://dx.doi.org/10.1080/2372966X.2021.2018918
© 2022 National Association of School Psychologists

with schizophrenia) and educating people on accurate
mental health information and appropriate attitudes and
behaviors towards stigmatized groups during critical
developmental periods, may contribute to decreased indi-
vidual and societal stigma (Clair et al., 2016). If MHL were
to be increased at a large scale across groups of individuals
or whole schools, this might decrease the societal stigma
of mental illness and change the norms of general attitudes
and beliefs of mental health. Stigma is a multidimensional
construct (Pescosolido & Martin, 2015), and individu-
al-level knowledge and understanding of mental health
and illness may reduce societal and cultural stigma (Clair
et al., 2016).
Mental health and mental illness are defined differently
across cultures (Abdullah & Brown, 2011; Ran et al., 2021),
and cultural factors, such as perception of illness and cul-
tural norms, influence how individuals understand and
seek help (or not) for mental health challenges (Eshun &
Gurung, 2009; Gurung & Radosevich, 2016). Stigma can
vary across cultures. For example, in some cultures people
with a mental illness can be viewed as social outcases (Lê,
2011), while people in Eastern countries may hold more
stigmatized attitudes towards mental illness than in
Western countries (Cheon & Chiao, 2012; Krendl &
Pescosolido, 2020). Although this review does not explore
factors that affect development of MHL across cultures,
these influences and beliefs need to be recognized during
the development and appraisal of MHL interventions to
ensure suitability to the target population (Misra et al.,
2021; Ran et al., 2021).
Increasing MHL among children and youth may lead
to an increase in help-seeking behaviors and positive men-
tal health through a preventative approach which could
benefit society in the future (Bagnell & Santor, 2012;
Ratnayake & Hyde, 2019). The theory of change (Funnell
& Rogers, 2011; Weiss, 1995) can be used to understand
how MHL interventions could produce the desired behav-
ior change by working backwards from a specified goal to
identify how to create that desired effect (Hernandez &
Hodges, 2001). For example, the goal of MHL interven-
tions is to increase MHL and specifically to increase men-
tal health knowledge, help-seeking behavior, and
competencies for self-care, and reduce mental illness
stigma. If there is an assumption that, generally, individ-
uals lack knowledge of mental health, support sources,
appropriate self-care strategies, and understanding of
mental illness, then the pathway to increasing MHL could
be to upskill individuals in these areas. Increasing MHL
could be through targeted educational programs (Grové
et al., 2015) and mental health promotion campaigns
(Anwar-McHenry et al., 2012). Young people report bar-
riers to caring for their mental health and seeking help,
Mental Health Literacy Interventions for Children and Youth 145
including a lack of mental health information and under-
standing sources of support in their community (Radez
et al., 2021; Tharaldsen et al., 2017). While knowledge or
education alone may be insufficient to produce behavior
change related to mental health, it is vital to increase
awareness, develop skills, and increase self-efficacy
(Arlinghaus & Johnston, 2018).
Little research has been conducted to determine the
major components of MHL interventions that seek to
increase young people’s understanding of mental health
and prevent mental illness; as such, there is a need to scope
the current literature pertaining to MHL interventions to
understand their impact, efficacy, and the quality of eval-
uation studies. This review evaluates school-based MHL
interventions for children (aged 6 to 12 years) and youth
(aged 13 to 18 years). MHL interventions are defined as
interventions focused on increasing mental health under-
standing, and promoting positive mental health behaviors,
such as seeking help and reducing negative attitudes
towards mental illness (Jorm, 2012). A MHL intervention
is a mental health intervention that takes an educational
approach. This approach can be proactive rather than reac-
tive towards mental illness, and the delivery of MHL inter-
ventions can vary. Some may target a specific individual
or group, or adopt a universal prevention approach (Ogden
& Hagen, 2018). This review focuses on MHL intervention
approaches in a school setting.
