Effectiveness of Mental Health Literacy Training for School Teachers: A Systematic Review Spanning 2012–2024

Abstract

Purpose of the Review:

The mental health of students is an increasing concern in school settings, with teachers often acting as the first line of support. As a result, there is growing interest in improving teachers’ mental health literacy (MHL) through structured training programs. This systematic review aims to synthesize available evidence on MHL interventions targeting school teachers and to evaluate their effectiveness in enhancing knowledge, attitudes, and the ability to identify and address students’ mental health issues.

Collection and Analysis of Data:

A comprehensive literature search was conducted across eight databases: PubMed, Scopus, Ovid Technologies (commonly referred to as Ovid, a biomedical and academic research database platform), ScienceDirect, Cochrane, PsycINFO, Education Resources Information Center (ERIC), and Google Scholar. Keywords included “MHL,” “teachers,” “intervention,” and “effectiveness.” Experimental studies published between 2012 and 2024 were considered. From the 3,459 initial records, 871 remained after duplicates were removed. Following the screening of titles and abstracts, 44 studies were examined in full, of which 13 satisfied the inclusion criteria. The final review included five randomized controlled trials (RCTs), two cohort studies, and six pre- and post-intervention studies. Compared to previous reviews, this review incorporated a greater number of high-quality studies. Overall, the interventions showed a positive impact on teachers’ mental health knowledge, attitudes, and supportive behaviors, although the magnitude of effects varied.

Conclusions:

The review highlights that MHL training programs can be effective in empowering teachers to better support students’ mental health needs. These findings support the need for contextually relevant, evidence-based training to strengthen educators’ roles in promoting student well-being.

Adolescence is a pivotal period of transition from childhood to adulthood, characterized by profound physical, emotional, cognitive, and social changes. ¹ It is often considered one of the healthiest stages of life. ² However, it is also the period where there is the onset of several mental disorders. The global prevalence of mental disorders in these age groups is rising, with half of all lifetime cases beginning before the age of 14.^3,4 In 2021, India accounted for 34.8% of the global population of children and adolescents aged 0–19. ⁵ A recent systematic review highlights a broad spectrum of mental health challenges among school-aged children and adolescents, including depression, anxiety, psychological distress, social phobia, attention deficit hyperactivity disorder, emotional and behavioral problems, as well as exposure to violence and abuse, with varying levels of severity and prevalence. ⁶ When these issues remain undiagnosed and untreated, symptoms often persist from infancy into adolescence and early adulthood, reducing the likelihood of recovery without timely intervention. ⁷ These mental health challenges significantly impact an adolescent’s quality of life and potential for achievement. ⁸ The most alarming outcome of untreated mental disorders in adolescents is suicide, which is rapidly increasing and has become one of the leading causes of death in this population. ⁹ Barriers, such as limited knowledge about mental health and privacy concerns, often hinder adolescents from accessing healthcare. ¹ They often need assistance from elders in identifying their mental health problems and in seeking help. ¹⁰ Given the lifetime prevalence of mental disorders, individuals are likely either to experience a mental disorder themselves or to interact closely with someone affected by one. Hence, it is essential to gain knowledge about mental disorders. ¹¹ The concept of mental health literacy (MHL) was first introduced by Jorm, who defined it as “knowledge and beliefs about mental disorders which aid their recognition, management, or prevention.” It encompasses several components, including the ability to identify specific mental disorders and psychological distress, understanding of risk factors and causes, awareness of self-help strategies and professional resources, attitudes that promote recognition and help-seeking, and knowledge of how to access mental health information. ¹¹ In recent times, the capacity to identify mental disorders in students among teachers has gained considerable attention within educational systems worldwide. Schools are key social institutions where young people spend most of their time and have close interactions with teachers, who are the essential gatekeepers in identifying students’ mental health issues. ¹² However, knowledge and skills are inadequate in identifying symptoms and referring students to professional help. Evidence suggests that MHL training for teachers enhances students’ knowledge and significantly reduces stigma.^13,14 MHL training also helps teachers differentiate between everyday challenges and potential mental health issues in students. ¹⁵ Evidence so far supports that teachers do not feel confident about identifying and supporting students who may have mental disorders. ¹⁶ It has been found that teachers also reported having stigma toward mental illness.^17,18 Teachers need psychoeducation to identify mental health issues in children, yet their readiness and ability to manage such challenges in the classroom are frequently overlooked or insufficiently addressed. ⁸ Educational systems have to be strengthened to safeguard and enhance children and adolescents’ mental health and psychosocial well-being. ⁶ Evidence of MHL flourished after the notable work done by Jorm AF and colleagues in 1997, ¹² marking the emergence of intervention studies in MHL from 2010. In a country such as India, where the student population is inordinately large, equipping teachers with MHL is a priority. Previous literature on MHL ¹⁰ generally focused on the overall school population and paid little attention to the methodology used. While addressing this gap, the present study focuses exclusively on intervention studies involving school teachers. It systematically reviews the existing MHL interventions spanning 2012–2024 while exploring and evaluating the effectiveness of MHL interventions tailored to teachers. This review critically analyses existing studies, identifies limitations in current approaches, and examines the impact of MHL programs on teachers’ knowledge, attitudes, and practices regarding mental health. This review adds to existing knowledge of MHL by incorporating recent studies and offering insights that can guide the development and implementation of more comprehensive and effective MHL programs tailored to educators’ specific needs. Overall, the review seeks to assess the effectiveness of MHL training programs for teachers.

