OF ALKENES

Subsequent to the previous two sections, which discussed the prevalence and disparities of mental health among adolescents and school-based mental health and wellbeing programmes, this section explores the implications for research and mental health practice among male adolescents, particularly in the school context. According to the literature, there are three main implications that are specific and relevant for school-based mental health interventions, the mental health and wellbeing of male adolescents and thus the current project. These include:

1) Changing how male students’ mental health issues are perceived in schools through multi-disciplinary teamwork, coordination of interventions, integration of interventions, modification of student support staff roles and development of systematic approaches to address male adolescent mental health (Adelman, 2010; Degney et al., 2012; Fives et al., 2011; Gulliver et al., 2010; Meredith et al., 2009).

2) The need to use schools to increase access to mental health and wellbeing services, including whole-school programmes and interventions, for adolescents (de Jong & Griffiths, 2008; Pommier et al., 2010).

3) The essentiality of available mental health interventions through expanded school resources and combining school and community resources specifically in relation to the collaboration of researchers and school staff (Christodoulou et al., 2011; Li et al., 2009; Powers & Tiffany, 2006; St Leger et al., 2007).

Despite an overrepresentation of males, there seems to be only limited literature on male adolescent health and specific mental health and wellbeing interventions for young males. Males have long been overlooked and under-theorised in mental health research, and little research exists that examines specifically how some males are able to negotiate their wellbeing more successfully (Riska, 2009). Specifically, in Australian and international school-based mental health research, numerous studies have involved female rather than male adolescents (see Pinto-Foltz, 2009; Schinke et al., 2008). There is a need for greater understanding of males’ experiences of mental

health (Ridge, Emslie & White, 2011), particularly around managing wellbeing (Addis, 2008) and programme effects. There is, therefore, a strong possibility that current initiatives that develop services for adolescents will fall short unless these are configured in ways that take the unique mental health and wellbeing issues of adolescent males into account. It is, therefore, necessary for mental health services and intervention programmes to be constructed for males (Pinkhasov et al., 2010), particularly across the entire range of adolescence, including, rather than excluding, the pubertal (under 16 years of age) period (Briggs, 2009). Further, engaging with mental health and wellbeing has implications for health professionals, as this suggests that formulating a range of intervention strategies, targeted to appeal to different needs, may be useful in terms of reaching out to young males.

The complexity of the nature of adolescent mental health and wellbeing can be seen through the diverse factors that play a part in the overall development of mental health and associated programmes. In addition, in consideration of the multiple ways that mental health has been measured and that mental health promotion programmes have been utilised, it is still important to place male adolescent mental health in its appropriate age/stage context, tailoring programmes to male adolescents’ unique needs and contexts. The current research primarily examines a programme development and performance progress among adolescent males aged 11 to 13 years.

The role of the school environment on adolescents’ mental health is becoming increasingly diverse and important, particularly as schools are being seen as a priority setting for health promotion (WHO, 2005). The school environment may provide students with the only source of mental health service (Weare & Markham, 2005), creating the opportunity for screening, early detection of problems and early intervention (Adelman & Taylor, 1998; Armbruster et al., 1997; Casat et al., 1999).

Schools also provide an avenue to disseminate, collect and report on adolescent health and wellbeing and associated programmes, particularly as school enrolment is compulsory among this age group (Masia-Warner et al., 2006; Testa & Coleman, 2006) and as a result have unparalleled contact with youths (Masia-Warner et al., 2006).

Studies have shown the importance of school-based mental health and wellbeing programmes and interventions, including their sustainability in school settings and

adolescent populations. Mental health research suggests that school-based mental health and wellbeing programmes foster adolescents’ emotional skills, enabling adolescents to realise optimal health and cope with adversity, reduce the chance of progression of mental health condition to a more severe phase and play a major role in the mental health of the adolescent. School-based mental health programmes are also seen as part of an essential support system that aims to enhance adolescents’ mental health and wellbeing. The focus of school-based mental health and wellbeing programmes largely concerns:

1) Promoting social-emotional development.

2) Preventing mental health and psychosocial problems.

3) Enhancing resiliency.

4) Intervening early after the onset of mental health-related problems.

5) Addressing factors in schools that affect young people such as bullying, alienation and student disengagement.

6) Establishing policies and practices for school-based mental health that confront equity considerations.