The literature of MHL commonly includes literacy
interventions targeting depression as it is the highest prev-
alent mental health disorder youth experience (Singh
et al., 2019; WHO 2017). Therefore, MHL interventions
targeting depression literacy for the general population
were included in this review. Depression literacy interven-
tions aim to increase knowledge and awareness of depres-
sion (Beaudry et al., 2017). Suicide prevention is related
to MHL; however, it is narrower in scope in that it specif-
ically relates to suicide literacy and help-seeking actions
during crises (Fitzpatrick, 2020). The current review has
excluded suicide prevention interventions due to their
focus on crisis specific intervention (Hayden & Lauer,
2000; Robinson et al., 2018; Singer et al., 2019).
This article conceptualizes MHL interventions accord-
ing to the theoretical model outlined by Bale et al. (2020),
the MHL Child Focused Model, which includes a) recog-
nizing changes in mental health, b) knowledge of
help-seeking actions and support, c) understanding influ-
ences of mental health, d) coping and resilience, and d)
attitudes towards mental health. This model was created
for children from age ten years and older, however Bale
et al. (2020) suggests that the domains in their MHL Child
Focused Model can be adapted to be developmentally
appropriate for younger children (O’Neill & Moore, 2016;
146 School Psychology Review, 2023, Volume 52, No. 2DOI: 10.1080/2372966X.2021.2018918
Pitre et al., 2007). Under the WHO’s (2005) definition of
positive mental health, increasing MHL in children and
youth could improve their resilience towards everyday
stress, productivity in school work, and contributions to
the community in the future.
Mental Health in Schools
The emergence and popularity of social and emotional
learning (SEL) in schools, particularly over the last decade,
may indicate a shift in priorities for schools and an
increased focus on mental health and wellbeing. SEL refers
to competencies in understanding and managing one’s
emotions, positive relationship skills, and responsible deci-
sion-making for personal, social, and collective wellbeing
(CASEL, 2021; Frydenberg et al., 2017; Weissberg et al.,
2015). Interventions that target social and emotional com-
petencies can reduce the risk of academic failure, behav-
ioral challenges, and emotional distress at school (CASEL,
2015; Durlak et al., 2011; Grové & Laletas, 2020; Taylor
et al., 2017). While SEL has similarities with MHL, there
are many distinguishing features. MHL, for instance, seeks
to build mental health vocabulary (e.g., understanding the
difference between stress and anxiety) in students. Another
difference includes developing knowledge of where and
how to seek help for mental health difficulties, and this is
not a commonly reported feature of SEL. Both SEL and
MHL can inform and support the other to provide a holis-
tic approach to student wellbeing in a school setting.
Supplemental Table 1 in the Supplemental Materials high-
lights the differences and similarities between SEL
and MHL.
Schools are recognized to be an important setting in
which to base mental health interventions due to the
onset of most mental health disorders occurring before
the age of 24 years (Allen & McKenzie, 2015; de Girolamo
et al., 2012; Kessler et al., 2005; Kutcher et al., 2016).
School psychologists are placed within schools often to
support student mental health, classroom management
for teachers, and school-based interventions (Kratochwill,
2007; Shernoff et al., 2016). School psychologists have a
breadth of knowledge of child and adolescent mental
health, and their role is critical in promoting and imple-
menting school-based preventative approaches to mental
illness, such as providing MHL interventions to students,
teachers, and the wider school community (e.g., parents)
(Burns, 2013; Kratochwill, 2007). Evidence suggests that
mental health interventions within the school environ-
ment can lead to improved academic skills and decreased
behavior problems (Weare & Nind, 2011), and that effec-
tive interventions should focus on MHL and engage
different aged children and youth (Power et al., 2008;
Wei et al., 2013; Wyn et al., 2000). Despite these
recommendations, a systematic review (Wei et al., 2013)
of 27 school-based MHL interventions found that all
studies met criteria for risk of bias (such as selection bias,
attrition bias, confounding, outcome measurement,
reporting bias), excluded methodological information,
and lacked valid outcome measures of MHL. However,
the review from Wei et al. (2013) does not consider more
recent research in the field. A recent systematic mapping
review (Patafio et al., 2021) identified that most studies
use a 12-week follow up to examine sustained effects,
however, a long term follow-up, such as one year, may be
more beneficial to measure behaviors that may take time
to change, such as actual help-seeking behavior. There is
evidence for using MHL interventions within a school
environment, though available research is methodolog-
ically and psychometrically limited (Kutcher et al., 2016;
Patafio et al., 2021; Seedaket et al., 2020; Wei et al., 2013).