Research Questions

1. Do school-based MHL interventions change knowledge, attitude, and behavior toward mental illness among teachers?

2. Do school-based MHL interventions effectively reduce stigma toward mental disorders among teachers?

Methods

Protocol and Registration

The review protocol was prospectively registered with the International Prospective Register of Systematic Reviews on 26 August 2023.

Eligibility Criteria

All initial studies obtained were examined and assessed for eligibility for inclusion in the systematic review according to the criteria outlined below.

Population

Studies involving school teachers (primary, secondary, or high school) as participants.

Intervention

Structured training programs aimed at improving MHL among teachers, including workshops, online modules, video lessons, or blended formats. Interventions could vary in duration (from short sessions to multi-week programs) and could be facilitated by mental health professionals, education experts, researchers, or trained teachers.

Comparator

Inclusion: Studies with waitlist controls, minimal intervention controls, treatment-as-usual groups, or other relevant comparison groups; studies without a comparator but using a pre–post design.

Exclusion: Studies lacking a pre–post assessment or without a defined comparison framework.

Outcomes

Inclusion: Studies reporting outcomes related to teacher knowledge, attitudes, skills, confidence, or classroom practices regarding MHL.

Exclusion: Studies not reporting teacher-specific outcomes (e.g., only student outcomes) or reporting only qualitative perceptions without measurable change.

Study Design

Inclusion criteria: Studies were eligible for inclusion if they used experimental or quasi-experimental designs to assess the effectiveness of MHL or related interventions. Eligible study designs encompassed randomized controlled trials (RCTs), including cluster and double-blind trials; quasi-experimental designs, such as non-RCTs and controlled before-and-after studies, and pre–post intervention studies conducted without a control group. Studies using a waitlist, minimal intervention, or other relevant comparators were also considered.

Exclusion criteria: Studies were excluded if they used purely observational or descriptive designs, including cross-sectional surveys, non-interventional cohort studies, case studies, case series, or qualitative research. Conference abstracts, editorials, commentaries, and review articles were also excluded, as they did not provide primary data on interventions.

Outcomes

The outcomes assessed were: (a) Understanding and recognition of mental illnesses, including awareness of their signs and symptoms and (b) levels of mental health stigma, encompassing attitudes, beliefs, emotional responses, and behavioral intentions toward individuals with mental health issues.

Setting

The included studies were limited to primary and higher secondary school environments where the interventions were implemented.

Location

Studies conducted in any country were eligible for inclusion, provided they met the other specified criteria.

Language and Time Period

Only studies published in English between 2012 and 2024 were included in this review.

Information Source and Search Strategy

The review drew upon various databases, including PubMed, Scopus, Ovid Technologies (commonly referred to as Ovid, a biomedical and academic research database platform), ScienceDirect, Cochrane, PsycINFO, Education Resources Information Center (ERIC), and Google Scholar. Specific keywords such as “MHL,” “teachers,” “intervention,” and “effectiveness” were used. Studies included in this review encompassed various intervention strategies, from workshops and training sessions to online modules, targeting teachers across different educational levels and geographical locations.

Study Selection

Duplicates were removed using Zotero (https://www.zotero.org/). The reviewer employed a two-step screening process: First, the titles and abstracts of all identified articles (aim, objective, method, result) were reviewed independently by two authors (the first author and second author) to determine their relevance; the two authors reviewed the full-text to decide final eligibility to include in the review.

Data extraction and Synthesis

The first and second authors independently screened the downloaded titles and abstracts. Full texts of articles meeting the inclusion criteria and of articles with unclear citations were retrieved. The authors independently assessed the full texts of potentially eligible documents, then reviewed and agreed on the final documents to be included in this review, selecting the studies and entering them into the review matrix using customized data collection from the various data sources. After consulting with the seventh author, the elements of the data collection form were refined to align with the research objectives. These elements—sample characteristics, methodology, MHL training for schoolteachers, and outcomes—were organized into tables. Subsequently, an additional reviewer (the third author) revised the tables after double-checking. The flow of study selection, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, is shown in Figure 1.