7) Building capacity among staff to address and promote healthy development of students.

8) Drawing on empirical evidence to aid in the development of effective interventions.

In addition, there are trends towards making services more accessible and responsive to the needs of young males. However, there is little understanding among researchers how school mental health and wellbeing programmes may affect the mental health of young male adolescents. A major problem in addressing the mental health needs of young males is their lack of access to and uptake of mental health services. Schools are, therefore, seen as essential partners in transforming the mental health of adolescents in Australia, particularly for male adolescents.

Therefore while the positive affect of school-based programmes on the mental health and wellbeing outcomes among adolescents are being recognised, the benefits of specific and targeted programmes for male adolescents are yet to be explored. A better understanding of mechanisms linking male adolescents’ mental health and wellbeing to specifically designed programmes is important for the development of optimal school-based programmes for young people. This is a pivotal aspect of the current project and forms part of the premise on which the current study explores mental health and wellbeing programmes.

Further, implementation of new practices in schools, specifically mental health promotion interventions, has given rise to several barriers and concerns, including dissemination, readiness for and fidelity of implementation, generalisability, adaptation, sustainability and replication of scale (Forman & Barakat, 2011; Nylen, Moran, Franklin & O’Hara, 2006). Massey, Armstrong, Boroughs, Henson and McCash (2005) examined the challenges for mental health programmes in schools.

They conducted focus groups with adolescent participants to determine any problems encountered as an innovative programme was in the early adoption phase. The first challenge identified by the focus groups was a lack of understanding of the role and purpose of the mental health service being provided. When diverse contributors are involved, such as the education system, mental health service providers and advocacy groups, many differing agendas were found to be apparent (Massey et al., 2005).

Although research findings indicate that emotional, behavioural and social problems of adolescents can be prevented or ameliorated through the use of these programmes, they have not been translated into practice in schools (Forman & Barakat, 2011).

Addressing the content and process of the intervention and its theoretical rationale and empirical basis are important components when implementing effective interventions in schools (Han & Weiss, 2005). Interestingly, Stewart-Brown (2001) notes that both controlled and randomised controlled study designs are often based on the assumption

‘that delivering a standardised intervention, which can be faithfully reproduced in different schools, is possible and desirable’ (p. 273). Research has also postulated that disregarding educational and health promotion literature, and the dynamic and idiosyncratic nature of schools, can lead to inappropriate applied research designs (Rowling, 2003).

Independent of the mixed reviews of school-based mental health and wellbeing promotion programmes, it is important to note that there are several factors that are consistently associated with positive outcomes (Forman & Barakat, 2011). Of those programmes specifically for young people, the few that have been evaluated for their impact found the following factors contributed to their effectiveness: (1) programme implementation; (2) support and co-operation of parents; (3) behaviour change-oriented intervention; (4) integration of programme content into general classroom curriculum; (5) developmentally appropriate programme contents; (6) elements of CBT; (7) social skills training; and (8) teacher consultation in promoting good mental health (Zhang & Feller, 2007).

There are other studies that showed the importance of the evaluation of programmes and practice, including their sustainability in school settings and with adolescent populations. Moreover, Christodoulou et al. (2011) assert that mental health promotion projects must include an evaluation component and have the evidence of how mental health promotion programmes should be implemented for the best outcomes. Correspondingly, Barry and Jenkins’ (2007) review of existing studies concluded that these programmatic aspects are essential for effective implementation.

In a French study, Potvin, Bilodeau and Gendron (2008) identified three main challenges for those evaluating mental health promotion programs: (1) defining the activity to be evaluated in order to raise pertinent evaluation questions; (2) implementing an appropriate, rigorous research methodology; and (3) producing pertinent knowledge for actions. Further, Pommier et al. (2010) note that in this context, and that of mental health promotion particularly in the school system, the choice of methodology is of paramount importance.