Evidence-Driven and Quality of Studies
Mental health literacy is growing in educational settings;
however, more research is required to determine evi-
dence-based interventions in order to benefit student
wellbeing (O’Connor et al., 2018; Wei et al., 2013).
Evidence-based practice is essential for health and educa-
tional professionals as it ensures quality care, continued
professional development, and practice that is guided by
appropriate research evidence (Kretlow & Blatz, 2011;
Prasun, 2013). Recently, evidence-based policies for
school-based interventions have been collated into a book,
making this accessible for schools (Allen et al., 2021). This
resource states that evidence can be rated by (a) nature
and quality of the evidence base, (b) evidence of impact,
(c) generalizability, (d) implementation ease, and (e)
potential for impact. Similarly, evidence-based interven-
tions that are considered to be high quality are compre-
hensively evaluated with robust psychometric tools to
measure the progress of expected outcomes (Lane &
Corrie, 2007). The lack of clear criteria for implementing
and evaluating mental health interventions has led to gaps
in the evidence base to support fidelity, which could affect
funding and uptake of interventions in the future (Durlak
& DuPre, 2008; Samartzis & Talias, 2019; Santor & Bagnell,
2012). Current research on school-based mental health
interventions have been subject to bias (e.g., facilitator
bias, participant bias, selection bias, attrition bias, and
reporting bias), and lacked randomization of participants,
a control group in the research design, and validated mea-
sures to evaluate their efficacy (Cilar et al., 2020; O’Connor
et al., 2018; Wei et al., 2013). These identified method-
ological concerns brings into question the quality of these
studies and how such interventions could be sustainable
in the future.

The Current Study
The current study aimed to review the literature pertaining
to MHL interventions, their focus and major components,
and evaluate the quality of the evidence base for MHL in
schools through two research questions:
Research question 1: What are the major components of
the existing school-based MHL interventions?
Research question 2: What are the quality ratings for the
identified school-based MHL interventions?
The findings of this study will help inform future devel-
opment and implementation of MHL interventions. It will
identify discrepancies in quality ratings of current MHL
intervention studies and recommendations for addressing
these discrepancies in future research.
METHOD
A scoping review of the literature was used to answer the
first research question. For this study, a scoping review is
defined as a type of research review that can be used to
map the extent of research activity on a specific topic, sum-
marize research findings and identify gaps in the existing
literature (Arksey & O’Malley, 2005). The searches, data
analysis, and reporting protocol followed The Joanna
Briggs Institute method (Aromataris & Munn, 2020) for
scoping reviews to gain a broad overview of the field,
uncover critical themes or concepts in relevant research,
and determine boundaries or current limitations of the
topic. For the second research question, the school-based
MHL interventions were assessed for quality of evidence
using the National Institutes for Health Study Quality
Assessment Tools (National Institutes of Health 2021).
Search Strategy
Six electronic databases were searched in May 2021:
Scopus, APA PsycInfo, Cochrane Library, ProQuest
Psychology, PubMed, and ERIC. Search terms used for
Table 1. Inclusion and Exclusion Criteria for Review of Mental Health Literacy (MHL) Interventions
Criterion Inclusion
Time period 2011−2021
Language English
Type of article Open Access, dissertations/theses, peer-reviewed articles
including RCTs, quasi-experimental studies, pre-post
studies, cluster-randomized control trials
Study focus Interventions focus on MHL, reported outcomes relating to
mental illness or mental health knowledge, stigma, and
attitudes towards mental health and help-seeking
behaviors
Population/sample Children (6–12 years), youth (13−18 years)
Setting Primary and secondary schools
Mental Health Literacy Interventions for Children and Youth 147
each database included “mental health literacy”, “interven-
tion”, and “children”. The ancestry approach (searching the
reference lists of included studies; Cooper, 2017) was used
to identify any further studies not yet included, and these
were reviewed following the same procedure as the studies
obtained directly from searches.