Figure 1. PRISMA Flowchart.

Quality Assessment

With the help of the National Institute of Health quality assessment tools (https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools), two reviewers independently evaluated the quality of the included articles. Based on the strength of the supporting data and the accessibility of the material, each article received a “yes” or “no” grade. Based on the percentage of “yes” answers, each study received a rating of good (7–9), fair (4–6), or poor (3). A poorly rated study has a significant probability of bias. If the reviewers’ scores differed, a mutual understanding was aimed for, and when an agreement was not reached, the article was sent to a third reviewer for expert evaluation.

Result

The present systematic review of the electronic database searches yielded 3,459 articles. A total of 620 articles were obtained after deduplication. After title and abstract screening, 576 articles were excluded. Of the 44 eligible articles, 13 met the inclusion criteria and were included in the final evaluation. The reference lists of these 13 articles were screened. Most studies were from North America^19–21 and the African region.^14,22–24 There were two studies from a Southeast Asian country,^25,26 one study from East Asia, ²⁷ two from a South Asian country,^28,29 and one from West Asia. ³⁰

Characteristics of the Included Studies

Our comprehensive quality assessment indicates that all included studies are of high-quality and pose no significant risk of bias (Table 1). The characteristics of the included studies are given in Table 2. Four studies employed RCT designs,^{20,25,27,28,30} another four used pre–post study designs.^{13,14,24,26,29} Two studies adopted a quasi-experimental pre–post interventional study ²² used a quasi-experimental pre–post research, ²³ quasi-experimental, controlled pre–post design, ²⁵ and yet another followed a cohort study design.^19,21 All these studies demonstrated significant enhancements in knowledge and attitude toward mental illness, alongside reductions in stigma associated with mental health issues. However, non-randomized studies may introduce a higher risk of sample bias. Therefore, further research is warranted, particularly in randomized controlled studies, to provide more empirical evidence.

Table 1.

Quality assessment of the articles.

Supplementary Table 1 Methodological quality of observational studies using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies
First author and year	1	2	3	4	5	6	7	8	9	Quality
(Carr et al., 2018)	Y	Y	Y	Y	Y	Y	NR	Y	NR	GOOD
(Wei et al., 2022)	Y	Y	Y	Y	Y	Y	NR	Y	NR	GOOD
The quality of the studies was evaluated using the National Institutes of Health (NIH) quality assessment tool for observational cohort and cross-sectional studies (https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools). Responses were coded as Y = yes, N = no, CD = cannot determine, and NR = not reported. Overall study quality was classified as poor, fair, or good.

Table 2.

