July 2006

This diagram illustrates the relative proportion of students in a school setting who may benefit from these four types of interventions.

1. Universal mental health promotion, which seeks to improve school psychosocial environments, skills-based health education for social, emotional learning and brings resources and programmes to all students to promote health, successful teaching and learning and academic success;
2. Selective interventions, which provide prevention programmes for young people and families, presenting risk factors for problems;
3. Indicated interventions, which provide early interventions to young people and families, exhibiting emotional and behavioural problems; and
4. Treatment, which provides more intensive services to youth and families, presenting establish emotional/behavioural problems.

These four types of interventions are necessary for to promote mental health and to intervene to prevent and treat mental illness. 1. Universal mental health promotion addresses an entire school community by creating an inclusive and supportive environment, where students and personnel feel safe and connected to the school. Focusing on the health of a school community, instead of simply the prevention of mental illness, requires a holistic approach to mental health. Varying forms of support can exist through a range of elements that create supportive environments for mental health. These elements interact and overlap:

the places in school settings: the classroom, the school buildings and environs, the school climate and the local area;
the people: the students, teachers, other school staff, families, health and community workers;
the processes and practices: decision-making, participation, caring, information exchange;
the policies involving the guidelines for action and for resource allocation; and
the programmes for the coordinated learning in classrooms and across the school activities that occur. (Rowling & Burr, 1997)

Universal initiatives “address a range of generic risk factors” and can increase the sense of self worth or resilience among students. How well does the Intercamhs definition represent your work?

Which type(s) of intervention do you address in your work? Join the webboard discussion: http://boards.edc.org:8080/ ~intercamhs-publicThese programmes may also focus on increasing skills related to emotional learning, which have been shown to improve academic performance and overall health (WHO, 2004). Stewart-Brown’s synthesis of reviews reports that programmes involving the whole school show the most positive results in promoting the mental health of students (Stewart-Brown, 2006). This was especially true when programmes were implemented with the principles of the “Health Promoting Schools approach”, consistent with Intercamhs:

involvement of the whole school,
changes to the school psychosocial environment,
personal skill development,
involvement of parents and the wider community, and
implementation over a long period of time.

The Collaborative for Academic, Social, and Emotional Learning (CASEL) and The Search Institute provide a number of tools for designing mental health promotion programmes for schools and syntheses of the research on the link between social and emotional learning and academic achievement. Ger Halbert is approaching her work in Ireland with a universal approach to mental health promotion by developing a social, personal and health education curriculum for schools in Ireland. The programme builds students’ social and emotional skills, while also increasing the capacity of schools and teachers to nurture the psychosocial development of students. (Read Ms. Halbert’s story) 2. Selective Interventions target young people who are at higher risk for mental health problems due to specific (biological, psychological or social) risk factors. Prevention of Mental Disorders: Effective Interventions and Policy Options, reviews many types of interventions for children who exhibit signs of conduct disorders, aggression or violence. Authors suggest that intervention strategies which target both parents and their children can help to reduce risk factors, and conduct problems. For example, school-organised programs focusing on social and problem-solving skills, along with parent management skills resulted in “a decrease in negative parent-child interactions and teacher ratings of conduct problems at school” (WHO, 2004). Abdulai Sulemana’s work with the Ghana Education Service focuses on students who have special needs. These students are often at high risk for behavioural and mental health problems and can benefit from selective interventions. They are ostracised and can develop mental health problems when they are not supported to cope with their particular learning needs. Mr. Sulemana and his team are developing a selective intervention to train teachers to identify students with special needs and provide appropriate learning conditions so they are better able to succeed academically.(Read Mr. Sulemana’s story) 3. Indicated interventions are for youth exhibiting emotional and behavioural problems. A review of research on school-based health centers (SBHCs) indicates that these services can have a significant impact on health status and health behaviours, including various indicators of mental health: alcohol/ tobacco/ drug use, emotional problems, intentional injuries and self-esteem (Geirstanger & Amaral, 2005). The availability of mental health services can play a critical role in reducing the prevalence of mental illness. School-based health centers provide valuable counselling and resources to students who seek help or who are referred by other school personnel. Abner Richard’s work in St. Vincent in the Caribbean is with youth, who start to exhibit behavioural problems and who are referred by teachers. As the psychologist for primary school students, Ms. Richard provides individual counselling; she also facilitates group sessions to build student skills. These indicated interventions seem to have an impact on improving student behaviour and academic performance and may prevent more intense mental health problems. (Read Ms. Richard’s story). 4. Treatment provides intensive services to youth presenting established emotional/ behavioural problems. Although many schools may not have treatment services readily available on site, establishing relationships with community agencies can greatly facilitate the treatment for students who need them. These services may be needed by only a small fraction of the student population, somewhere between 3-12%, but the critical element is that there are no barriers to students who need and seek these services.

