{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T12:02:36Z","timestamp":1791633756654,"version":"4.3.4"},"reference-count":46,"publisher":"Royal College of Psychiatrists","issue":"4","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"unspecified","delay-in-days":5,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["BJPsych open"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec id=\"S2056472426120092_as1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Adolescent mental health is a growing public health concern due to the high prevalence of mental disorders, many of which remain unrecognised and untreated. School staff are strategically positioned to promote mental health, recognise mental health problems and support pathways into care, but often lack sufficient mental health literacy (MHL) and confidence to act.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120092_as2\">\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This study evaluated the effects of the WhySchool project, a school-based programme to promote MHL among teachers and school health professionals (SHPs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120092_as3\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>\n                      We implemented WhySchool in 72 public middle and high schools across Portugal through a cascade training approach. With a pre\u2013post design, we assessed 788 teachers and 201 SHPs on mental health knowledge (MHK), personal depression stigma, openness to seeking help and confidence in identifying\/referring students. Paired-sample\n                      <jats:italic>t<\/jats:italic>\n                      -tests with Cohen\u2019s\n                      <jats:italic>d<\/jats:italic>\n                      estimated changes, and generalised linear mixed models (GLMMs) accounted for confounders and within-subject variability.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120092_as4\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The programme was associated with significant improvements in all outcomes across both professional groups, with moderate-to-large effect sizes (MHK\n                      <jats:italic>d<\/jats:italic>\n                      = 1.12 (95% CI 1.04 to 1.20); stigma\n                      <jats:italic>d<\/jats:italic>\n                      = \u22121.05 (95% CI \u22121.12 to \u22120.97); openness\n                      <jats:italic>d<\/jats:italic>\n                      = 0.44 (95% CI 0.37 to 0.51); confidence\n                      <jats:italic>d<\/jats:italic>\n                      = 0.87 (95%CI 0.79 to 0.94)). GLMMs confirmed these results. Gains varied across professional groups and demographic characteristics, with those having lower baseline scores generally benefiting most.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120092_as5\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The WhySchool resulted in observable improvements in teachers\u2019 and SHPs\u2019 MHL, including increased knowledge, reduced stigma, improved help-seeking attitudes and strengthened confidence to support students. The cascade model provides a viable and sustainable strategy for large-scale implementation, empowering educational communities to better support student mental health.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1192\/bjo.2026.12009","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T06:48:30Z","timestamp":1783320510000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["WhySchool project: effects of a school-based mental health literacy programme on teachers and school health professionals"],"prefix":"10.1192","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3742-0052","authenticated-orcid":false,"given":"Joana","family":"Moreira","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/043pwc612","id-type":"ROR","asserted-by":"publisher"}],"name":"Institute of Public Health, University of Porto"},{"id":[{"id":"https:\/\/ror.org\/043pwc612","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Porto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virg\u00ednia","family":"Concei\u00e7\u00e3o","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/043pwc612","id-type":"ROR","asserted-by":"publisher"}],"name":"Institute