{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T18:33:15Z","timestamp":1765477995489,"version":"3.48.0"},"reference-count":53,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T00:00:00Z","timestamp":1765411200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>In England, 1 in 5 children and young people (CYP; aged 8\u201325 years) has a probable mental disorder with higher rates among those living in poverty, and among white children compared with other ethnic groups. However, in the UK, research shows that the prevalence of mental health conditions and associated service use differs among some ethnic minority groups (e.g., Asians) suggesting potential unmet mental health need. Early interventions have been shown to improve life outcomes, and UK government policies encourage the promotion of mental health and wellbeing in schools and colleges, but poor mental health continues to rise. Despite evidence showing that mental health problems occur as early as age 5 years, limited research focusses on primary schools (children aged 5\u201310 years). Northwest London (NWL), UK, is a diverse region in London, is in the top 20% most deprived, and has a high demand for CYP mental health services. The aim of our study was to explore teachers\u2019 perspectives of promoting positive mental health in NWL primary schools. We created a semi-structured interview based on policy guidance. Nine teachers were recruited and interviewed during June and July 2024. Thematic analysis identified six overarching themes: (1) mental health needs; (2) responsibility; (3). factors contributing to poor mental health; (4). barriers and (5) facilitators to providing support; and (6) collaboration. Subthemes included lack of skills to address the broad spectrum of mental health needs, funding, resources, and lack of support systems to ensure all children receive the right support at the right time. Our study highlights implementation gaps for promoting mental health policy in diverse real-world settings, and suggests that whilst schools play an important role for early mental health intervention, wider complexities limit sufficient support provision. Our findings have potential implications for mental health promotion policies in school settings.<\/jats:p>","DOI":"10.1371\/journal.pone.0336946","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T18:29:12Z","timestamp":1765477752000},"page":"e0336946","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cI think it is our responsibility, but not solely our responsibility\u201d: A qualitative study exploring teachers\u2019 perspectives on promoting mental health in Northwest London primary schools"],"prefix":"10.1371","volume":"20","author":[{"given":"Cecilia N.","family":"Ashu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dougal S.","family":"Hargreaves","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tamsin","family":"Robinson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dasha","family":"Nicholls","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0023-1573","authenticated-orcid":true,"given":"Bina","family":"Ram","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,12,11]]},"reference":[{"key":"pone.0336946.ref001","author":"NHS Digital","year":"2023"},{"issue":"9","key":"pone.0336946.ref002","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1016\/S2215-0366(24)00163-9","article-title":"The Lancet Psychiatry Commission on youth mental health","volume":"11","author":"PD McGorry","year":"2024","journal-title":"Lancet Psychiatry"},{"key":"pone.0336946.ref003","author":"UK Government","year":"2024"},{"key":"pone.0336946.ref004","author":"Mentally Healthy Schools"},{"key":"pone.0336946.ref005","author":"Mental Health Foundation","year":"2024"},{"key":"pone.0336946.ref006","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.neubiorev.2021.07.030","article-title":"A systematic review of the persistence of childhood mental health problems into adulthood","volume":"129","author":"M Mulraney","year":"2021","journal-title":"Neurosci Biobehav Rev"},{"key":"pone.0336946.ref007","author":"NHS England","year":"2021"},{"key":"pone.0336946.ref008","author":"The Royal College of Paediatrics and Child Health","year":"2022"},{"issue":"3","key":"pone.0336946.ref009","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1136\/jech-2023-221223","article-title":"Inequalities in mental health service utilisation by children and young people: a population survey using linked electronic health records from Northwest London, UK","volume":"78","author":"AI Lazzarino","year":"2024","journal-title":"J Epidemiol Commun Health"},{"issue":"1","key":"pone.0336946.ref010","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s12888-022-04438-5","article-title":"Inequalities in children\u2019s mental health care: analysis of routinely collected data on prescribing and referrals to secondary care","volume":"23","author":"WP Ball","year":"2023","journal-title":"BMC Psychiatry"},{"key":"pone.0336946.ref011","author":"R Brown","year":"2018"},{"key":"pone.0336946.ref012","article-title":"Why schools should promote students\u2019 health and wellbeing","volume":"348","author":"C