Jenni Jennings’ work with School-Based Health Centers addresses students’ mental health, through mental health evaluations, group and family therapy and referrals for more intense treatment when necessary. (Read Ms. Jenning’s story)

Voices from our members Intercamhs members around the world are working on diverse aspects of school mental health efforts to both improve mental health of students and to improve their ability to succeed academically and in their lives. In this newsletter, we share the experiences of four Intercamhs members including their work and its relationship to the Intercamhs approach described above. For a directory of members, follow the instructions at: http://www.intercamhs.org/html/member_database.html . Share your story with Intercamhs! Reading stories of others’ work in the field of mental health and schools can be a powerful reminder of our common goals. To share your stories and experiences, for a future newsletter, please contact us at: [email protected] or call Mora Oommen at 617-618-2845 or fax 617-527-4096.

Ger Halbert National Counsel for Curriculum and Assessment Ireland As Education Officer, Ms. Halbert oversees curriculum development for schools in Ireland. Most recently, she has worked to develop and implement a “social, personal and health education” curriculum, a universal strategy to build social and emotional skills of students while also improving the capacity of school personnel to nurture the development of students. Social, Personal and Health Education (SPHE) is part of the core curriculum in primary education (4 12 years) and junior cycle, post-primary (12 15 years). Both SPHE curricula are designed as enabling curricula where teachers and schools can select learning outcomes that are appropriate for their students. The SPHE curricula are spiral in their design, meaning that the same modules can be re-visited at different times with a particular emphasis which is more appropriate and relevant to the students. At primary level, a team of primary teachers with particular expertise in SPHE support the implementation of SPHE in primary schools. At second level, in junior cycle, a partnership between the Department of Education and Science and Department of Health and Children combine expertise to provide an SPHE support service for teachers and schools. Training and support at both levels focuses on providing professional development for SPHE teachers and training and support for whole school staffs and management in support of their role in the social, personal and health education of students. The primary cycle curriculum focuses on 3 different levels:

“It’s me”, which covers taking care of oneself, including personal hygiene and personal responsibility;
“Me and my community”, expanding to interpersonal issues such as participating in a school or other community;
“Me and my world” which addresses citizenship and broader ways to contribute to society.