of Public Health, University of Porto"},{"id":[{"id":"https:\/\/ror.org\/043pwc612","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Porto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Mehlum","sequence":"additional","affiliation":[{"name":"Institute of Clinical Medicine, University of Oslo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanley","family":"Kutcher","sequence":"additional","affiliation":[{"name":"Dalhousie University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6334-4607","authenticated-orcid":false,"given":"Ricardo","family":"Gusm\u00e3o","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/043pwc612","id-type":"ROR","asserted-by":"publisher"}],"name":"Institute of Public Health, University of Porto"},{"id":[{"id":"https:\/\/ror.org\/043pwc612","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Porto"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"S2056472426120092_ref6","doi-asserted-by":"publisher","DOI":"10.3390\/su15118981"},{"key":"S2056472426120092_ref5","doi-asserted-by":"publisher","DOI":"10.1177\/0706743715616609"},{"key":"S2056472426120092_ref1","unstructured":"1 Institute for Health Metrics and Evaluation. Global Burden of Disease (GBD) Compare. Institute for Health Metrics and Evaluation, 2023 (https:\/\/vizhub.healthdata.org\/gbd-compare\/)."},{"key":"S2056472426120092_ref3","doi-asserted-by":"publisher","DOI":"10.1038\/s41380-021-01161-7"},{"key":"S2056472426120092_ref42","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-019-4398-1"},{"key":"S2056472426120092_ref11","unstructured":"11 World Health Organization (WHO). Comprehensive Mental Health Action Plan 2013\u20132030. WHO, 2021 (https:\/\/iris.who.int\/bitstream\/handle\/10665\/345301\/9789240031029-eng.pdf?sequence=1)."},{"key":"S2056472426120092_ref22","doi-asserted-by":"publisher","DOI":"10.1192\/bjo.2021.407"},{"key":"S2056472426120092_ref26","doi-asserted-by":"publisher","DOI":"10.33422\/ijce.v1i1.11"},{"key":"S2056472426120092_ref32","unstructured":"32 EUTIMIA. Why Youth Mental Health Care School \u2013 Based with Primary Care Liaison. The EEA and Norway Grants, 2015 (https:\/\/eeagrants.org\/archive\/2009-2014\/projects\/PT06-0015)."},{"key":"S2056472426120092_ref37","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-842X.2001.tb00586.x"},{"key":"S2056472426120092_ref45","unstructured":"45 Gaspar, M , Noronha, C , Moraes, B , Domingos, L , Raimundo, M , Cerqueira, A , et\u00a0al. Sa\u00fade Psicol\u00f3gica e Bem-estar [Psychological Health and Well-Being]. DGEEC and Aventura Social Associa\u00e7\u00e3o [Aventura Social Association], 2024 (https:\/\/info.dgeec.medu.pt\/saude-psicologica-e-bem-estar-2024\/)."},{"key":"S2056472426120092_ref41","volume-title":"IMSCI 2008 \u2013 2nd International Multi-Conference on Society, Cybernetics and Informatics, Proceedings","author":"Suzuki","year":"2008"},{"key":"S2056472426120092_ref25","doi-asserted-by":"publisher","DOI":"10.1037\/a0022714"},{"key":"S2056472426120092_ref10","doi-asserted-by":"publisher","DOI":"10.1037\/a0025957"},{"key":"S2056472426120092_ref28","first-page":"240","article-title":"Mental health literacy: a review of what it is and why it matters","volume":"7","author":"Furnham","year":"2020","journal-title":"Int Perspect Psychol"},{"key":"S2056472426120092_ref17","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-155-2-201107190-00005"},{"key":"S2056472426120092_ref21","doi-asserted-by":"publisher","DOI":"10.1192\/bjo.2019.23"},{"key":"S2056472426120092_ref31","unstructured":"31 European Commission. YouthWiki: Portugal. 7.5. European Commission, 2023 (https:\/\/national-policies.eacea.ec.europa.eu\/youthwiki\/chapters\/portugal\/75-mental-health)."},{"key":"S2056472426120092_ref33","unstructured":"33 Kutcher, S , Wei, Y. Mental Health and High School Curriculum Guide: Understanding Mental Health and Mental Illness (Version 3). Mental Health Literacy, 2017 (https:\/\/mentalhealthliteracy.org\/product\/mental-health-high-school-curriculum\/)."