Brief, structured programmes teaching coping and problem-solving skills can reduce depression and anxiety symptoms among African schoolchildren when delivered by trained non-specialists, according to a review of 122 scholarly studies.
But the same review concludes that counselling on its own cannot prevent mental health problems or change the school, family and social conditions that contribute to learners’ distress.
The findings come from Lydia Namatende-Sakwa and colleagues in the Education and Youth Empowerment research team, writing for The Conversation. Their review screened 1,759 records and examined school-based and school-linked strategies for addressing mental health among children and adolescents.
Namatende-Sakwa’s argument is that schools need to sit inside a wider support system rather than rely on stand-alone services such as counselling rooms, one-off programmes or individual guidance teachers.
The authors set out why the question is urgent in Africa specifically. Specialist mental health services are limited, children face a combination of social, economic, health and humanitarian risks, and the continent has a young population.
Schools, they note, are often among the first places where emotional and behavioural difficulties become visible, as learners start missing classes, withdrawing from friends or struggling academically.
What the review found promising
Among the approaches with promising evidence, Namatende-Sakwa and colleagues highlight brief, structured interventions delivered by trained non-specialists. One example they cite is Shamiri, a four-week group intervention tested in Kenyan secondary schools.
Students meet in small groups for an hour each week for exercises including problem-solving, reflection on personal growth and writing gratitude letters, 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, and the benefits were still evident seven months later.
Other approaches the review identifies as promising include improving mental health awareness among learners and staff so they can recognise signs of distress, reduce stigma and know when and where to seek help; 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; and the use of 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.
As the authors put it, school mental health does not have to mean therapy.
The limits of the counselling room
Counselling is one of the most common school-based mental health approaches, providing a confidential space where learners can talk through emotional, behavioural or social difficulties with a trained adult.
Namatende-Sakwa and colleagues do not dismiss it: 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.
The review found 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.
The authors put the point sharply: 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.
Teachers as supporters, not substitutes
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 the authors insist on 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 wellbeing 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, the authors argue. 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 reviewed, implementation repeatedly depended on school leadership, cultural adaptation, financing, confidentiality, safeguarding, supervision, clear referral pathways and coordination across sectors. Isolated interventions are unlikely to be enough.
Where the evidence is thin
The review’s evidence base 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.
Namatende-Sakwa and colleagues conclude that school mental health systems should combine prevention, early identification, teacher support, family and community engagement, and clear referral pathways to specialist care. Charity Waweru-Mwangi contributed to the article.
Source: The Conversation
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