Mental Health Literacy Among School Teachers

S. No	Authors and Year	Country	Aim and Objective	Design	Sample size/ Age	Assessment method and Tools used	Material used for Intervention/ Facilitated by /Duration	Findings	Effect Size
1	(Kutcher et al., 2015)	Malawian	To evaluate the impact of the intervention on educators, a repeated-measures within-participants design was employed.	Pre- and post-test study designs	Sample Size: 217 /Age (average age is 20–30 years old)	Pre-post assessment Tools used: Questionnaire	Material: Canadian school mental health curriculum resource (the Guide) Mode of Training: 3-day workshop using a teach-the-teacher approach, led by trainers who were either mental health professionals (one psychologist and one psychiatrist) or had some background in mental health Duration: 3 days	Significant improvement in mental health-related knowledge and attitude.	Large effect size
2	(Pereira et al., 2015)	Brazil	The aim was to develop a web-based program to educate primary school teachers about child mental disorders and to evaluate its effectiveness compared with print and video materials alone and with no intervention.	Randomized control trial	Sample Size: Schools randomized (n = 9) Web-Based Interactive Education (WBIE): Complete case analysis: n = 52 Intention-to-treat (ITT) analysis: n = 75 Text- and Video-Based Education (TVBE): Complete case analysis: n = 32 ITT analysis: n = 67 Waitlist Control: Complete case analysis: n = 31 ITT analysis: n = 71 Age (mean ± SD): WBIE: 39.7 ± 10.3 TVBE: 43.1 ± 11.3 Waitlist: 38.16 ± 7.0	Pre-post assessment Tools used: Questionnaire	1)Web-Based Interactive Education (WBIE) @) Text- and Video-Based Education (TVBE) Facilitated by: Videobased tutorial Duration: 3 weeks	There was a significant improvement in mental health-related knowledge, beliefs, and attitudes, with a reduction in the prevalence of stigmatizing concepts following the intervention.	No significant change was observed in attitudes toward mental health.
3	(Kutcher et al., 2016)	Tanzanian	The study aimed to assess the effect of participating in a refresher training program on teachers’ mental health knowledge and attitudes.	A pre- and post-study design was used.	Sample Size: 61 Age: Not mentioned	Pre-post assessment Tools used: Questionnaire	Material: Canadian school mental health curriculum resource (the Guide) Mode of training: Facilitated by: A Master Trainers Team (MTT) comprised of four mental health experts—two psychiatrists and two psychologists. Duration: 3 days	Highly significant improvements in teachers’ overall knowledge, including mental health knowledge, and curriculum-specific knowledge. Teachers’ stigma against mental illness decreased. Teachers also reported high rates of positive help-seeking (more than ¾ of the sample).	Moderate effect
4	(Carr et al., 2018)	Cannada	To evaluate the impact of a mental health literacy program on preservice teachers’ knowledge, attitudes, and help-seeking efficacy	Prospective cohort study (pre, post, and follow-up) design Age: Not Mentioned	Sample Size:59 Female: 41 Males: 18	Pre and post, and 3 months follow-up Tools used: Questionnaire	Canadian school mental health curriculum resource (the Guide) Facilitated by: Teacher-led programme Duration: 1 day	Highly significant improvements in teachers’ overall knowledge including mental health knowledge, and curriculum-specific knowledge. Teachers’ stigma against mental illness decreased. Teachers also reported positive help-seeking.	Substantial effect size
5	(Tay et al., 2019)	Malaysia	The study aimed to evaluate the effectiveness of a newly developed mental health literacy program for refugee teachers in Malaysia.	The study utilized a single-group pre- and post-test design.	Sample Size: 68 teachers Age:(Mage = 30.26	Study Design: Pre-Post Measures: Mental Health Knowledge Schedule Reported and Intended Behavior Scale Attitudes and Knowledge about Mental Health Conditions Mental Health Literacy Questionnaire for Young Adult Form Facilitated by: Not reported Duration: 8 hours	An eight-hour trauma-informed mental health literacy program was developed by the researchers in collaboration with clinical psychologists specifically for refugee teachers.	The program led to highly significant and substantial improvements in mental health-related knowledge, attitudes, behaviors, and help-seeking behaviors, along with a reduction in stereotypes toward mental illness.	Medium effect
6	(Nguyen et al., 2020)	Vietnam and Cambodia	The study aimed to experimentally assess the efficacy of an evidence-based MHL program, initially developed in Canada, following adaptations by the research team for use in Vietnam.	Vietnam Study: Pre-post randomized design Cambodia Study: Quasi-experimental, controlled pre-post design	Sample Size: Vietnam Study 1: 80 teachers Cambodia Study 2: 67 teachers Age: Median age: 36 years	Assessment Design: Pre-post Tools Used: Mental Health Literacy Scale (MHLS; O’Connor & Casey, 2015) Mental Health Knowledge and Attitude Test (36 items) developed to accompany The Guide (Kutcher & Wei, 2017)	Material: Canadian school mental health curriculum resource (The Guide) Facilitated by: Trained teachers Duration: 5 weeks	In the Vietnam study, teachers demonstrated higher levels of recognition, self-efficacy, and willingness to interact, along with lower stigma, compared to the control group. In contrast, the Cambodia study did not achieve statistical significance for recognition of mental health disorders, help-seeking, self-efficacy, or stigma.	The program’s effects on teachers were significant, with some showing large effect sizes, while the Cambodia study reported smaller but still significant effects.
7	(Ueda et al., 2021)	Japan	To evaluate the effectiveness of a mental health literacy (MHL) educational program for teachers	Two-arm, parallel-group, non-blinded randomized controlled trial (RCT)	Sample Size: 112 teachers Intervention group: 49 Waitlist control group: 43 Excluded: 20 Age: Mean 41.6 ± 13.5 years	Assessment: Pre-post Instruments Used: 19-item questionnaire assessing general mental health knowledge Case vignettes to evaluate recognition of specific mental disorders (depression, panic disorder, schizophrenia) Items 1–3 from the Depression Stigma Scale (DSS) to measure attitudes toward students with depressive symptoms Measures of intention to help students with depressive symptoms Reported and Intended Behavior Scale – Japanese version (RIBS-J) for mental health-related behaviors	Intervention: 50-minute video lesson designed to improve teachers’ knowledge and skills Facilitated by: Video developed by experts in child and adolescent psychiatry and early education Duration: 50 minutes	Significant improvements were observed in mental health knowledge, recognition of specific mental disorders, and intention to help students with depressive symptoms Stigma was reduced, though to a lesser extent	Effect sizes: Knowledge/Recognition: Large (d = 1.60) Intention to help students: Large (d = 0.97) RIBS-J (behavior): Small (d = 0.10)