Inclusion and Exclusion Criteria
The inclusion and exclusion criteria for the articles are
outlined in Table 1. Studies were not limited based on geo-
graphic location, race, gender, or culture. A time period
of the last ten years (2011–2021) was selected as the con-
cept of MHL is relatively new in the research base. Grey
literature is defined as articles published by government,
national public health agencies, health bodies, and mental
health charitable organizations. Peer-reviewed articles and
dissertations/theses were included. Four dissertations/
theses were identified, however none met the search inclu-
sion criteria. Specific disorders or populations refer to
individuals diagnosed with a mental illness or medical
condition. Studies targeting specific disorders or popula-
tions were excluded as such interventions tend to focus on
treatment and management of existing symptoms for diag-
nosed mental illnesses. While this review aimed to evalu-
ate MHL (including depression literacy) interventions for
the general population, and not for participants diagnosed
with a mental illness or medical condition.
Study Selection
The search process yielded a total of 973 studies. These
citations were imported into Covidence (Veritas Health
Innovation, 2021), a screening and data extraction tool.
The lead author used Covidence to collate all citations,
remove duplicates, and categorize included and excluded
studies. Eighty-three studies were selected for full-text
screening once the inclusion criteria were applied. A total
of 21 studies were selected in the review. Using the ances-
try approach (Cooper, 2017), an additional six studies were
selected for review. Citations were imported and managed
Exclusion
Articles outside these dates
Non-English articles
Systematic reviews, literature reviews, scoping reviews,
meta-analyses, study protocols. Grey literature such as
government documents
Other focus areas, for example substance use prevention
interventions, suicide prevention studies, social–emotional
learning interventions, eating disorder prevention, and not
yet undertaken trials
University students, adults, older adults, individuals with
specific disorders or specific populations
Settings unlikely to be attended by children and youth, for
example workplaces. Home and community environments
148 School Psychology Review, 2023, Volume 52, No. 2DOI: 10.1080/2372966X.2021.2018918
with the bibliographic manager EndNote version 9.3.3
(Clarivate Analytics, 2020). To help ensure validity of the
final results, one of the authors screened and evaluated
each article and the second author checked and discussed
the results with the first author. They came to a consensus
on the interpretation of the results. Figure 1 outlines the
phases of the search procedures for reviewing MHL inter-
ventions in a PRISMA flowchart (Moher et al., 2009).
Data Charting and Quality Appraisal
A Google Sheet was used to chart the data for articles
selected for inclusion. The data extracted was used to
develop a qualitative summary of each study, which was
used to assess the methodological quality using the
National Institutes of Health Study Quality Assessment
Tools (2021) by two authors (inter-rater reliability = 80%).
When the ratings differed, the disagreements were dis-
cussed with the third author. Studies were assessed for risk
of bias, sufficient detail of intervention, attrition rate, out-
come measures (validated or standardized, multiple mea-
sures taken), and follow-up rate. Questions asked of the
study for assessment included for controlled studies, “Was
the study described as randomized, a randomized trial, a
randomized clinical trial, or an RCT?”, “Was the overall
drop-out rate from the study at endpoint 20% or less of
the number allocated to treatment?”, and “Were outcomes
assessed using valid and reliable measures, and imple-
mented consistently across all study participants?”. For
noncontrolled studies, “Was the sample size sufficiently
large enough to provide confidence in findings?”, “Was the
test/service/intervention clearly described and delivered
consistently across the study population?”, “Were the out-
come measures prespecified, clearly defined, valid, reli-
able, and assessed consistently across all study
participants?”, and “Was the loss to follow-up after baseline
20% or less?” (National Institutes of Health 2021). Ratings
are defined as follows: Good had the least risk of bias, and
results appeared valid. Fair was susceptible to some bias
but not sufficient to invalidate the results. Poor indicated
significant risk of bias (National Institutes of Health 2021).
Studies were also assessed for reporting bias by whether a
protocol was published or whether the study was regis-
tered on a trial registry.
