We are delighted to announce the inaugural Child and Adolescent Mental Health (CAMH) journal debate on universal school-based mental health interventions.
The session will be chaired by Prof Umar Toseeb, featuring a panel of leading experts — Dr. Lucy Foulkes, Dr. Jack Andrews, Prof. Bronwynè Coetzee, Dr. Louise Birrell, and Dr. Emma Carter — who authored recent debate papers on universal school-based mental health interventions in the CAMH journal.
About the session
This session will examine the future of universal school-based mental health interventions, focusing on their variable impact and ongoing controversies. The discussion will explore concerns about limited or inconsistent outcomes in high-income countries, alongside evidence of greater promise in low- and middle-income contexts. Panellists will critically assess the potential for unintended adverse effects, and the need for more context-sensitive, flexible approaches. Particular attention will be paid to the importance of context, and the role of students in shaping meaningful change. The debate will offer fresh perspectives on how schools can respond to the growing mental health needs of young people.
Debate papers
The debate will centre around the topic of universal school-based mental health interventions. Listed below are papers from the CAMH journals on the topic from authors that will join us on the day.
Debate: Where to next for universal school-based mental health interventions? Addressing the mental health crisis among young people in low- and middle-income countries
Authors; Bronwyne Coetzee, Maria Loades
Abstract – In their paper, Birrell et al. (Child and Adolescent Mental Health, 2025) are rightly concerned about the future of universal school-based mental health interventions. They highlight the successes and failings of these interventions and demonstrate that there is still much to learn about their potential in preventing or mitigating the onset of common mental health conditions like anxiety, depression, trauma and substance use. But encouragingly, and thanks in part to the potential these interventions hold for addressing the mental health gap in low and middle-income countries (LMIC), the authors advise that we as researchers need to take a step back in order to take a better step forward. They suggest that instead of abandoning ship altogether, we should critically examine the shortcomings of these interventions in their current format and work more closely with young people themselves to design and deliver interventions, which have long-term benefits for their communities. In this paper, we want to emphasise the urgency with which these interventions, developed in this way, are needed in LMIC. We emphasise the need to co-develop, adapt, test and evaluate school-based interventions, and the potential they hold for reducing the burden of mental health care in resource-constrained settings.
Debate: Where to next for universal school-based mental health interventions? Time to move towards more effective alternatives
Authors; Jack L. Andrews, Lucy Foulkes
Abstract – There is an urgent need to improve mental health outcomes among young people. One approach taken to address this problem has been the design and delivery of universal school-based prevention, based on therapeutic models such as CBT and mindfulness. Such interventions are delivered to groups of young people, irrespective of risk or need. However, in this commentary, we argue that the initial appeal of universal interventions has not been supported by the evidence: universal school-based prevention is less effective than targeted approaches, often leads to null or unsustained positive effects, has the potential to elicit negative effects and is not well liked by young people themselves. In addition, many young people in each classroom already meet the criteria for a mental disorder, meaning that prevention approaches may not be appropriate or effective for this group. In this commentary, we respond to Birrell et al.’s (2025) paper by arguing that the field should move away from universal prevention and instead invest our limited resources in the refinement and dissemination of interventions with a stronger evidence base, such as one-to-one, targeted and indirect approaches.
Debate: Where to next for universal school-based mental health interventions?
Authors; Louise Birrell, Lucinda Grummitt, Scarlett Smout, Pallab Maulik, Maree Teesson, Nicola Newton
Abstract – In this article, we evaluate the current state of universal school-based mental health prevention. We argue that the field is at another pivotal turning point, with many unanswered questions. As youth mental health issues rise in prominence and prevalence, schools increasingly adopt mental health and well-being programmes. However, recent large-scale trials have reported varied effects, raising questions about their effectiveness. We critically analyse these findings and place them in a global context. We contend results in high-income countries should not be seen as a failure of universal prevention overall and unpack key learnings from trials that have not found significant preventive effects. A comprehensive perspective of the data reveals both negative and positive aspects, as well as some signposts for the way forward. We advocate for programme adaptation based on feedback, embracing proportionate universalism and exploring alternative prevention strategies without discarding universal prevention. We urge continued research with stakeholder involvement, emphasising a nuanced approach to universal school-based mental health prevention, is urgently needed to move the field forward.
Debate: Where to next for universal school-based mental health interventions? The value of student voices in informing the design and implementation of universal school-based mental health interventions
Author; Emma Carter
Abstract – Universal school-based mental health interventions present a promising approach to addressing youth mental health challenges; however, evidence suggests their effectiveness is often limited and unsustained. One contributing factor to this issue is the frequent superficial involvement of students in the design, implementation and evaluation of initiatives. In response, this paper advocates for the urgent prioritisation of student voice within these programmes, using in-depth and purposive qualitative approaches that empower youth to actively co-create and shape interventions. Research highlights that incorporating student voice can yield vital insights into what is effective and ineffective in programmes, particularly for marginalised groups. Moreover, engaging students in co-designing methodologies that help amplify their voices ensures research processes are better aligned with their needs and preferences, fostering greater ownership and improved outcomes. This shift, which repositions students as active collaborators rather than passive recipients, has the potential to enhance both the effectiveness and equity of initiatives.
About the speakers
Prof. Umar Toseeb is a Senior Lecturer in Psychology in Education at the Department of Education, University of York. Umar uses behavioural and genetic data from existing population based datasets to understand special educational needs and mental health in childhood and adolescence. Umar is also one half of ACAMH’s ‘Mind the Kids’ podcast team.
Dr. Lucy Foulkes
I am a Prudence Trust Research Fellow in the Department of Experimental Psychology at the University of Oxford. I am also an honorary lecturer at UCL. My group’s work focuses on mental health and social development in adolescence. I am particularly interested in whether efforts intended to reduce mental health problems, such as awareness-raising campaigns and school initiatives, may inadvertently increase these problems in some individuals.
