Empowering Schools to Tackle Mental Health: A Commentary with Six Recommendations for Engaging Health Educators in Saudi Arabia

Introduction

There is growing evidence that the burden of men- tal health issues is increasing both globally and within Saudi Arabia, especially among children and adolescents. Globally, depression and depres- sive symptoms among children and adolescents have risen steadily over the past three decades [1]. In Saudi Arabia, mental disorders affect over 40% of youth, with anxiety alone impacting 27% of this group [2]. In Riyadh, the capital of Saudi, the prev- alence of moderate to severe depression in the ad- olescent population is reported at 32.4% [3]. Gender-specific studies reveal further concerns. Among adolescent girls in Saudi Arabia, depres- sion and anxiety rates have reached as high as 41.5% and 66.2%, respectively [4]. A more recent study reported 30.0% depression and 27% anxiety among female students in Riyadh [5]. Depression and anxiety among male students were found to be 56.3% and 56%, respectively [6]. Another study concluded that female secondary school students were significantly more prone to anxiety and stress Nawaf Alnuwaysir (Nalnowaiser@ksu.edu.sa) is with the Department of Community Health Sciences, King Saud Uni- versity, Riyadh, Saudi Arabia. DOI: 10.52609/jmlph.v5i4.232

Saudi Arabia

than their male peers. Students who had been bul- lied also showed notably higher levels of depres- sion compared with those who had not been bullied [7]. These findings point to a consistent, and possi- bly rising, trend in adolescent mental health chal- lenges in Saudi Arabia—an ongoing concern that warrants urgent attention and immediate action. A variety of factors are driving the rise in mental health problems; they include anxiety about the fu- ture, pressure regarding academic performance, ex- posure to bullying or cyberbullying, and, most dis- turbingly, the stigma associated with seeking men- tal health support. One of the most critical barriers is self-stigma, which refers to feelings of shame or embarrassment that prevent individuals from seek- ing help, particularly for mental health concerns. An additional factor is obesity, a growing concern among children and adolescents globally. For in- stance, a recent study found that weight-related self-stigma was positively associated with higher rates of depression and anxiety among youth [8]. It is essential to raise awareness about the signs of mental health issues and how to seek appropriate support. Equally important is addressing and reduc- ing the stigma surrounding mental health, ensuring that seeking help, especially during vulnerable times, is seen as a strength rather than a weakness. Reaching families, schools, and communities is vi- tal, as they serve as key connections to young peo- ple. In this context, health educators play a critical and influential role in promoting mental health and guiding individuals toward care. Health educators are qualified professionals who aim to improve in- dividual and community well-being by promoting healthy behaviours, supporting adaptation to health changes, and preventing disease. Health education initiatives may encompass a wide range of topics, including physical activity programs, HIV preven- tion, tobacco use prevention, and, crucially, the promotion of mental health [9]. Reaching students in schools and offering mental health education classes can significantly improve mental health lit- eracy. Through these programs, they can learn to recognize early signs of depression and anxiety, manage various mental health challenges, and,

most importantly, when and how to seek help. Im- plementing such initiatives at an early age not only strengthens mental health awareness as students grow older, but also helps to reduce stigma associ- ated with mental illness [10]. Saudi Arabia has actively implemented health edu- cation across various settings to increase public awareness of diseases, obesity, and other health risks. In a recent study, 97% of Riyadh residents agreed on the importance of having health educa- tors in schools, highlighting strong community sup- port in this regard [11]. Numerous regional studies in Saudi Arabia over the past decades have exam- ined the prevalence of mental health disorders among children and adolescents; nonetheless, na- tional studies remain limited. Therefore, this com- mentary serves as a crucial call for the formal inte- gration of health educators into school-based men- tal health strategies in Saudi Arabia. Such integra- tion can enhance awareness of the early signs of mental health issues, reduce the stigma preventing individuals from seeking help, and ultimately con- tribute to decreasing the overall burden of mental health disorders in the population.

Six Recommendations for Schools The following six recommendations are proposed to enhance mental health awareness and support among students. They aim to provide practical, ac- cessible, and non-stigmatizing approaches that can be implemented within educational settings. Since adolescents spend a significant part of their day at school, this environment offers a valuable opportunity for early mental health intervention. Integrating health educators into schools can play a key role in raising awareness among both students and staff; it is also essential to train teachers, prin- cipals, and parents to recognize early signs of men- tal health concerns and enable timely support. In addition, incorporating mental health topics into existing health curricula can help students engage meaningfully with the subject and improve their mental health literacy [10].

1.Healthy Schools Program The Healthy Schools Program, launched by the Ministry of Health in alignment with WHO stand- ards, focuses on promoting various aspects of stu- dent health. Notably, it emphasizes the importance of supporting students’ mental well-being [12]. In- tegrating health educators into this program is strongly recommended, as they can play a vital role

in addressing mental health needs through proac- tive engagement and education. They can quickly assess mental health status using the PHQ and GAD screening tools, allowing them to better en- gage with students and develop appropriate inter- ventions if needed. These tools are widely used in school settings for early identification of depres- sion and anxiety [13,14].

