Avoiding erroneous decisions: evidence, population impact and acceptability of universal mental health interventions in schools – a commentary on Andrews et al.

Bonell, Chris, Rose‐Clarke, Kelly, Deighton, Jess, Moore, Graham ORCID: https://orcid.org/0000-0002-6136-3978, Kuyken, Willem and Greenberg, Mark 2026. Avoiding erroneous decisions: evidence, population impact and acceptability of universal mental health interventions in schools – a commentary on Andrews et al. Child and Adolescent Mental Health 10.1111/camh.70126

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Abstract

Foulkes and colleagues argue many ‘universal’ interventions to prevent mental health problems are harmful (‘inflating prevalence’ because they raise awareness of mental health problems, encouraging those without such problems to misinterpret everyday concerns as symptoms of mental health disorders, causing avoidance of stressful situations, worsening mental health), relatively ineffective (effect sizes being smaller than for targeted interventions) and/or unacceptable to students, and should be discontinued. These arguments are based on weak evidence. While their ‘prevalence inflation’ hypothesis is potentially important and plausible when applied to awareness-raising interventions, evidence for it is currently weak and there is a tendency to overgeneralise to broader interventions. Arguments about the relative impacts of universal and targeted interventions fail to distinguish between individual and population impacts. Arguments about unacceptability are based on selected findings from a few studies, not reflecting broader evidence. These arguments could lead to erroneous decisions to discontinue universal mental health interventions in schools when they are most needed.

Item Type:	Short Communication
Date Type:	Published Online
Status:	In Press
Schools:	Schools > Social Sciences (Includes Criminology and Education) Schools > School of Social and Spatial Sciences Research Institutes & Centres > Centre For Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer)
Publisher:	Wiley
ISSN:	1475-357X
Date of First Compliant Deposit:	29 September 2026
Last Modified:	29 Sep 2026 11:31
URI:	https://orca.cardiff.ac.uk/id/eprint/189889

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