The aims of the SPHE curriculum in junior cycle are to develop skills for self-fulfillment and living in communities, to promote self-esteem and self-confidence, to enable students to develop a framework for responsible decision-making, to provide opportunities for reflection and discussion and to promote physical, mental and emotional health and well-being. The SPHE curriculum in junior cycle focuses on 12 modules covering topics such as belonging and integrating, emotional/ physical and sexual health, self-esteem and making informed decisions. Schools are required to offer one period per week for SPHE in each of the three years of junior cycle education. SPHE teachers in junior cycle teach other subjects and it is strongly recommended that teachers take on teaching SPHE voluntarily and are not assigned it without prior consultation. Ms. Halbert is responsible for the development of the SPHE curriculum for senior cycle students (15 18 years). Planning for the SPHE curriculum framework in senior cycle will be completed in the next academic year. There will a particular emphasis on training for SPHE teachers in support of active teaching methodologies, experiential learning and teachers ability to handle the complex issues that may arise during SPHE lessons in senior cycle. "One of the first times the health agency and the education agency collaborated was during the development of our social and personal health education curriculum for junior cycle students." -Ger HalbertDevelopments in SPHE in Ireland over the last decade and a half have been informed amongst other influences, by Irelands participation in the European Health Promoting Schools (HPS). This initiative focused on creating an international consensus on the concept of the health promoting school building a living and working environment that creates and strengthens health. Schools were encouraged to consider four areas: the school environment physical and social; the SPHE programme; the involvement of parents and the community; policies that address health issues. During the original implementation of HPS, the evaluation found that while the concepts of the health promoting schools were extremely effective and well-received, schools had difficulty sustaining the programs once the funding and support ceased. Teachers and administrators once enthused by the idea had trouble staying motivated to pursue the program. In some instances, the Health Service Executive at local level have assumed the mantle of supporting schools in becoming health promoting schools by introducing a tiered award system and this has had a re-vitalising effect. In Ireland, the similarities and connections between SPHE and Civic, Social and Political Education (CSPE) is recognized. While each of the subjects address a specific area of the students holistic education, each subject draws heavily on constructivist and active learning methodologies. Developments in professional development for teachers may in the future include training for all teachers on these active methodologies, which can be used in support of teaching and learning in any subject and can support universal mental health promotion efforts. This approach to mental health promotion which encourages teachers and students to take an active part in creating a supportive and inclusive school environment has shown signs of success based on anecdotal evidence. The preliminary evaluation data shows that SPHE is having an impact on both the teachers and the students. Teachers have started to integrate more active participative methodologies into the teaching of their primary subjects. An unanticipated outcome of the implementation of SPHE has been teachers own positive personal experience in relation to their participation in professional development for SPHE. They feel more capable of managing their own stress and emotions, which they see as beneficial to their work and their lives. One implementation challenge has been ensuring that all schools deliver a quality SPHE programme. The evaluation data to date suggests strongly that the appointment of an SPHE co-oordinator in the school to support teaching and learning in SPHE, the collaborative development of relevant policies and the promotion of a supportive whole school environment for SPHE is critical. Where schools follow this practice, the SPHE experience has been found to be more effective. Ms. Halbert's future goals include the completion of the curriculum framework for SPHE in senior cycle and exploring the inclusion of training for teaching SPHE in pre-service teacher education. “I believe this would help pre-service teachers be familiar with SPHE, integrate active methodologies and the associated beliefs into their way of teaching from the start of their careers, which seems easier than asking teachers to un-learn their teaching style after being trained intensively in their primary subject.” The SPHE curriculum information can be found at: http://www.sphe.ie/teachers.htm CONNECTION TO INTERCAMHS APPROACH TO MH AND SCHOOLS: Universal mental health promotion

Abdulai Sulemana Greater Accra Regional Education Offices of Special Education Ghana Mr. Sulemana has worked for the Ghana Education Service for 20 years, 1986-2006. The Ghana Education Division, one of the ten Divisions of the Ghana Education Service is responsible for the education and training of children with special educational needs, and implements the policies of the Education Ministry. Currently, Mr. Sulemana is the Coordinator for the Greater Accra Regional Education Offices of Special Education and he leads a team which arranges education programmes for students with mental retardation, low vision, blindness; hearing impairment/loss and other developmental/learning disabilities. "Every child will have the needed support education to access quality basic education, to acquire skills that will assist them to develop their potential, to facilitate poverty reduction and to promote socio-economic growth and national development, irrespective of his/her disability."A recent initiative undertaken by Mr. Sulemana was to pilot Inclusive Education Strategies within and around Accra in 3 Regions: Greater Accra, Eastern and Central. Typically, students with special needs are identified in school and are then sent to specialised schools. Inclusive education involves preparing mainstream schools to support students with special needs to thrive in that school environment, rather than to transfer them to separate schools. The overarching goal is to reduce the effects of disabilities or prevent the occurrence of learning and other developmental problems later in life for children presumed to be at risk for such problems. The objectives of this initiative are to train teachers and school administrators to: 1. Identify accurately and as early as possible students with special needs; 2. Offer appropriate learning experiences for them, and 3. Promote tolerance and understanding for these students who are often marginalised. Special needs, and more broadly, mental health issues are primarily seen in Ghana as conditions that are untreatable—in schools, this means that students with mental health issues are considered stupid, and unable to learn. These students often do not experience the nurturing learning environments that would allow them to succeed in school. Instead this lack of attention may in turn lead to the development of mental health problems. Research from Ghana indicates that late identification of students with special needs may exacerbate behavioural problems such as aggression, hyperactivity, and self-injury (Hayford & Avoke, 1997). Also noticed among this group of individuals were poor attention span, poor memory, inability to follow instruction, inability to work with peers, uninterested in class work and perseveration. All of these indicators demonstrate the need to better prepare teachers to identify students to provide more supportive learning environments for students with special needs. Mr. Sulemana is optimistic that Ghana is making progress on this front. Ghana is among one of the first African countries to train teachers for schools dedicated to special needs, dating back to 1965. This history, coupled with recent efforts, seems to be having a positive impact on the community at large, and especially on parents of students with special needs, who are very appreciative of the work. There is an increased awareness that keeping students together helps all students thrive, and that everyone is responsible for ensuring that youth are receiving a proper education. Mr. Sulemana realises that this process will require a lot of work and remains positive: “It is not an easy task to implement this programme in remaining regions of the country-- it will call for a systematic and strategic planning process with the commitment of all stakeholders. Irrespective of his/her disability, every child must have access to quality basic education, acquire skills that will assist them to develop their potential and to facilitate poverty reduction and promote socio-economic growth and national development.” CONNECTION TO INTERCAMHS APPROACH TO MH AND SCHOOLS: Indicated Interventions

