Destigmatizing psychosis: Investigating the effectiveness of a school-based programme in Hong Kong secondary school students

A systematic mapping review of interventions to improve adolescent mental health literacy, attitudes and behaviours

AIM

The onset of mental illness is most common in adolescence, therefore mental health promotion efforts frequently target this age group. Evaluation literature in this area is largely segmented into specific domains in terms of settings, countries, and/or groups of young people, but an overall understanding and comparison across these areas is lacking. The current review aims to provide such an overview of interventions/programs which attempt to improve adolescents' mental health literacy, attitudes/stigma and behaviours.

METHODS

A systematic mapping review synthesized the strengths and weaknesses of published interventions/programs to improve mental health outcomes in youth. Ten databases and grey literature sources were searched, and results were categorized according to sample, location/setting, type of information presented, delivery and testing procedures, mental health outcome/s evaluated, and limitations.

RESULTS

One hundred and forty articles met the inclusion criteria; 126 were original records and 14 were reviews. Mental health literacy and attitudes/stigma were examined most frequently, and studies were predominantly conducted in school-based environments and high income economies. Intervention/program effectiveness varied across outcome/s measured, setting, and control group usage, with mental health literacy exhibiting the most positive changes overall. Common limitations included no long-term follow up or control group inclusion.

CONCLUSIONS

Despite generally positive changes seen throughout studies in this area, effectiveness differed across a range of methodological domains. Most research is conducted in schools and higher income economies, but the lack of investigation in other contexts (i.e., internet or community) or lower income countries suggests our understanding in this area is constrained.

Promotion of Mental Health Literacy in Adolescents: A Scoping Review

In recent years, there has been an important commitment to the development of programs to promote mental health literacy (MHL) among adolescents, due to the prevalence of mental health problems and the low level of MHL that affects this group. The aim of this study was to map the structure and context of programmes/interventions for promoting MHL among adolescents in school settings. A scoping review was conducted following the guidelines of The Joanna Briggs Institute. We searched for studies on programmes/interventions promoting at least one of the components of MHL of adolescents, written in Portuguese, English or Spanish, published from 2013 to 2020, in MEDLINE, CINAHL Plus with Full Text, SciELO, SCOPUS, OpenGrey, RCAAP and in the article reference lists. This review included 29 articles. The majority of programmes/interventions addressed one or more of the four components of MHL, with the knowledge of mental disorders and stigma reduction components being the most covered; were taught by adolescent's regular teachers; used face to face interventions; had a height variable duration; used non-validated instruments; were implemented in a classroom environment; and showed statistically significant improvements in adolescent's MHL levels. More research is needed to implement/construct programmes/interventions promoting adolescents' MHL concerning knowledge on how to obtain and maintain good mental health.

Effectiveness of arts interventions to reduce mental-health-related stigma among youth: a systematic review and meta-analysis

BACKGROUND

Educational interventions engage youth using visual, literary and performing arts to combat stigma associated with mental health problems. However, it remains unknown whether arts interventions are effective in reducing mental-health-related stigma among youth and if so, then which specific art forms, duration and stigma-related components in content are successful.

METHODS

We searched 13 databases, including PubMed, Medline, Global Health, EMBASE, ADOLEC, Social Policy and Practice, Database of Promoting Health Effectiveness Reviews (DoPHER), Trials Register of Promoting Health Interventions (TRoPHI), EPPI-Centre database of health promotion research (Bibliomap), Web of Science, PsycINFO, Cochrane and Scopus for studies involving arts interventions aimed at reducing any or all components of mental-health-related stigma among youth (10-24-year-olds). Risk of bias was assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. Data were extracted into tables and analysed using RevMan 5.3.5.

RESULTS

Fifty-seven studies met our inclusion criteria (n = 41,621). Interventions using multiple art forms are effective in improving behaviour towards people with mental health problems to a small effect (effect size = 0.28, 95%CI 0.08-0.48; p = 0.007) No studies reported negative outcomes or unintended harms. Among studies using specific art forms, we observed high heterogeneity among intervention studies using theatre, multiple art forms, film and role play. Data in this review are inconclusive about the use of single versus multiple sessions and whether including all stigma components of knowledge, attitude and behaviour as intervention content are more effective relative to studies focused on these stigma components, individually. Common challenges faced by school-based arts interventions included lack of buy-in from school administrators and low engagement. No studies were reported from low- and middle-income countries.