8	(Imran et al., 2022)	Pakistan	The impact of a teacher training programme based on the WHO-EMRO Manual of School Mental Health on enhancing teachers’ awareness and ability to identify student mental health concerns, without significant effects on their overall self-efficacy or confidence, compared to a waitlist control group.	Randomized control trial	Sample size: 331 Intervention group: 118 participants Waitlist control group: 113 participants Mean age (SD): Intervention group: 32.6 (9.0) years Waitlist group: 32.3 (10.3) years	Assessment Schedule: Data were collected at three points—before the intervention, immediately after, and at a three-month follow-up. Measures: Mental Health Literacy: WHO questionnaire adapted for Pakistan Teachers’ Self-Efficacy: Teachers’ Sense of Self-Efficacy Scale (TSES) Confidence in Helping Students: Self-rated measure of teachers’ confidence in supporting students Training Feedback: Participants’ satisfaction and perceived usefulness Students’ Behavior: Strengths and Difficulties Questionnaire (SDQ) School Environment: School Psychosocial Profile Questionnaire	Teacher training on school mental health using WHO-EMRO Manual Facilitated by psychiatrist and psychologist over 3 days	There was a significant increase in mental health literacy, improved teacher self-efficacy in classroom management and student engagement, and greater confidence in supporting students with mental health issues.	Mental health literacy scores showed a significant effect over time.
9	(Atilola et al., 2022)	Nigeria	To determine the impact of a school-based training program on depression-literacy among a cohort of high-school students and their teachers in South-West Nigeria.	The quasi-experimental post–pre interventional study	Sample Size: 294 teachers Mean age of the Teachers were 39.8	Pre-post assessment Tools Used: The pre-survey was a 5–10 minute, 22-item survey which is part of the original Break Free from Depression Modules.	Adapted version of the Break Free from Depression, a 4-module depression awareness curriculum Facilitated by a clinical psychologist Duration: 1 day	There was a significant positive difference at post-test in the knowledge, confidence, and slight positive change in attitude.	Medium effect size
10	(Wei et al., 2022)	Cannada	To improve educators’ mental health knowledge, early identification skills, and decreasing stigma.	Pre – Post intervention	Sample size: 949 Age: Not mentioned	Pre – Post Assessment Tools Used: Questionnaire	‘Go-To Educator Training’ (GTET) Facilitated by: mental health and education professionals Duration: 3 days	Significant improvement in mental health-related knowledge and stigma.	Knowledge increased with a large effect (d = 2.12), while stigma decreased slightly (d = 0.14), likely because baseline stigma scores were already high in Ontario (M = 51.39, SD = 4.48 out of 56).
11	(Manjula et al., 2023)	India	To examine the effect of a mental health literacy (MHL) program on teachers’ knowledge, attitudes, and help facilitation regarding depression and suicidal behaviors	Pre- and post-assessment, single-group design with a 3-month follow-up	Sample Size: 102 high school teachers Age: Mean 41.74 years (range 23–62)	Pre- and post-assessment, single group design with a follow-up after 3 months Tools Used: Kessler Psychological Distress Scale (K10) Researcher-developed questionnaire	Intervention: Mental health literacy program developed by the research team Facilitated by: Researchers from NIMHANS (Departments of Clinical Psychology, Biostatistics, and Psychiatric Social Work) Duration: Two sessions of 2–3 hours each over 3 weeks	Teachers recognizing depression as a mental illness increased from 74.5% (pre) to 87.3% (post) Ability to differentiate self-harm from suicidal behaviors improved from 44% to 54% Attitude scores decreased significantly from 26.62 ± 3.77 (pre) to 24.62 ± 4.14 (post) (t = 4.67, P = .001), indicating more positive attitudes toward depression and suicidality Recognition of depressive symptoms improved from pre- to post-assessment Willingness to spend time with depressed students increased from 53% to 56%	Not Mentioned
								Referrals to mental health professionals increased from 51% to 56% Identifying depression in students improved from 68% to 80%
12	(Bichoualne et al., 2023)	Morocco	To assess the impact of MHL training on the teachers’ mental health knowledge, attitude, and self-efficacy.	Quasi-experimental pre–post research	Sample Size-36 Age: 33 teachers (91.6%) were between 25–50 years, two were under 25, and one was over 50	Pre-Post assessment. Tools Used: 1) a 30-item pre-test survey of the TMHL curriculum guide program; 2) the Devaluation of Consumer Scale (DCS); and 3) the Student Mental Health Self-Efficacy Teacher Survey (SMH-SETS).	TMHL curriculum modules Facilitated by: Delivered online by the research team (College of Education, Zhejiang Normal University, and Beijing Normal University Duration: Online 6-week training program. Each week: 2-hour session (total » 12 hours).	The findings revealed a significant level of improvement in relation to the teachers’ MHL knowledge, attitude, and self-efficacy after the training. The study findings reveal the effectiveness of MHL training in improving in-service teachers’ knowledge, attitude, and self-efficacy in relation to mental health.	The effect size in this study is in accordance with Cohen’s guidelines for a large effect (d ≥ 0.8).
13	(Elyamani et al., 2024)	Qatar	To assess the effectiveness of the World Health Organization School Mental Health Program (WHO-SMHP) in promoting MHL among secondary schools’ teachers in Qatar.	A two-arm randomized controlled trial.	Sample Size-195 Age: Mean 41.5 years	Pre -Post and 3 months follow-up Tools Used: MHL was conducted using the self-administered tool developed by the WHO for use in the EMRO region.	WHO-EMRO Manual of School Mental Health in improving teachers’ Facilitated by: eight locally-based psychologists Duration: WHO-SMHP delivered over 3 days (December 17, 19, 20, 2018). 6 hours per day (7:30 AM–1:30 PM), totaling 18 hours.	The intervention group showed a significant improvement in MHL: Immediate post-assessment (T1): Mean difference of 19.08, Cohen’s d = 2.63 (p < 0.001). Three months post-assessment (T2): Mean difference of 16.61, Cohen’s d = 1.86 (p < 0.001). Significant increase in mean MHL score in the intervention group: From 57.84 at T0 to 73.96 at T2 (p = 0.004). Workshop effect: Large initial impact (Cohen’s d > 2), but effect size diminished over time, remaining significant.	Strong interaction observed (p = 0.001), highlighting a substantial increase in MHL scores for the intervention group compared to the control group. Regression analysis confirmed the intervention’s effectiveness in improving MHL scores (p = 0.001), with a strong influence of time (p = 0.001)