Abner Richards Ministry of Education St. Vincent Island, Caribbean Abner Richards works in the curriculum development unit of the Ministry of education in St. Vincent and the Grenadines in the Caribbean as a psychiatric nurse. She is responsible for providing counselling in two primary schools. Ms. Richards visits each school two times per week: in the mornings, she conducts individual counselling sessions with children; in the afternoons, she facilitates group activities. Ms. Richards leads sessions with entire classes of children on a variety of topics. Sessions she has recently facilitated with primary school classes include activities related to sharing feelings, improving self-esteem, stigma and the psycho-social aspects of HIV/ AIDS, or other issues of interest to the school administration. These selective intervention sessions are conducted by Ms. Richards herself, or by guests from the local community. “It is important that we build connections with the broader community. Students seem to enjoy the additional perspectives that a guest brings to a given topic area "We know once [students] are psychologically wellthey are going to be well-rounded, and be able to perform academically." -Abner RichardsThe individual sessions are with students who are either referred by teachers or who themselves come forward, indicating interest in attending counselling. This indicated intervention offers early guidance for students who have already started to exhibit emotional or behavioural problems. Similarly, at a new secondary school counselling programme, teachers refer students due to the behaviour problems that have an impact on their academic performance. The students attend the center for counselling as well as academic work/ tutoring. Individualised plans are then established for the students, and their progress is monitored on a regular basis. These programmes engage educators in the process of assessing students’ mental health and create integrated support for the academic success and mental health of students. “What has been of great interest to me is that students actually enjoy coming to centre, which helps them respond positively to the emphasis on improving their academics. We have made sure the environment is supportive of students. If the new programme shows evidence of having impact on both behaviour and academics, we hope that the programme will be duplicated in other schools.” Anecdotally, Ms. Richards finds that teachers perceive the benefits and need for "One of the strengths of the programme is due to the fact that children are more readily willing to admit their problem and willing to share their feelings. If we help them continue to be this honest beyond primary school, it will serve them well as they grow up." the programme. Teachers comment that since children have been going to counselling, they have noticed improved behaviour in their classroom. In addition, their study habits improve, and there seems to be an improvement in their grades as well. As teachers see changes in children’s behaviour, they are encouraged to be understanding of all students in their class: “This week, I observed a teacher being very patient and giving a student a second chance [to improve his/her behaviour]. I believe it was due to the changes they see in the other students who come to counselling.” One of the most difficult challenges in Ms. Richard’s work is that though the child may be making progress in the context of the counselling session, or school, his/her behaviour reverts when the child is in the home environment. To address this challenge, Ms. Richards also works with parent groups to discuss the importance of counselling and the beneficial impact of counselling on children’s behaviour and their academic success. During these sessions, she also develops parents’ skills to detect signs of depression or other mental health problems. These types of initiatives are based on St. Vincent’s Federal Education Act. It includes provisions for guidance counselling and addressing mental health issues in schools. “In general,” Ms. Richards says, “people here understand the impact that various social issues, such as divorce, violence, or other stress, can have on students. Our goal is to assist children in the school environment and focus on the holistic development of child. We know once they are psychologically well—they are going to be well-rounded, and able to perform academically.” Ms. Richards hopes that this work could expand to give more access to these services: “If I could change something about my work, I would make sure each school had access to a counsellor at least three days per week. I think it takes additional time to make a real impact. … One of the strengths of the programme is due to the fact that children are more readily willing to admit their problem and willing to share their feelings. If we help them continue to be this honest beyond primary school, it will serve them well as they grow up.” CONNECTION TO INTERCAMHS APPROACH TO MH AND SCHOOLS: SELECTIVE INTERVENTIONS INDICATED INTERVENTIONS