CONCLUSION

Arts interventions are effective in reducing mental-health-related stigma to a small effect. Interventions that employ multiple art forms together compared to studies employing film, theatre or role play are likely more effective in reducing mental-health-related stigma.

Innovative approach to adolescent mental health in Japan: School-based education about mental health literacy

AIMS

Improving mental health literacy through school-based education may encourage mental health promotion, prevention and care and reduce stigma in adolescents. In Japan, instruction about mental illness has been formulated in a Course of Study that reflects governmental curriculum guidelines, which will be enforced from 2022 to promote an understanding of current issues of adolescent health. Educational resources available to schoolteachers have been developed. This article describes the development processes and contents of these resources.

METHODS

Our collaborating team, consisting of mental health professionals and schoolteachers, developed educational resources, based on feedback from high school students in general and young people who had experienced mental health problems.

RESULTS

The new Course of Study covers: (1) mechanisms of mental illness, prevalence, age at onset, risk factors and treatability; (2) typical symptoms of mental health problems and illnesses; (3) self-help strategies for prevention of and recovery from mental illness; (4) enhancing help-seeking and helping behaviour and (5) decreasing stigma associated with people with mental health problems. The educational strategy is targeted at high school students (grades 10-12) and is conducted by teachers of health and physical education. The educational resources include short story animated films, filmed social contact and educators' manuals, which are freely available through the internet and open to all concerned including schoolteachers in Japan.

CONCLUSIONS

Our efforts are expected to help implement mental health education of the public throughout Japan and other countries and promote the practice of early intervention and prevention of mental illnesses in adolescents.

Educational Response to a Student with Psychosis at the Secondary Level: A Non-Experimental Single-Case Study

Students with psychosis in school within the ordinary education system are a reality in the classroom. To study their correct adaptation at school, it is necessary to consider numerous factors such as the personal characteristics of the student, environmental variables, educational measures put in place as well as emotional and cognitive aspects. The aim of this research was to monitor the teaching-learning process of a student diagnosed with psychosis and enrolled in a public school at the secondary level in the ordinary modality with support during an academic year, with the usual resources provided by a guidance department to assess the impact of the educational measures and plans on his emotional and academic fields. This was a single case study in which both qualitative and quantitative information was collected (N = 1). The participant was a student with special needs at the secondary level. An analysis of the results of psychometric tests, plan for diversity, observational analysis, academic file, scholastic history, and multiple interviews were carried out. The findings show how the educational curriculum can be adapted to improve the competences of a student with psychosis by encouraging an increase in social abilities and potential cognitive abilities through the counseling department. The conclusions of this research can provide a guideline for comparison of different educational systems, paying greater attention to the development of emotional aspects, and opting for inclusive measures. In this line, this study shows that students with psychosis can share classrooms and studies with their peers, thus fulfilling the principle of educational inclusion.

Analysis of the Usefulness of a Serious Game to Raise Awareness about Mental Health Problems in a Sample of High School and University Students: Relationship with Familiarity and Time Spent Playing Video Games

BACKGROUND

One of the main challenges in the field of mental health today is the stigma towards individuals who have psychological disorders.

AIMS

This study aims to analyse the usefulness of applying a serious game developed for the purpose of raising awareness among students about mental health problems and analyse whether its usefulness can be influenced by the type of video games or the time that students usually devote to playing with this type of entertainment.

METHOD

The serious game introduces four characters who display the symptoms of different psychological disorders. A total of 530 students participated in the study, 412 of whom comprised the experimental group and 118 the control group, 291 came from secondary school classes and 239 were university students.

RESULTS

The findings show that this serious game significantly reduced total stigma among students. Variables like time habitually spent playing video games or video game preference had no bearing on the results.

CONCLUSION

Our findings suggest that the serious game is an appropriated tool to reduce stigma, both in high school and university students, independently of the type of video games that young people usually play, or time spent playing video games.