Only four studies conducted a long-term follow-up,^19,28–30 revealing significant effects. The remaining studies did not include follow-up assessments.^{15,20–22,24–27} These studies have only examined short-term knowledge aspects, failing to investigate long-term changes in attitudes, reduced stigma, and increased help-seeking behaviors.

Most studies used the Canadian School Mental Health Curriculum Resource (the Guide), which demonstrated significant improvements in teachers’ knowledge and help-seeking behavior, as well as reductions in stigma toward mental illness.^{14,19,21,24,25} When the same Canadian School Mental Health Curriculum Resource (the Guide) was adopted in Southeast Asian nations (Cambodia and Vietnam), higher levels of recognition, self-efficacy, and willingness to interact, and lower levels of stigma were reported in the randomized controlled study in Vietnam compared with the control group. On the other hand, Cambodia’s quasi-experimental, controlled pre–post design study failed to reach statistical significance regarding recognition of mental disorders, help-seeking, self-efficacy, and stigma. ²⁵ For the intervention, two studies utilized the World Health Organization - Eastern Mediterranean Regional Office (WHO-EMRO) Manual of School Mental Health, resulting in improvements in teachers’ MHL, enhanced self-efficacy in classroom management and student engagement, and increased confidence in supporting students with mental health issues.^28,29 Most of these studies lacked randomization, which emphasizes the necessity of additional randomized research to yield more empirical data.

Effectiveness of Interventions

Intervention Facilitated by and Duration of the Training

Studies on teacher training in MHL have been conducted in several countries using different formats and durations. Studies from Malawi and Tanzania delivered 3-day workshops facilitated by mental health professionals,^14,24 while studies from Pakistan and Canada also conducted 3-day training sessions led by psychiatrists, psychologists, or education experts.^13,28 Shorter formats included studies from Canada with a 1-day teacher-led program, ¹⁹ a study from Nigeria, with a 1-day clinical psychologist-led program, ²² and a study from Japan with a 50-minute video lesson developed by child psychiatry experts. ²⁷ Longer interventions study from Brazil used a 3-week web-based tutorial ²⁰ and studies from Vietnam and Cambodia used a 5-week teacher-facilitated program, ²⁵ and another study from Morocco delivered a 6-week online program. ²³ Other notable formats included a study from Malaysia, an 8-hour workshop facilitated by researchers and psychologists, ²⁶ a study from India that provided two sessions of 2–3 hours within 3 weeks, facilitated by researchers, ²⁹ and a study from Qatar that implemented the WHO-School Mental Health Programme (SMHP) through locally trained psychologists over 3 days (18 hours). ³⁰

Improvement of Knowledge

Across all studies, the interventions led to a significant improvement in teachers’ understanding of mental health. The large to considerable effect sizes observed across several interventions indicated a substantial increase in knowledge about mental health. Notably, programs that used several resources such as digital and web-based resources,^20,23,27 manuals,^20,22,26,28 and the Canadian School Mental Health Curriculum^{14,19,21,24,25} showed significant effectiveness in improving teachers’ understanding.