Jenni Jennings DallasIndependent School District Dallas, Texas, USA As the Executive Director of Youth & Family Centers in the Dallas Independent School District, Jenni Jennings oversees 10 school-based health centres, where mental health is a primary focus. The school-based health centers provide access to mental health services, including diagnosis and treatment interventions for students and their families. Each centre director is a mental health professional, and is supported by a mental health team that includes a child and adolescent psychiatrist, therapists, parent educator and child psychologists. Students are referred to the clinic by student support teams at the schools. Mental health interventions include mental health evaluations by a multidisciplinary team, and group and family therapy. The involvement of family in nearly all treatment is vital to the approach taken by the Dallas Independent School District’s Youth & Family Centers. Students referred to the programme participate in family sessions to build skills and resilience of the entire family to manage conflict and stress. These services are available to all students, and have been seen as useful by the local community. Families themselves have been known to request therapy from the school-based health centre. "When Hurricane Katrina survivors entered their schools, Dallas students were patient with the transition and helped the new students integrate into their new surroundings, [whereas] in other cities, it was reported that there was violence between the newcomers and the other students." -Jenni JenningsEvaluation of the programme has shown that there has been a quantifiable improvement in academic outcomes for participating students. Since 1995, Ms. Jennings and her research team have collected data on student attendance, discipline, grades and test scores. Because the programme is based on school board policy, the school-based health centers have open access to all students’ information. Evaluations have been conducted on grades and attendance prior to an intervention, and compared with those indicators 6 weeks post-intervention. Yearly attendance data show enormous improvement after the interventions, with an increase of 60-85% in attendance. Tracking of grades shows more moderate, but significant, improvement in grades following MH interventions. The most statistically significant improvement is in school behaviour with a 85-92% decrease in school discipline problems after treatment. Ms. Jennings believes that the actions of the school-based health centres have had an impact on the climate of the schools. “When Hurricane Katrina survivors entered their schools, Dallas students were patient with the transition and helped the new students integrate into their new surroundings. The school-based health centre teams collaborated with school psychologist, nurses and counsellors to provide immediate physical health screenings and mental health interviews when the Katrina students were bussed from the emergency shelters to the schools. The teams met weekly with more than 1,200 students in Friends in New Places groups. In other cities, it was reported that there was violence between the newcomers and the other students.” Ms. Jennings believes that the supportive climate that has been established over the years allowed students to be more sympathetic to the new students and resilient in face of challenging situations."Another amazing part of the story is that Intercamhs members from around the world called to help, including Robert Burke, whose college students from Miami University made almost 60 handmade blankets for Katrina students." Ms. Jennings' work in Dallas exemplifies collaboration between mental health professionals, school/ teachers and parents to support students, which is a cornerstone of Intercamhs’ approach to mental health and schools. She uses several types if interventions: indicated interventions for those referred to her SBHC by teachers and treatment services for those who are assessed to have more serious mental health problems. CONNECTION TO INTERCAMHS APPROACH TO MENTAL HEALTH AND SCHOOLS: INDICATED INTERVENTIONS TREATMENT Share your story with Intercamhs! Reading stories of others’ work in the field of mental health promotion in schools can be a powerful reminder of our common goals and can lay a foundation for partnerships. If you are interested in sharing your experiences for a future newsletter, contact us at: [email protected] or call Mora Oommen at 617-618-2845 or fax 617-527-4096.

Conferences Summary of CREATING CONNECTIONS CONFERENCE April 7, 2006 Canmore, Alberta, Canada In April, Gloria Wells a resident of Alberta and a Board Member for Intercamhsa and EDC co-convener and co-sponsor the first provincial conference to advance school based mental health in Alberta, and potentially elsewhere in Canada and the U.S. With the contributions of the Intercamhs Board, the Alberta Coalition for Healthy School Communities and the Calgary Health Region, approximately 75 participants, representing the Public Education and Health sectors in Alberta, and leading practitioners from the U.S., Australia and Alberta, met to share current practices across the school based mental health spectrum. Participants identified opportunities for ongoing networking and collaboration in this work. A compilation of information on conference speakers and conference sessions can be found at www.creatingconnections2006.org The full conference summary can be found here Upcoming Conferences The Promotion of Mental Health and Prevention of Mental and behavioural Disorders Theme: Developing Resilience and Strength Across the Lifespan October 11-13, 2006 Conference in Oslo, Norway www.worldconference2006.no Fourth World Conference, will feature a pre-conference workshop, October 10, 2006, on child and adolescent mental health and schools, co-sponsored by Intercamhs and the Psykisk Helse I Skolen in Norway. As in the previous three conferences, the programme has two dimensions. The first dimension covers:

