A sytems perspective on mental health prevention: schools’ networks and prevention quality

Schools are a key setting for public health efforts to prevent mental health problems among children and adolescents. While many effective school-based interventions have been identified, less attention has been paid to the wider prevention systems in which schools are embedded and how these systems relate to prevention quality. This study examined the school-based mental health prevention system in Estonia, with a focus on how schools’ relationships with actors across sectors relate to prevention quality. A national system mapping survey was conducted among schools providing basic and secondary education and combined with archival data on the implementation of evidence-based prevention programmes (n = 132 schools). Prevention quality was assessed using two indicators: the number of evidence-based programmes implemented, and school representatives’ satisfaction with prevention efforts. Implementation of evidence-based programmes was primarily associated with structural system characteristics, including access to funding networks and connections with programme providers. In contrast, satisfaction with prevention was more strongly linked to relational factors, such as collaboration with families and local community partners. Findings highlighted both shared system challenges and differences between schools. The systems perspective used in this study may inspire similar mapping efforts in other contexts and support more effective population-level mental health promotion.

Key messages

• System-level factors are meaningfully related to the quality of school-based mental health problem prevention.

• For high-quality prevention, there is a need to strengthen relationships alongside system structures.