Attitude and Stigma Reduction

The intervention results indicate reduced stigma and positive changes in attitudes. The impact of several interventions showed a significant improvement in stigmatized beliefs and attitudes toward mental illness,^{14,19,22–27,29,31} while some studies reported a decline in stigmatized beliefs and attitudes toward mental illness.^20,25,27 Yet, across interventions, teachers’ attitudes showed observable beneficial adjustments, suggesting a trend in the right direction toward de-stigmatizing mental health issues.

Behavioral Changes and Help-seeking Efficacy

The reviewed interventions often produced favorable behavioral shifts and improved effectiveness when teachers received MHL interventions. ²⁰ Teachers showed enhanced self-efficacy, self-assurance in dealing with students’ mental health issues, and a greater inclination to seek assistance. ²⁵ Findings from these studies indicated that personal help-seeking intentions improved significantly and were sustained even 3 months post-intervention. ¹⁹ Similarly, a study conducted in Pakistan highlighted that increasing MHL enhances self-efficacy and boosts confidence in supporting vulnerable students within school settings. ²⁸ Teachers expressed strong confidence in their ability to seek help for themselves and to support students, friends, family members, and peers. ¹⁴ Additionally, another study emphasized the importance of enhancing self-help strategies due to improved MHL. ²⁶

Disparities Between Interventions

Although most interventions yielded favorable results across various categories, some differences were observed. Variations in effect sizes and outcomes can be attributed to differences in study designs, intervention approaches, and cultural contexts. For instance, interventions that included interactive programs, specialized training workshops, and curriculum resources demonstrated greater effectiveness in improving knowledge than control groups. Additionally, culturally tailored interventions had mixed effects on stigma reduction and attitude change.

Variation in Effect Size

The effect size varied across the outcome measures, ranging from minor to substantial. Baseline scores, intervention specificity, and knowledge enhancement consistently showed more significant impact sizes,^{14,19,21,23,24,26,28,30} while behavioral improvements, stigma reduction, and attitude modifications showed moderate to smaller effect sizes.^20,25,27

Discussion

This systematic review provides valuable insights into the effectiveness of MHL training for school teachers. The current review expanded the focus to include both randomized and non-randomized studies, with particular attention to experimental designs and the long-term sustainability of interventions.

This review identified 13 studies: Five RCTs, two cohort studies, and seven pre–post studies. Compared to previous reviews, the present one includes more RCTs and non-randomized controlled studies. However, very few studies conducted post-intervention follow-ups. Most interventions utilized the MHL Canadian School Mental Health Curriculum Resource (the Guide), while two studies followed the WHO-EMRO Manual of School Mental Health to improve teachers’ MHL. Additionally, most studies did not use standardized tools to assess MHL. The training duration ranged from 50 minutes to 6 weeks and was delivered by mental health professionals, including psychiatrists, psychologists, education specialists, trained teachers, and researchers. We included five RCTs; the results align with previous systematic reviews, indicating that cultural context remains largely unaddressed. Future research should prioritize culturally relevant approaches and standardized assessment tools in this area. This review assessed the MHL interventions influencing knowledge regarding mental health, the attitudes and stigma surrounding it, help-seeking intentions, and help-seeking efficacy among school teachers.

The current study emphasizes that MHL training consistently improved teachers’ understanding of mental illness across all studies. As a result, the effectiveness of MHL programs for teachers aligns with findings from previous reviews. ³² Many interventions demonstrated a notable improvement in reducing stigmatizing beliefs and attitudes toward mental illness, while a few studies reported only modest reductions in such stigma.^20,25,27 Behavioral changes and improved help-seeking efficacy were consistently observed as outcomes of the interventions. However, variations existed due to differences in study designs, intervention formats, and cultural contexts. The effect sizes ranged from small to large across outcome measures, with knowledge enhancement consistently showing the largest effect sizes. This might be a temporary effect; we could not identify long-term effects except for one study that conducted long-term follow-ups. Overall, the review highlights the significant impact of MHL programs on educators’ MHL attitudes and behaviors. Our review found comparable improvements in MHL and reductions in stigma, consistent with findings from previous reviews. ¹⁰

A recent systematic review found that digital MHL interventions had positive, sustained effects on mental health, particularly benefiting emerging adults. ³³ In this current review, it was found that both a web-based intervention and a short-term video-based MHL program led to significant improvements in knowledge about mental illness and increased willingness to assist students with depression. However, there was no noticeable reduction in stigma toward mental illness, and behavioral changes were not assessed due to a lack of follow-up measures. Furthermore, there was limited research specifically addressing digital MHL among school teachers. In today’s digital age, digital interventions have become increasingly prevalent and valuable, potentially reducing the need for extensive workforce and time. Moreover, they offer easier access to the target population, and more cost-effective interventions will likely emerge in the years to come.

