Review: Delivering mental health support within schools and colleges – a thematic synthesis of barriers and facilitators to implementation of indicated psychological interventions for adolescents
Authors: Gee Brioney , Wilson Jon , Clarke Tim , Farthing Sophie , Carroll Ben , Jackson Christopher , King Kahfee , Murdoch Jamie , Fonagy Peter , Notley Caitlin 
Published: April 2020

Background

Increasing the role of schools and colleges in the provision of mental health services for young people has the potential to improve early intervention and access to treatment. We aimed to understand what factors influence the successful implementation of indicated psychological interventions within schools and colleges to help guide increased provision of mental health support within education settings.

Methods

Systematic search for studies that have reported barriers or facilitators to the implementation of indicated interventions for adolescent emotional disorders delivered within schools and further education/sixth form colleges (CRD42018102830). Databases searched were EMBASE, MEDLINE, PsycINFO, CINAHL, British Nursing Index, ASSIA, ERIC and British Education Index. A thematic synthesis of factors reported to impact implementation was conducted.

Results

Two thousand five hundred and sixty‐nine records and 177 full texts were screened. Fifty studies were identified for inclusion, all of which were of school‐based interventions. Eleven analytic themes were developed encompassing intervention characteristics, organisational capacity, training and technical assistance, provider characteristics and community‐level factors. Findings indicate the need to select appropriate interventions, consider logistical challenges of the school context and provide training and supervision to enable staff to deliver interventions with fidelity. However, structural and environmental support is required for these facilitators to have the greatest impact on successful implementation.

Conclusions

Implementing indicated school‐based mental health interventions is challenging. Those involved in planning school‐based mental health initiatives must be alert to the impact of factors on multiple interacting levels. There is a lack of research on implementing mental health support within further education and sixth form colleges.

Key Practitioner Message

Increased utilisation of schools and colleges as a setting for early intervention has been proposed as a means of improving access to mental health treatment, but successful implementation of mental health interventions within educational settings is challenging.

Based on a synthesis of current evidence, we recommend that young people and education professionals should be involved in the selection of school‐based interventions to ensure they are acceptable and practical to deliver within the logistical constraints of the school environment.

Those delivering interventions within schools, as well as staff involved in identifying young people who might benefit from these interventions, must receive high‐quality ongoing training and support. Senior school leaders play an important role in championing mental health interventions and developing a school culture that prioritises mental well‐being.

Health and education policy should be designed to promote a cross‐sector focus on the emotional health of young people.

There is a lack of evidence on the implementation of indicated psychological interventions within sixth form and further education colleges.