Prevention and promotion research and development (subcommittee chair: Richard H. Price, University of Michigan, USA)
Programme Dissemination and Implementation (subcommittee chair: Helen H. Herrman, University of Melbourne, Australia)
Training (subcommittee chair: Eva Jané-Llopis, World Health Organization European Regional Office, Copenhagen, Denmark)
Policy (subcommittee chair: Thomas H. Bornemann (Mental Health Programme, The Carter Center, USA)

The second dimension covers

Enhancing Resilience in Schools
The Economy of Mental Health Promotion and Prevention
Human Rights in Relation to Promotion and Prevention
Reaching the Population
Building Coalitions Across Sectors

See upcoming conferences calendar

Intercamhs' board member, Katherine Weare, is quoted in a recent GLEF publication on Social Emotional Learning: She is “totally convinced that the evidence, for example, from the systematic review of school-based programs of SEL demonstrates a clear link between social and emotional learning and academic performance.”
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Join Intercamhs, and let us know what you think! The Intercamhs approach to “Mental Health and Schools” found on the Intercamhs home page (www.intercamhs.org) is a working document. We expect it will evolve as members offer us feedback about what aspects of this definition are useful in communicating your work, and what aspects are not. Share with us:

How well does the Intercamhs definition represent your work?
Which type(s) of intervention do you address in your work and how?
What issues would you like the next Intercamhs newsletter to address?

Please comment on these topics or others at our Web board: http://boards.edc.org:8080/~intercamhs-public.

Resources and References Resources Health Promoting Schools Initiative, WHO, http://www.who.int/school_youth_health/gshi/hps/en/ Intercamhs, http://www.intercamhs.org The Collaborative for Academic, Social and Emotional Learning, http://www.casel.org National Center for Mental Health Promotion and Youth Violence Prevention, http://www.promoteprevent.org Search Institute, http://www.search-institute.org/research/Insights/ Social, Personal, Health Education curriculum (Ireland), http://www.sphe.ie/teachers.htm References Hayford, S. & Avoke, M. (1997) The Impact of Late Identification on the Education of Individuals with Mental Retardation in Ghana. Ghanaian Journal of Special Education. 2(1), 78-81. Geirstanger, S.P., & Amaral, G. (2005) School-Based Health Centers and Academic Performance: What is the intersection? April 2004 Meeting Proceedings. White Paper. Washington, DC: National Assembly on School-Based Health Care. Rowling, L. & Burr, A. (1997). Creating supportive environments. In D. Colquhoun, K Goltz, & M. Sheehan, The health promoting school: Policy, programmes and practice in Australia. Marrickville, NSW. Harcourt Brace. Stewart-Brown, S. (2006). What is the evidence on school health promotion in improving health or preventing disease and, specifically, what is the effectiveness of the health promoting schools approach? Copenhagen, WHO Regional Office for Europe/Health Evidence Network report. Accessed 16 June 16, 2006 from http://www.euro.who.int/document/e88185.pdf WHO. (2004) Promoting Mental Health: Concepts, Emerging Evidence, Practice. A Report of the World Health Organization, Department of Mental Health and Substance Abuse in collaboration with the Victorian Health Promotion Foundation and The University of Melbourne. Geneva, Switzerland.: Author. www.who.int/entity/mental_health/evidence/en/promoting_mhh.pdf WHO. (2004) Prevention of Mental Disorders: Effective Interventions and Policy Options. A Report of the World Health Organization, Department of Mental Health and Substance Abuse in collaboration with the Prevention Research Centre of the Universities of Nijmegen and Maastricht. Geneva: Author. http://www.who.int/mental_health/evidence/en/prevention_of_mental_disorders_sr.pdf