Source: The Conversation – Africa – By Lydia Namatende-Sakwa, Associate Research Scientist, African Population and Health Research Center
Schools are often among the first places where emotional and behavioural difficulties become visible. Learners may start missing classes, withdrawing from friends or struggling academically.
Schools are strategically positioned for mental health intervention because of their centrality in the lives of children and adolescents. They are an important entry point for mental health responsive action that can reach large numbers of children and adolescents through existing systems.
The burden of child and adolescent mental health is especially urgent in Africa for three reasons. First, specialist mental health services are limited. Second, children face a combination of social, economic, health and humanitarian risks. And third, the continent has a young population. In 2024, 46% of Africa’s population were children under 18.
Evidence from high-income countries suggests that comprehensive mental health interventions involving schools, families and communities can improve mental health, social functioning, learning and general wellbeing.
We are part of a research team, Education and Youth Empowerment, that examines inclusive and quality education in Africa, with a focus on school mental health, gender and adolescent well-being. We recently carried out a review of school-based and school-linked strategies aimed at strengthening capacity to address mental health among children and adolescents. Our study screened 1,759 records and 122 scholarly studies that met our criteria.
Among our main findings were these:
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Promising evidence that brief, structured programmes that teach coping, emotional and problem-solving skills can reduce symptoms of depression and anxiety and improve well-being when delivered by trained non-specialists.
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Counselling on its own is not enough to prevent mental health problems or address the wider school, family and social conditions that contribute to learners’ distress.
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Teachers can play an important role in promoting wellbeing, recognising signs of distress and helping learners access support, but they should not be expected to diagnose or treat mental health conditions.
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Support needs to extend beyond the school to include families, communities, health services and child-protection systems.
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Schools need to be part of a wider mental health support system, rather than relying on stand-alone services such as counselling rooms, one-off programmes or individual guidance teachers.
This evidence was geographically uneven. Most studies came from a relatively small number of countries, particularly Ghana, Uganda, Tanzania, South Africa and Kenya. Evidence was much more limited from francophone and lusophone Africa, north and central Africa, and from rural, remote, pastoralist and conflict-affected settings.
Our findings point to the need for school mental health systems that combine prevention, early identification, teacher support, family and community engagement, and clear referral pathways to specialist care.
What’s working
Our review found promising evidence for brief, structured interventions delivered by trained non-specialists. These include Shamiri, a four-week group intervention tested in Kenyan secondary schools. Under this programme, students meet in small groups for an hour each week, taking part in exercises such as problem-solving, reflecting on personal growth and writing gratitude letters. The sessions are led by trained lay facilitators.
In a trial involving 413 adolescents, participants showed greater reductions in depression and anxiety symptoms than those in a study-skills programme. Benefits were still evident seven months later.
Other promising approaches included:
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improving mental health awareness among learners and staff to recognise signs of distress, understand mental health, reduce stigma, and know when and where to seek help
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trained teachers, school staff or peer facilitators building skills such as emotional regulation, empathy, relationships and problem-solving, while enabling young people to support one another
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using games, music, dance, creative activities and physical movement to support emotional wellbeing, social connection and coping.
An approach employed among refugee children in Uganda combines movement, games, dance, breathing exercises and group activities. Evidence points to improvements in wellbeing and social connectedness, with benefits for traumatic stress and bullying.
These approaches show that school mental health does not have to mean therapy.
Why counselling isn’t enough
Counselling is one of the most common school-based mental health approaches. It provides a confidential space where learners can talk through emotional, behavioural or social difficulties with a trained adult. Counselling matters, but it cannot change everything around a child.
Some learners need confidential spaces to discuss grief, anxiety or family difficulties. But counselling usually responds after a problem has emerged and cannot, by itself, change the conditions contributing to that problem.
Our review showed that many of the pressures affecting children’s mental health – including bullying, violence, poverty, family stress and unsafe school environments – sit beyond what individual counselling can address. Counselling therefore needs to be combined with preventive, whole-school and community-linked approaches.
A school can have a counselling room and still be unsafe. It can have a guidance teacher and still tolerate bullying. It can teach learners to recognise depression and anxiety while having no way to get specialised care.
Role of teachers
Because specialist mental health professionals are scarce, many school-based programmes rely on task-sharing: training teachers and other non-specialists to take on defined mental health support roles. They can help create supportive environments, recognise signs of distress, reduce stigma and guide learners towards appropriate help.
But there must be boundaries. Teachers should not be expected to diagnose mental health conditions, manage serious cases or become substitute psychologists. Evidence from task-sharing programmes in low- and middle-income countries shows that non-specialists are most effective when their roles are clearly defined and supported by training, supervision and referral pathways to more specialised care, as well as clear procedures for confidentiality, safeguarding and referral.
Teacher well-being also matters. Adding mental health responsibilities without time, resources and support risks increasing workload and stress.
Beyond the school gate
Evidence from low- and middle-income countries shows that children’s mental health is shaped not only by what happens at school, but also by family, community and wider social conditions. Reviews of community- and family-based approaches show that involving caregivers, trusted community actors and referral services is valuable.
Schools cannot address children’s mental health alone. Parents and caregivers need support to recognise distress and follow through on referrals. Non-teaching staff also matter because learners may first confide in another trusted adult.
Schools need functioning links with health facilities, child-protection services, community organisations and social protection systems.
Across the studies we reviewed, implementation repeatedly depended on school leadership, cultural adaptation, financing, confidentiality, safeguarding, supervision, clear referral pathways and coordination across sectors.
Schools need mental health systems, not isolated services
Our review showed that isolated interventions are unlikely to be enough. Effective school mental health depends on the wider system around them, including leadership, trained staff, supervision, safeguarding, referral pathways, family engagement, teacher well-being, coordination with health and social services, and sustainable financing.
Charity Waweru-Mwangi contributed to this article.
– How can African schools support children’s mental health? Research shows what works and what doesn’t
– https://theconversation.com/how-can-african-schools-support-childrens-mental-health-research-shows-what-works-and-what-doesnt-292878