Our current research projects including the following:
– Understanding how school-based mental health interventions might lead to unintended harm in adolescents, and who is most at risk
– Assessing how learning about mental health problems might change adolescents’ reporting of these symptoms
– Exploring self-diagnosis of mental health problems in adolescence and its relationship to identity development at this age
In the past I have also focused on social cognition in adolescents, particularly social risk, social reward and social influence processes, and how these are related to mental health problems.
We use a range of methods in our work, including experimental designs, scale development, longitudinal analysis and systemic review/meta-analysis. I am increasingly interested in using qualitative approaches to address questions that quantitative methods cannot reach.
I have extensive experience of public science communication. My first book, What Mental Illness Really Is (…and what it isn’t), is out now in paperback (Penguin Random House). It was published as Losing Our Minds in hardback in 2021. I am currently writing my next book, about adolescent development, due for publication in summer 2024 (Penguin Random House). I regularly give public talks about mental health (e.g. Royal Institution), frequently discuss this topic on podcasts and radio (e.g. BBC’s All In The Mind, Guardian Science), and have written many articles for the mainstream media (e.g. The Guardian, New Scientist).
Dr. Jack Andrews
Jack is a Wellcome Trust Fellow in the Department of Experimental Psychology at the University of Oxford, where he leads the Social Mental Health Lab. He is also the Stevenson Junior Research Fellow at University College, Oxford. His work examines social cognitive development and peer influences on mental health during adolescence, and school-based interventions. Prior to joining Oxford, Jack completed his PhD at UCL and was a postdoc at UNSW and the University of Sydney, in Australia.
Prof. Bronwynè Coetzee
Prof Bronwynè Coetzee is an Associate Professor of Psychology at Stellenbosch University in the Faculty of Arts and Social Sciences. Her current research focuses on promoting the psychological well-being of young people and their caregivers in South Africa. Her work centres on two interconnected areas: (1) examining psychosocial and behavioural factors associated with chronic and progressive illnesses, and (2) developing early, evidence-based interventions to support mental health and well-being in young people and their caregivers. A central focus of her scholarship is the co-creation, implementation, and evaluation of scalable, contextually grounded mental health programmes. With funding from the Wellcome Trust, she led the development of 4 Steps To My Future, the first universal, school-based mental health programme co-designed with young people, caregivers, teachers, and the NGO Community Keepers in South Africa. She is a National Research Foundation Y1-rated researcher (2022-2027) and was inducted into the South African Young Academy of Science (SAYAS) in 2022. She is currently serving her second term on the executive committee of the Psychological Society of South Africa’s Division for Research and Methodology.
Dr Louise Birrell (PhD, BPsych, BSocSc)is a Senior Research Fellow and NHMRC Emerging Leadership Fellow at the Matilda Centre, University of Sydney. As the Program Lead for Young People’s Mental Health & Wellbeing, Dr Birrell’s research focuses on identifying risk and protective factors for youth mental health and substance use. Dr Birrell also develops and evaluates preventive interventions, playing a key role in two major school-based digital health trials in Australia, collectively involving 142 schools and >13,000 students.
Dr Birrell has authored 56 peer-reviewed publications, 1 book chapter & 7 government reports in youth mental health and substance use.
Dr Birrell works across multidisciplinary teams with a number of key stakeholders including: the Department of Health, schools, philanthropy, digital agencies and national peak bodies for mental health prevention. Dr Birrell acted as academic co-lead of the NHMRC Centre for Research Excellence in Prevention and Early Intervention in Mental Illness and Substance Use (PREMISE) Youth Advisory Board and is current chair of Capacity Building for the NHMRC Centre of Research Excellence in the Precision Treatment of Depression, where she supports and leads key initatives for EMCR development.
Dr. Emma Carter, McKenzie Postdoctoral Fellow, Univeristy of Melbourne, Faculty of Education. Interests in the impacts of disadvantage on cognitive and social-emotional development and strategies that can best address the needs of learner’s from underserved backgrounds. Her PhD research examined the psychosocial experiences of disadvantaged students from ethnic minority backgrounds involved in programmes aimed at identifying and developing high academic potential within Australia and the UK. Case studies included the Academic Leader’s Programme (Cape York Institute of Policy and Leadership, Australia) and the Emerging Scholar’s Intervention Programme (Support and Help in Education Trust, UK).
Emma has previously worked as a Research Assistant for REAL Centre where she supported the development of the survey instrument for a longitudinal evaluation of the impact of Speed Schools for out-of-school children in Ethiopia. In 2012, she also worked as a Policy Advisor for the Cape York Institute for Policy and Leadership in Australia. Here, she developed a research base informing recommendations for the ‘Opportunity System’, a reform project aimed at improving psychological, educational, social and economic outcomes for Indigenous Australians. Emma has over 10 years of international experience as a teacher, having worked in Australia, China, the United Arab Emirates and the UK. She has also worked as a Research Associate for the REAL Centre where she undertook a comprehensive evaluation of Complimentary Basic Education (CBE) in Ghana. The CBE programme aims to bridge achievement gaps of out-of-school children so they can be reintegrated into mainstream public education after nine months of accelerated learning instruction. Currently, Emma works as a Senior Research Associate at the REAL Centre for the Mastercard Foundation’s Leaders in Teaching initiative, a project focused on improving STEM teaching quality in secondary schools in Rwanda. Alongside this role she also works as a consultant for the World Bank’s Global Education Division where she co-leads the development of the classroom observation tool, Teach Secondary, has supported on the development of Teach Primary (2nd Edition) and supports country implementation.