2.Psychoeducation Workshops Psychoeducation workshops have been widely im- plemented and have demonstrated positive out- comes [15,16]. They are a vital step in raising awareness, for both parents and teachers, about common signs of mental health issues among stu- dents. These workshops serve as an initial point of engagement, encouraging parents to build open, supportive communication with their children about emotions and mental well-being.

3.Anonymous Feedback While anonymous reporting systems (ARS) and “Say Something” are widely used in U.S. schools to address safety concerns [17,18], they can also be adapted as effective tools for reporting mental health issues. Stigma may prevent students from openly discussing their mental health concerns; an ‘Anonymous Feedback’ or ‘Support’ box is essen- tial to address this barrier. Such boxes offer stu- dents a safe and private way to express their thoughts or report sensitive issues, such as bully- ing, which they might be uncomfortable sharing with parents or school staff. This approach enables schools to receive honest input from students and take appropriate action based on their concerns and suggestions.

4.Resource Hub Digital mental health interventions have been shown to be effective for students [19], supporting the use of online resource hubs. Today, most stu- dents have internet access via their personal de- vices. Thus, by providing them with a variety of re- liable and accessible mental health resources such as coping strategies, educational materials, and re- ferral contacts, and by engaging all students through a school website, shared online folders, or online classroom platforms, schools can ensure that important information is readily accessible in a pri- vate and non-stigmatizing manner. This approach empowers students to seek support at their own pace and comfort level.

5.Mental Health First Aid (MHFA) Signs of mental health issues can sometimes go un- recognized by teachers, parents, and peers—or even the students themselves. Mental Health First Aid (MHFA) is a structured training program that teaches people to identify, understand, and respond to signs of mental health issues or emotional dis- tress, enabling non-professionals to offer initial support until professional help is available [20]. MHFA training can equip classmates to identify early warning signs in their peers, and to and report concerns, anonymously or directly, to the school health educator for appropriate support.

6.Multitiered Systems of Support (MTSS) MTSS is a flexible and scalable model for integrat- ing mental health services into schools, improving both emotional well-being and academic outcomes [21]. This approach provides support at three lev- els: for all (Tier 1), targeted (Tier 2), and intensive (Tier 3). Health educators play an important role across all tiers: delivering school-wide mental health education, identifying at-risk students using tools such as PHQ and GAD, and coordinating re- ferrals for students in need. This structured ap- proach not only identifies students’ needs and pro- vides early intervention, but also ensures students seek help, reduces stigma, and prevents problems from escalating. By embedding mental health sup- port into school routines, MTSS ensures that all students receive the appropriate level of care, time- ously and consistently.

Implementation Consideration s While this commentary advocates for the integra- tion of health educators to address mental health challenges in schools, several practical considera- tions must be acknowledged within the Saudi con- text. First, there is currently a limited number of health educators trained specifically in mental health, which may delay immediate implementa- tion and require structured training programs prior to deployment in schools. Second, given the cul- tural sensitivity surrounding mental health topics, such initiatives may initially encounter hesitation or limited engagement from students and staff, par- ticularly due to persistent stigma. Third, regional disparities in school resources and infrastructure present a logistical challenge, suggesting the need to pilot such interventions in select schools prior to nationwide adoption. Evaluating outcomes from these pilot schools before expanding can ensure

that constructive feedback is incorporated and nec- essary adjustments made to improve the effective- ness and acceptance of such initiatives.

Systemic Barriers Systemic barriers may also contribute to delays in implementing these recommendations. First, the absence of mental health content in current school curricula may make adoption challenging without curriculum reform and teacher training. Second, limitations in human resources, particularly the availability of qualified health education profes- sionals, could slow progress due to recruitment processes, training demands, and funding for sala- ries. Third, successful implementation will require strong intersectoral collaboration, particularly with the Ministry of Education, Ministry of Health, and the Public Health Authority, to ensure the initia- tive’s sustainability and alignment with national strategies.

Sustainability and Evaluation Strategies To promote long-term sustainability, it is essential that relevant ministries and authorities establish supportive policies and maintain regular oversight, ensuring that mental health initiatives are imple- mented in alignment with national strategies and with the objectives of Vision 2030. Schools must also receive adequate resources, both in terms of funding and human capital, to carry out these pro- grams effectively. Collaboration with global initia- tives, such as those of the CDC and WHO, can pro- vide the benefit of proven training models and the- oretical frameworks. Regular evaluations, whether annually or as deemed appropriate, are crucial to track schools' adherence to these initiatives and identify areas for improvement.

Conclusion

Urgent and coordinated action is required to ad- dress the growing mental health burden among ad- olescents in Saudi Arabia. Schools offer a powerful platform to reach students early, build mental health literacy, and reduce associated stigma. By integrating trained health educators and imple- menting the six strategies recommended herein, Saudi schools can create supportive environments that promote emotional well-being. However, suc- cessful implementation depends on stakeholder collaboration, curriculum reform, adequate re- sources, and regular evaluation. With strong policy support and a phased, culturally sensitive approach, mental health education can become a sustainable

and impactful part of the school system.