RESULTS
The scoping review aimed to address the research ques-
tions: (1) What are the major components of the existing
school-based MHL interventions? and (2) What are the
quality ratings for the identified school-based MHL inter-
ventions? A total of 27 relevant studies that evaluated
school-based MHL interventions were identified. These
studies examined populations in: Italy (n = 2), Australia
(n = 1), China (n = 1), Japan (n = 2), United States of
America (n = 7), Portugal (n = 1), Germany (n = 1), United
Kingdom (n = 5), Canada (n = 4), Nigeria (n = 1), Vietnam
and Cambodia (n = 1), and Norway (n = 1). Study designs
included randomized controlled trial (n = 13), pre-post
evaluation (n = 9), quasi-experimental (n = 3), and non-
randomized control trial (n = 2). More than half of the
studies used a control group (n = 17), and of these, 13 were
described as randomized; however, only five reported the
randomization method. For studies using a control group,
allocation concealment and assignment blinding was not
reported for some studies (n = 6 and n = 10), and some
studies reported allocation was concealed (n = 4); however,
for most studies, assignment was nonblinded (n = 8). For
studies without a control group (n = 10), it was unable to
be determined whether eligibility criteria for the study
population were prespecified (n = 5), and almost half did
not take multiple measurements (n = 4). The age of par-
ticipants in each sample ranged from five to 19 years, with
most studies targeting children and youth aged 13 to
16 years. Sample sizes ranged from 42 to 14,690 partici-
pants. Various professionals delivered the intervention in
the identified studies, namely mental health professionals
or school teachers. For seven studies, teachers received
training in the intervention before implementing it within
their classroom. One study did not specify who delivered
the intervention (Greenwood et al., 2016). A majority of
studies (n = 22) did not publish a protocol paper or register
the study on a trial registry, making it difficult to assess
reporting bias. The 27 school-based MHL interventions
reviewed included The Guide (Kutcher et al., 2015;
Mcluckie et al., 2014; Nguyen et al., 2020), Peer Education
Project (Eisenstein et al., 2019), Breaking the Silence
(Lanfredi et al., 2019; Wahl et al., 2011), Youth Education
and Support (Riebschleger et al., 2019), Finding Space for
Mental Health (Campos et al., 2018), How to get up and go
when you’re feeling low and I gotta feeling (Sharpe et al.,
2017), Eliminating the Stigma of Differences (Painter et al.,
2017), OpenMinds (Patalay et al., 2017), Adolescent
Depression Awareness Program (Ruble et al., 2013; Swartz
et al., 2017), SchoolSpace (Chisholm et al., 2016), The
Curriculum Guide (Milin et al., 2016), The Little Prince is
Depressed (Lai et al., 2016), Definizione di obiettivi e solu-
zione di problemi (establishing goals and problem solving;
Gigantesco et al., 2015), HeadStrong (Perry et al., 2014),
Paul down in the dumps and Understanding depression in
adolescents (Schiller et al., 2014), S.P.E.A.K (Bulanda et al.,
2014), Mental Health for Everyone (Skre et al., 2013), and
In Our Own Voice (Pinto-Foltz et al., 2011). Five interven-
tions did not have a specific name (Bella-Awusah et al.,
 Mental Health Literacy Interventions for Children and Youth 149

Figure 1. PRISMA Flowchart for Review of Mental Health Literacy Interventions

150 School Psychology Review, 2023, Volume 52, No. 2DOI: 10.1080/2372966X.2021.2018918
2014; Greenwood et al., 2016; Katz et al., 2020; Ojio et al.,
2015, 2019). The major components of the existing school-
based MHL interventions identified in this review include:
• understanding symptoms of mental illness,
• how to use appropriate coping skills,
• caring for one’s mental health,
• helping others affected by mental illness,
• sources of help and how negative attitudes increases
the stigma of mental illness,
• intervention duration ranging from a single session
(15 to 45 minutes in duration) to 20 hours spread
across multiple sessions, and
• delivery of programs including educational lectures,
group discussion, activities, independent learning,
presentations, videos, games, and distribution of
booklets and stories.