Bonell","year":"2014","journal-title":"BMJ"},{"key":"pone.0336946.ref013","author":"iTHRIVE","year":"2015"},{"key":"pone.0336946.ref014","author":"GOV UK"},{"issue":"4","key":"pone.0336946.ref015","doi-asserted-by":"crossref","first-page":"316","DOI":"10.34172\/hpp.2020.50","article-title":"School as ideal setting to promote health and wellbeing among young people","volume":"10","author":"M Pulimeno","year":"2020","journal-title":"Health Promot Perspect"},{"key":"pone.0336946.ref016","author":"Public Health England","year":"2021"},{"key":"pone.0336946.ref017","author":"Department for Education","year":"2024"},{"key":"pone.0336946.ref018","author":"NHS England"},{"key":"pone.0336946.ref019","author":"Department of Health and Department for Education","year":"2017"},{"issue":"8","key":"pone.0336946.ref020","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/XQWU4117","article-title":"Early evaluation of the Children and Young People\u2019s Mental Health Trailblazer programme: a rapid mixed-methods study","volume":"11","author":"J Ellins","year":"2023","journal-title":"Health Soc Care Deliv Res"},{"key":"pone.0336946.ref021","author":"NHS"},{"issue":"1","key":"pone.0336946.ref022","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s40359-018-0242-3","article-title":"Systematic review of resilience-enhancing, universal, primary school-based mental health promotion programs","volume":"6","author":"A Fenwick-Smith","year":"2018","journal-title":"BMC Psychol"},{"issue":"4","key":"pone.0336946.ref023","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1080\/13540602.2011.580525","article-title":"Supporting children\u2019s mental health in schools: teacher views","volume":"17","author":"A Graham","year":"2011","journal-title":"Teach Teach"},{"issue":"11","key":"pone.0336946.ref024","doi-asserted-by":"crossref","first-page":"2359","DOI":"10.1002\/pits.22648","article-title":"Supporting primary school students\u2019 mental health needs: teachers\u2019 perceptions of roles, barriers, and abilities","volume":"59","author":"L Maclean","year":"2022","journal-title":"Psychol Schools"},{"issue":"6","key":"pone.0336946.ref025","doi-asserted-by":"crossref","first-page":"1621","DOI":"10.1093\/heapro\/daab010","article-title":"Educators\u2019 perceived mental health literacy and capacity to support students\u2019 mental health: associations with school-level characteristics and provision in England","volume":"36","author":"R Mansfield","year":"2021","journal-title":"Health Promot Int"},{"issue":"6","key":"pone.0336946.ref026","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1080\/01411920903249308","article-title":"Part and parcel of teaching? Secondary school staff\u2019s views on supporting student emotional health and well\u2010being","volume":"36","author":"J Kidger","year":"2010","journal-title":"Br Educ Res J"},{"issue":"1","key":"pone.0336946.ref027","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1080\/1754730X.2014.978119","article-title":"Teachers\u2019 role breadth and perceived efficacy in supporting student mental health","volume":"8","author":"KR Mazzer","year":"2014","journal-title":"Adv Sch Ment Health Promot"},{"issue":"5","key":"pone.0336946.ref028","first-page":"372","article-title":"Secondary school teachers\u2019 experiences of supporting mental health","volume":"14","author":"L Shelemy","year":"2019","journal-title":"J Ment Health Train"},{"issue":"1","key":"pone.0336946.ref029","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1080\/13632752.2019.1582742","article-title":"Supporting students\u2019 mental health in schools: what do teachers want and need?","volume":"24","author":"L Shelemy","year":"2019","journal-title":"Emot Behav Diffic"},{"key":"pone.0336946.ref030","first-page":"1","article-title":"Supporting children\u2019s mental health in primary schools: a qualitative exploration of educator perspectives","author":"A Giles-Kaye","year":"2022","journal-title":"Aust Educ Res"},{"issue":"1","key":"pone.0336946.ref031","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1007\/s12310-020-09398-3","article-title":"Acceptability and feasibility of early identification of mental health difficulties in primary schools: a qualitative exploration of UK school staff and parents\u2019 perceptions","volume":"13","author":"J Childs-Fegredo","year":"2020","journal-title":"School Mental Health"},{"issue":"2","key":"pone.0336946.ref032","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1080\/02643944.2016.1167110","article-title":"Addressing the \u2018elephant in the room\u2019. The role of the primary school practitioner in supporting children\u2019s mental well-being","volume":"34","author":"G Danby","year":"2016","journal-title":"Pastoral Care Educ"},{"issue":"4","key":"pone.0336946.ref033","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1007\/s12310-016-9187-y","article-title":"Child, teacher and parent perceptions of the FRIENDS classroom-based universal anxiety prevention programme: a qualitative study","volume":"8","author":"E Skryabina","year":"2016","journal-title":"School Ment Health"},{"key":"pone.0336946.ref034","author":"NHS England"},{"key":"pone.0336946.ref035","author":"Department for