},{"key":"S2056472426120092_ref12","doi-asserted-by":"publisher","DOI":"10.1080\/1754730X.2013.784615"},{"key":"S2056472426120092_ref34","doi-asserted-by":"publisher","DOI":"10.1186\/s12955-022-01945-7"},{"key":"S2056472426120092_ref18","volume-title":"Adapta\u00e7\u00e3o e Bem Estar nas Escolas Portuguesas [Adaptation and Well-Being in Portuguese Schools]","author":"Marques Pinto","year":"2011"},{"key":"S2056472426120092_ref15","doi-asserted-by":"publisher","DOI":"10.1891\/1559-4343.14.3.178"},{"key":"S2056472426120092_ref40","first-page":"1","article-title":"Cascade approach on teachers\u2019 continuous professional development to improve learning outcomes in pre-primary and primary education: experience in the implementation of the F4L project in East Africa","volume":"16","author":"Bazuca","year":"2025","journal-title":"J Educ Pract"},{"key":"S2056472426120092_ref43","volume-title":"SHE Monitoring Report 2020: Country-specific Results of Portugal","year":"2020"},{"key":"S2056472426120092_ref30","doi-asserted-by":"publisher","DOI":"10.1007\/s11218-025-10166-x"},{"key":"S2056472426120092_ref20","volume-title":"Mental Health Literacy in Nova Scotia\u2019s Education System: 15 Years after the Evergreen Framework","author":"Page","year":"2025"},{"key":"S2056472426120092_ref16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsp.2020.01.001"},{"key":"S2056472426120092_ref19","doi-asserted-by":"publisher","DOI":"10.2989\/17280583.2023.2229876"},{"key":"S2056472426120092_ref9","doi-asserted-by":"publisher","DOI":"10.1192\/bjo.2024.843"},{"key":"S2056472426120092_ref29","doi-asserted-by":"publisher","DOI":"10.1007\/s12310-018-9291-2"},{"key":"S2056472426120092_ref23","doi-asserted-by":"publisher","DOI":"10.1080\/1754730X.2016.1252276"},{"key":"S2056472426120092_ref8","doi-asserted-by":"publisher","DOI":"10.1016\/j.chc.2011.09.005"},{"key":"S2056472426120092_ref13","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20732"},{"key":"S2056472426120092_ref2","unstructured":"2 World Health Organization (WHO). 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WHO, 2024 (https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/adolescent-mental-health)."},{"key":"S2056472426120092_ref35","doi-asserted-by":"publisher","DOI":"10.1037\/h0029636"},{"key":"S2056472426120092_ref38","doi-asserted-by":"publisher","DOI":"10.1111\/eip.12964"},{"key":"S2056472426120092_ref39","doi-asserted-by":"publisher","DOI":"10.1111\/camh.12609"},{"key":"S2056472426120092_ref7","doi-asserted-by":"publisher","DOI":"10.1080\/00098655.2010.484441"},{"key":"S2056472426120092_ref27","doi-asserted-by":"publisher","DOI":"10.1186\/s40359-022-00820-w"},{"key":"S2056472426120092_ref46","doi-asserted-by":"publisher","DOI":"10.1787\/e13bef63-en)"},{"key":"S2056472426120092_ref14","doi-asserted-by":"publisher","DOI":"10.1111\/eip.12793"},{"key":"S2056472426120092_ref4","doi-asserted-by":"publisher","DOI":"10.1111\/camh.12609"},{"key":"S2056472426120092_ref36","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0263622"},{"key":"S2056472426120092_ref24","first-page":"59","article-title":"Secondary school teachers\u2019 attitude to mental illness in Ogun State, Nigeria","volume":"12","author":"Aghukwa","year":"2009","journal-title":"Afr J Psychiatry (Johannesburg)"},{"key":"S2056472426120092_ref44","doi-asserted-by":"publisher","DOI":"10.1787\/f8d7880d-en)"}],"container-title":["BJPsych Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S2056472426120092","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T06:48:46Z","timestamp":1783320526000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S2056472426120092\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":46,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["S2056472426120092"],"URL":"https:\/\/doi.org\/10.1192\/bjo.2026.12009","relation":{},"ISSN":["2056-4724"],"issn-type":[{"value":"2056-4724","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. Published by Cambridge University Press on behalf of Royal College of Psychiatrists","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e175"}}