Details of each study’s intervention components is pro-
vided in Supplemental Table 2 in Supplemental Materials.
For assessment of quality, the following criteria were
used to indicate higher quality studies: randomized par-
ticipants (if using control group), used a control group,
used reliable and valid measures, had good attrition (less
than 20% loss at follow up), conducted follow up outcome
measures, and provided sufficient detail of the interven-
tion. Studies assessed as poor quality met two or less of
the criteria (n = 8), fair quality met three of the criteria
(n = 12), and good quality met four or more of the criteria
(n = 7). No pattern was found between quality rating and
professional delivery of the intervention. See Supplemental
Table 3 in Supplemental Materials for the quality assess-
ment of each study based on the table framework from
Hawker et al. (2002).
DISCUSSION
School-based MHL intervention evaluation is still an
evolving area of research in psychology and education.
Figure 2 demonstrates the indicators of effective school-
based MHL interventions and recommendations for stud-
ies based on this review.
The main concepts covered by the identified MHL
interventions in this review were mental health informa-
tion (including recognition of symptoms of mental illness,
risk factors, and treatment), understanding of sources of
help, coping skills, the stigma of mental illness, and impor-
tance of positive mental health behaviors. Despite some
interventions delivered to Eastern countries with a typi-
cally collectivist culture (Triandis, 2015), such as Japan
and China (Lai et al., 2016; Ojio et al., 2015, 2019), these
interventions focused on the same MHL components as
interventions delivered to Western countries. A variety of
professionals (e.g., mental health professionals, school
teachers) delivered the intervention, and training was
identified as important, however researchers also sug-
gested that training may not be feasible within a school’s
budget (Milin et al., 2016). It was suggested teachers
undergo training or be provided with resources to increase
their competence in discussing mental health with stu-
dents to address funding constraints when applying MHL
interventions within schools (Kutcher et al., 2015; Ojio
et al., 2015; Patalay et al., 2017). Interventions developed
by mental health professionals but delivered by teachers
had positive effects on MHL outcomes (Ojio et al., 2019),
and liaison between teachers and mental health profes-
sionals was suggested to increase practicality and potential
for widespread dissemination (Bella-Awusah et al., 2014).
Wahl et al. (2011) found that providing a manual to teach-
ers without specific training was sufficient for positive
effects on MHL, however, teachers did not deliver the
intervention consistently which may affect fidelity. The
Guide/The Curriculum Guide had positive effects on
MHL when delivered by trained teachers who had access
to the program manual throughout implementation
(Kutcher et al., 2015; Mcluckie et al., 2014; Milin et al.,
2016; Nguyen et al., 2020). Overall, it appears that the use
of teachers may provide an opportunity to increase the
sustainability of MHL programs, however, adequate train-
ing and resources should be provided.
Of the 27 MHL intervention studies, eight were rated
as poor quality, 12 were rated as fair quality, and seven
were rated as good quality. The results found in this review
are similar to that of Kelly et al. (2007), Wei et al. (2013),
and Patafio et al. (2021). Many interventions were not
evaluated using control group designs, and outcomes were
measured using questionnaires specifically designed for
the study or not validated. A lack of control groups raises
concerns about the accuracy and generalizability of find-
ings and whether the results were attributed to external
factors outside of the MHL intervention (Kinser & Robins,
2013). Such limitations raise concerns about generalizabil-
ity, reliability, and validity (Chesterson, 2009; WHO, 2005).
Questionnaires and other tools are used to evaluate
MHL interventions in order to demonstrate utility and
efficacy (Wei et al., 2015). Researchers suggest that the
evaluation measures should have adequate psychometric
properties, are contextually and culturally appropriate
for the target populations, and that measures are taken
at different time points to measure follow-up and long-
term outcomes (Barry, 2019; Dray, 2018; Weare, 2017).
For studies that did not randomize participants to groups
when control groups were used brings into question
whether results are subject to selection bias (Lai et al.,

Figure 2. Indicators and Recommendations for Effective School-Based Mental Health Literacy (MHL) Interventions
2016; Ruble et al., 2013; Skre et al., 2013; Wahl et al.,
2011). Previous research has highlighted the high risk of
bias in current studies evaluating MHL interventions and
future studies should focus on appropriate methods to
reduce bias (Patafio et al., 2021; Wei et al., 2013).
