A collaborative and sustainable approach to address mental health promotion and early identification in schools in the Canadian Province of Nova Scotia and beyond

Background The adolescent years (here, ages 12 to 24) are a critical period for the onset of mental disorders, when approximately 70% of all lifetime mental disorders can be diagnosed (O'Connell, Boat, Warner, et al., 2009; Kessler, Berglund, Demler, Jin, Merikangas, & Walters, 2005). Mental health problems or mental disorders, if unrecognized and untreated, can lead to substantial negative personal, social, and civil consequences, including school drop-out/incompletion (Breslau, Miller, Joanie Chung, & Schweitzer, 2011; Kessler, Foster, Saunders, & Stang, 1995), poor social relationships (Bhatia, 2007; Shochet, Dadds, Ham, & Montague, 2006), less robust vocational success, justice system contact, early mortality (including suicide), and a high burden of disability (O'Connell et al., 2009; World Health Organization, 2004). While severe mental disorders (such as psychosis) do onset in adolescence (American Psychiatric Association, 2013) most, especially emotional/mood disturbances, are mild or moderate in intensity (Kessler et al. 2012). Substantial evidence for successful treatment of mental disorders in young people exists and positive outcomes may be enhanced if evidence-based treatment is provided early in the course of illness (Rutter et al., 2008). Thus, early identification and early effective interventions, support, and ongoing care for youth developing a mental disorder is needed. This may not only advance positive treatment outcomes, but also may help facilitate healthy psychosocial development (Kutcher, 2011; Waddell, Offord, Shepherd, Hua, & McEwan, 2002). Since most youth attend school, schools are an obvious venue through which to address their health and mental health needs. Promoting physical health and applying public health interventions, such as vaccinations, in schools has long been supported by international organizations, such as the World Health Organization (WHO), United Nations Educational, Scientific, and Cultural Organization (UNESCO), and United Nations International Children's Emergency Fund (UNICEF) (WHO Regional Office for Europe, 1996). More recently, school mental health has received international attention.