Previous reviews failed to identify a practical training module for school teachers. However, our review emphasizes that most studies that used the Canadian School Mental Health Curriculum Resource (the Guide) consistently demonstrated improved knowledge and attitudes, and reduced stigma among teachers. Nonetheless, when applied in Southeast Asian nations such as Cambodia and Vietnam, variations in outcomes were observed. While Vietnam’s RCT reported favorable outcomes, including higher recognition, self-efficacy, and willingness to interact, Cambodia’s quasi-experimental study failed to achieve statistical significance in several key domains. ¹⁰

Furthermore, most MHL interventions have been identified in studies originating in North America and Africa. Two studies originated in Southeast Asia, one in East Asia, and only one in a Mediterranean country. There is a lack of research in low-income nations. However, further studies are needed, especially in low and middle-income countries, as highlighted in previous reviews. ³³ Besides, a school-based MHL study from Canada found that when teachers receive MHL training, there is a significant improvement in the early identification of mental health issues and in the quantity and quality of referrals to tertiary child and adolescent mental health services. This, in turn, leads to positive treatment outcomes. ¹⁵ It is of paramount importance to acknowledge the role of Mental Health Professionals (MHPs) (psychiatrists, psychiatric social workers, clinical psychologists, and mental health nurses) in this area, as they play a crucial role in the preventive, promotive, and curative aspects of mental health. However, the lack of human resources in the field of mental health in low- and middle-income countries is scary. Hence, the MHPs can be utilized to train school teachers, school counselors, and other stakeholders on MHL, screening, and appropriate referrals to professionals at the school level.

This systematic review highlights the effectiveness of MHL training in improving teachers’ mental health knowledge and attitudes and in decreasing associated stigma. Only a small number of studies implemented culturally contextualized interventions. However, further research, particularly through RCTs with long-term follow-up and the use of standardized tools, is warranted to consolidate and expand upon these findings. Future research should focus on developing and culturally adapting the MHL programs to ensure the interventions are effective across diverse social settings. Additionally, tailoring interventions to specific cultural contexts can maximize the impact of MHL training globally. Incorporating teachers from low- and middle-income countries is essential, as they are currently underrepresented in this review. The National Suicide Prevention Strategy of India aims to integrate the mental well-being curriculum in all educational institutions by 2030, ³⁴ considering the alarming mental health issues and suicide rates among school-going children and adolescents. ⁹ Education institutions and policy frameworks can encourage structured partnerships with mental health experts to equip teachers with the necessary training and facilitate ongoing knowledge sharing, mental health screening, and streamlined referral procedures.

Strengths and Limitations

This study assessed the effectiveness of an MHL intervention tailored for school teachers. The review highlights studies with robust methodologies, including RCTs, quasi-experimental studies, and pre–post study designs. Additionally, this study explores the specific tools utilized for the intervention. However, reliance on non-standardized tools to assess MHL raises concerns about the reliability and validity of the findings, and analyzing only 13 studies limits their generalizability. This review included data solely from peer-reviewed journals accessed through scientific databases, excluding unpublished reports from educational institutions, information from non-profit organizations, and community service data. Additionally, as no meta-analysis was conducted and methodological and clinical heterogeneity were not assessed, publication bias was not examined. We might have overlooked additional pertinent research that was not found in the primary databases we looked through.

Conclusions

The review of MHL interventions for school teachers emphasizes their crucial role in improving mental health awareness and promoting constructive attitudes and practices. Across the 10 studies analyzed, interventions consistently led to notable improvements in mental health–related knowledge. A generally positive trend was observed, though outcomes varied in terms of stigma reduction and attitude changes. Furthermore, these interventions facilitated beneficial behavioral shifts, enhancing teachers’ self-efficacy in addressing students’ mental health needs and promoting positive help-seeking behaviors. Disparities in effectiveness were noted, influenced by study designs, intervention formats, and cultural contexts. Effect sizes also varied across outcome measures, with knowledge enhancement consistently showing larger effect sizes. Overall, the review underscores the value of tailored MHL programs in equipping teachers to better support students’ mental well-being, emphasizing the need for continued research and customized interventions to address diverse educational contexts effectively.