Methodological limitations, such as use of nonstandard-
ized measures and lack of a comparison group, can create
gaps in the literature which may pose barriers to uptake
of interventions in the future (Durlak & DuPre, 2008;
Santor & Bagnell, 2012).
Schools allow access to large populations of children
and youth and provide an already established setting for
learning and education (Lanfredi et al., 2019; Milin et al.,
2016), and most schools prioritize mental health and
wellbeing (Allen et al., 2018). Some studies suggested
that teachers implementing MHL interventions within
schools provide a cost-effective and sustainable avenue
for widespread application in school settings (Milin et al.,
2016; Ojio et al., 2015, 2019). Kutcher et al. (2015),
Swartz et al. (2017), and Gigantesco et al. (2015) found
the use of teachers for delivering the MHL intervention
successful. They asserted that it is necessary to involve
schools in the implementation of interventions to
increase the intervention’s utility, acceptability, and fea-
sibility under real-world conditions. The WHO (2002)
note that the involvement of teachers and school staff
could be beneficial for the implementation and
Mental Health Literacy Interventions for Children and Youth 151
evaluation of interventions as they are with school stu-
dents often. Others highlight the need for substantial
training for school staff to effectively document the prog-
ress and impact of interventions (Stephan et al., 2015;
Weare, 2010). It appears that the use of teachers provides
an opportunity to increase the sustainability of MHL
interventions, however adequate training (e.g., profes-
sional development workshops and resources) should be
provided. Given that school psychologists seek to provide
evidence-based support, they are likely best placed to
deliver and examine MHL interventions for students
(Kratochwill, 2007). School psychologists could support
the development of MHL through:
• evidence-based interventions of various modalities,
for example group programs educational lectures,
group discussion, and activities based on principles
of therapeutic techniques (Hernandez & Hodges,
2001, 2006; Marinucci et al., 2021);
• reducing stigma towards help seeking and breaking
down barriers to seeking mental health care by offer-
ing psychology services in the school environment
(Meyers & Swerdlik, 2003; Oyen et al., 2020);
• assessment of student mental health and MHL and
tailoring interventions to suit student needs
(National Association of School Psychologists,
2021);
152 School Psychology Review, 2023, Volume 52, No. 2DOI: 10.1080/2372966X.2021.2018918
• training to teachers and parents in understanding
the mental health of students and possibly imple-
menting evidence-based interventions (Shernoff
et al., 2016); and
• advocating for preventative school-wide approaches
within schools to address the MHL needs of youth
(Hage et al., 2007).
In addition to the critical aspects of school-based MHL
interventions found in this scoping review, the literature
advocates for universal application of mental health inter-
vention, collaboration across stakeholders, and careful
implementation and monitoring of interventions.
Universal application refers to the ability to apply an inter-
vention to a broad population, embed it in the curriculum
or as an additional program, and adopt a whole-school
approach (Weare & Nind, 2011). Involving partnering
organizations and the target population during program
development contributes to effective practices (Duggal &
Bagasrawala, 2019). A limitation outlined by Bella-Awusah
et al. (2014) was using a program developed in the UK
with a population in Nigeria, as not enough weight was
given within the program to local cultural beliefs about
mental health problems for the target population. Dudgeon
et al. (2014) and Coombes et al. (2001) state that the
involvement of the relevant communities and stakeholders
in the development and planning of the program is vital
to ensure the program is culturally sensitive and relevant
to the target population. The WHO (2005) suggests that
collaboration should be initiated from the beginning of
the development of an intervention as this may allow for
cultural factors to be recognized and incorporated into the
intervention. It may also allow for funding infrastructure
to be developed for broader dissemination (McDaid et al.,
2017). Social and emotional learning interventions have
extensive efficacy with a universal application across
schools and are now embedded in school curriculums,
such as in Australian schools (Australian Curriculum,
Assessment and Reporting Authority, 2020; Taylor et al.,
2017). Mental health literacy interventions could follow a
similar trajectory to benefit all students and provide com-
prehensive education and support in their school years
alongside SEL.