Education","year":"2018"},{"key":"pone.0336946.ref036","doi-asserted-by":"crossref","first-page":"200312","DOI":"10.1016\/j.mhp.2023.200312","article-title":"Priority actions for promoting population mental health and wellbeing","volume":"33","author":"MM Barry","year":"2024","journal-title":"Mental Health & Prevention"},{"key":"pone.0336946.ref037","author":"GOV UK","year":"2024"},{"key":"pone.0336946.ref038","author":"GOV UK","year":"2024"},{"key":"pone.0336946.ref039","author":"Ministry of Housing CLG. English Indices of Deprivation 2019 - LSOA Level UK","year":"2019"},{"key":"pone.0336946.ref040","doi-asserted-by":"crossref","first-page":"114523","DOI":"10.1016\/j.socscimed.2021.114523","article-title":"Sample sizes for saturation in qualitative research: a systematic review of empirical tests","volume":"292","author":"M Hennink","year":"2022","journal-title":"Soc Sci Med"},{"key":"pone.0336946.ref041","volume-title":"NVivo (Version 14) 2023 [Accessed via Imperial College London]","author":"Lumivero"},{"issue":"6","key":"pone.0336946.ref042","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1016\/0260-6917(91)90009-Y","article-title":"A method of analysing interview transcripts in qualitative research","volume":"11","author":"P Burnard","year":"1991","journal-title":"Nurse Educ Today"},{"issue":"3","key":"pone.0336946.ref043","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1080\/02667363.2019.1585332","article-title":"The emotional literacy support assistant (ELSA) programme: ELSAS\u2019 and children\u2019s experiences","volume":"35","author":"S McEwen","year":"2019","journal-title":"Educ Psychol Pract"},{"issue":"3","key":"pone.0336946.ref044","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1080\/00313831.2016.1147068","article-title":"Teacher stress related to student mental health promotion: the match between perceived demands and competence to help students with mental health problems","volume":"61","author":"S Ekornes","year":"2017","journal-title":"Scand J Educ Res"},{"key":"pone.0336946.ref045","doi-asserted-by":"crossref","DOI":"10.3389\/feduc.2024.1505077","article-title":"We are left to fend for ourselves: understanding why teachers struggle to support students\u2019 mental health","volume":"9","author":"A Dabrowski","year":"2025","journal-title":"Front Educ"},{"issue":"3","key":"pone.0336946.ref046","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1111\/camh.12322","article-title":"Review: The association between anxiety and poor attendance at school - a systematic review","volume":"24","author":"K Finning","year":"2019","journal-title":"Child Adolesc Ment Health"},{"key":"pone.0336946.ref047","author":"Department for Education","year":"2023"},{"key":"pone.0336946.ref048","doi-asserted-by":"crossref","first-page":"1292520","DOI":"10.3389\/fpubh.2024.1292520","article-title":"Staff perspectives on poor mental health in secondary school students: an increasing problem handled with insufficient resources","volume":"12","author":"\u00c5 Svensson","year":"2024","journal-title":"Front Public Health"},{"key":"pone.0336946.ref049","article-title":"Secondary school staff experiences of supporting and promoting adolescent mental health in Ireland","author":"A Blix","year":"2024","journal-title":"Irish Educ Stud"},{"issue":"1","key":"pone.0336946.ref050","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1111\/camh.12639","article-title":"Review: Crisis responses for children and young people - a systematic review of effectiveness, experiences and service organisation (CAMH-Crisis)","volume":"29","author":"D Edwards","year":"2024","journal-title":"Child Adolesc Ment Health"},{"issue":"3","key":"pone.0336946.ref051","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1111\/j.1475-3588.2012.00677.x","article-title":"How do schools promote emotional well-being among their pupils? Findings from a national scoping survey of mental health provision in English schools","volume":"18","author":"P Vostanis","year":"2013","journal-title":"Child Adolesc Ment Health"},{"issue":"5","key":"pone.0336946.ref052","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/S2215-0366(14)70312-8","article-title":"Mental health interventions in schools 1: Mental health interventions in schools in high-income countries","volume":"1","author":"M Fazel","year":"2014","journal-title":"Lancet Psychiatry"},{"issue":"1","key":"pone.0336946.ref053","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1097\/01.chi.0000187243.17824.6c","article-title":"Teachers\u2019 beliefs about mental health needs in inner city elementary schools","volume":"45","author":"HJ Walter","year":"2006","journal-title":"J Am Acad Child Adolesc Psychiatry"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0336946","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T18:29:16Z","timestamp":1765477756000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0336946"}},"subtitle":[],"editor":[{"given":"Nik Hisamuddin","family":"Nik Ab. Rahman","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,12,11]]},"references-count":53,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,11]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0336946","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,11]]}}}