Therefore, despite research demonstrating the value of early intervention in schools, the efficiency of interventions for adolescents who are at risk of or exhibiting substantial mental health problems and the importance of mental health in development, adolescent mental health continues to be sporadically considered, particularly among male adolescents. Regardless of the discourse, however, all approaches adhere to the belief the schools can have a wider role, outside their traditional academic one (Weare, 2010). However, what is provided by schools under the rubric of mental health programmes and whether those programmes are effective,

is largely unknown (Hoagwood & Erwin, 1997; Powers & Tiffany, 2006; Rones &

Hoagwood, 2000). Recognising that health is a complex, socially determined concept means that activities to promote health require careful planning, and often collaboration with different agencies (Center for Mental Health in Schools, 2006;

Weare & Markham, 2005). Correspondingly, the question still remains as to what these integrative learning and teaching programmes should look like, and how such processes work in the context of the school environment among male adolescents.

Nevertheless, there are very few studies that link the importance of collaboration with adolescents and the school community as active participants in research. Given this, and the acceptance and use of encouraging participation by all stakeholders, the incorporation of school staff and students to design and implement a mental health and wellbeing programme for male adolescents is a valuable and appropriate approach to underpin this research. Specifically, in using this design to identify ways to cater for and assist male adolescents to develop positive mental health and associated skills, we will better understand the relationship between mental health, the use of schools as an avenue to deliver effective mental health promotion and prevention among young males, and male adolescents’ sense of mental health and wellbeing. The current project recognises the value of discussing mental health and wellbeing issues with stakeholders and utilising their responses to tailor prevention and intervention programmes to their needs. Facilitating discussions with the male adolescents and school administration is the optimal ways to discern issues, further needed support and eventual experiences of the mental health and wellbeing programme.

Research has emphasised that youth-specific approaches are necessary when implementing effective school-based mental health and wellbeing promotion programmes (Hickie & Walter, 2009). Literature has highlighted that school-based mental health promotion programmes should be characterised by their developmentally-oriented approach to the management of poor mental health and wellbeing, including the acknowledgement of the evolving nature and complex pattern of mental illness in this age group; young peoples’ individual and group identity and unique life-stage issues (Mrazek & Haggerty, 1994); and their discerning help-seeking behaviours (Rickwood et al., 2005). The US Center for Mental Health in

Schools (2006) report recommends that any attempts to alter the manner in which mental health treatment is delivered must take into account the opportunities and needs of the school. Analyses and approaches to such innovations have paid little attention to the context and have had a limited procedural framework (Addis, 2002;

Elliott & Mihalic, 2004; Greenberg, 2004). Adelman and Taylor (2009) conclude that with these deficiencies throughout the implementation process and context, innovations are diffused and their effectiveness limited.

Schools are positioned as one of the key sites for delivering programmes, being regarded as having the greatest potential for making valuable contributions to reducing mental health and wellbeing problems (Mittelmark, Kickbusch & Rootman, 2007; Naidoo & Wills, 2009). Poor mental health and wellbeing among male adolescents is therefore more likely to be detected effectively treated within a school setting. The current project utilises these features of such school mental health and wellbeing frameworks, making it an effective avenue for a programme that is more accessible and responsive to the needs of young males.

Advancing mental health and wellbeing of male adolescents in schools hinges upon the development of a comprehensive, multifaceted approach to strengthen students, families, schools and communities. Mental health and wellbeing programmes in schools must reflect a shared agenda to integrate the improvement of adolescent mental health and the need to collaborate with different stakeholders. The current study seeks to examine the implementation of a mental health and wellbeing promotion programme in the school context, with the hope that encouraging the participation of the whole-school community may be of value to understanding effective mental health strategies and providing an empirical basis for programmes in male youth-specific research, and act as a means to diffuse problems raised in earlier research.

There is an urgent need for effective school-based adolescent interventions,

particularly targeting adolescent males. To date, secondary school-based interventions have been limited by their single-faceted approach, small scale effects and gender bias. To address these shortfalls in the current literature, the current mental health and wellbeing programme was designed and implemented. The aim of the study was to investigate male adolescent mental health issues, needs and services for effective

mental health promotion in schools. Identifying these areas has directed the aims of this project and responds to research into school mental health promotion programmes for adolescents both in Australia and internationally (Brener, Martindale et al., 2001;

Cardemil et al., 2010; Christner, Mennuti & Whitaker, 2009; Levitt et al., 2007;

Naidoo & Wills, 2009; Wells et al., 2003). This is also significant in relation to the current projects’ subsidiary questions. Thus, this research utilises a study design in which the school community and students have the opportunity to shape, produce and evaluate a mental health and wellbeing programme specific to their contextual needs.