Future Research and Limitations
Future research for MHL interventions should ideally pro-
vide sufficient detail for replication, compare with a con-
trol group, and take multiple measurements of outcomes.
Robust implementation and evaluation of interventions
will assist in increasing feasibility for universal application
and build the evidence base of school-based MHL for
children and youth. Cultural and social economic factors
should be considered if programs are developed in differ-
ent settings to which they are implemented.
A limitation of this study is the exclusion of MHL inter-
ventions targeting individuals diagnosed with a develop-
mental disorder or mental illness. Future research could
incorporate different types of populations in the review of
the outcomes of MHL interventions to determine similar-
ities and differences between specific and general popu-
lations for their need of MHL. A second limitation is the
inclusion of interventions solely focused on MHL, as other
interventions exist that target MHL and other concepts,
for example, mental health first aid (Hart et al., 2016,
2020). These studies were excluded as they focused on
suicide prevention which was not within the scope of this
review. Future research could consider other aspects of
MHL within interventions informed by the themes iden-
tified by Bale et al. (2020).
CONCLUSION
Approximately 50% of mental health problems arise
during late childhood to youth development, with the
mean age of onset of mental illness being 14.5 years (Solmi
et al., 2021; WHO, 2020). It is estimated that 10-20% of
youth experience mental health problems yet are often
underdiagnosed and undertreated (Kessler et al., 2007).
We cannot wait until adulthood to give adequate treatment
options for mental health. There is a need for children and
youth to receive information about mental health and
mental illness to identify problems and increase help-seek-
ing behavior early. Implementing MHL interventions with
young people has the potential to increase their under-
standing of mental health, reduce stigma towards mental
illness and create a platform for which often avoided con-
versation can take place (Barry et al., 2019; Kelly et al.,
2007; Tully et al., 2019). Mental health literacy can be
viewed as a foundation for mental health promotion, early
intervention for mental illness, and a way for children and
youth to connect with necessary supports (Gigantesco
et al., 2015; Milin et al., 2016; Perry et al., 2014). This arti-
cle builds on previous reviews of the literature and pro-
vides further evidence of the existing research gaps found
by the researchers (Patafio et al., 2021; Wei et al., 2013,
2015). The mixed studies of MHL interventions and their
level of quality demonstrate the need for research and
development of MHL interventions through a compre-
hensive evaluation. Implications of this scoping review
reveal the need for control trial studies and standardized
measures of MHL with good psychometric properties to
evaluate the significance of MHL interventions. As the
field hopefully progresses to action (Jorm, 2020), attention

is needed to implement effective mental health education
for all children and youth today and in the future.
DISCLOSURE
We have no known conflict of interest to disclose.
FUNDING
This research did not receive any specific grant from funding
agencies in the public, commercial, or not-for-profit sectors.
ORCID
Alexandra Marinucci https://orcid.org/0000-0002-1737-9550
Christine Grové https://orcid.org/0000-0002-0528-2620
Kelly-Ann Allen https://orcid.org/0000-0002-6813-0034
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AUTHOR BIOGRAPHICAL STATEMENT
Alexandra Marinucci is a doctoral candidate within the Faculty of
Education at Monash University. Her research focuses on mental
health literacy for youth with a preventative and educational
approach and how this can be incorporated into school settings.
Dr. Christine Grove is an educational and developmental psy-
chologist and a Senior Lecturer in the Faculty of Education at
Monash University. Alongside clinical practice, she lectures in
inclusion and psychology and supervises research students
within this area. Her research interests lie in engaging with the
young person’s perspective and experience across psychology
and education.
Dr Kelly-Ann Allen, PhD FAPS, FCEDP is an Educational and
Developmental Psychologist, a Senior Lecturer in the Faculty of
Education, Monash University, and an Honorary Senior Fellow
at the Centre for Wellbeing Science, University of Melbourne.
Her research is concerned with a sense of belonging across the
lifespan and the applied focus of school belonging.