🔍💡 Mental health of secondary school adolescents: this thesis shows how school nurses identify, guide, and support young people, despite often suboptimal organisations. #YouthMentalHealth #SchoolNurse
🧠🏫 The real role of school nurses in Quebec: between clinical intuition, sexual education, and fragile collaborations, the study reveals what facilitates or hinders access to mental health care for adolescents. #SchoolHealth #YouthPrevention
This thesis provides a nuanced view, situated in Quebec, of the real role of school nurses in the mental health of adolescents aged 14 and over, beyond theoretical mandates.
It is directly useful to school nurses, school health coordinators, school management, CISSS/CIUSSS managers, and youth prevention teams who wish to structure or strengthen a frontline offer in mental health in schools.
It allows for the identification of very concrete levers (detection, guidance, promotion through sexual education) and organisational barriers to adjust practices, training, and interprofessional collaborations.
Source: 📒 The mental health of adolescents: the role of school nurses
📜🔗LINK
Number of pages: 114 pages
1. Analytical summary
Context, issues, and audiences
The mental health needs of adolescents have significantly increased, particularly since the COVID-19 pandemic, as schools serve as a central place for life and access to services for young people. School nurses are identified as frontline professionals responsible for assessing physical and mental health, intervening, and referring, but their role in mental health is poorly defined and varies greatly by region and environment. The literature review shows few studies specifically focused on adolescents, a high international heterogeneity, and limited transferability to the Quebec context, which justifies a dedicated study. In this thesis, the author aims to understand, from the perspective of Quebec school nurses, how their role in mental health is realised with adolescents aged 14 and over attending secondary schools, and what personal and organisational factors influence this practice. Fifteen nurses from different regions of Quebec were interviewed through semi-structured interviews, using a descriptive interpretative approach.
Operational contributions for field actors
The study highlights three main activities that form the core of the mental health role of school nurses: identifying clinical signs of mental health issues, directing adolescents to specialised professionals, and promoting mental health through sexual education. It meticulously documents the identification strategies (intuition, observation, trust relationships, environmental signals), referral practices (referral to doctors, psychologists, community resources), and how sexual education content is used as discussion levers on consent, relationships, self-esteem, and distress. The factors influencing the role are of two kinds: personal (attitude, skills, clinical confidence) and organisational (recognition of the role by partners, collaboration, assignment to multiple schools, workload, service structures). The thesis leads to implicit recommendations for nursing practice, management, teaching, and policies: clarify the role in mental health, strengthen specific skills, better structure interprofessional collaboration, and fully integrate the school nurse into frontline mental health services.
2. Key points of the document
The rise in mental health needs among adolescents and the centrality of the school environment
The document reminds us that the mental health needs of adolescents have been increasing for several years, with a worsening since COVID-19, as young people spend the majority of their time at school, making the school environment a crucial entry point for frontline services. [file:1, p. ii-iii, 6-8, 13]
Three central activities of the nursing role in mental health
Based on the interviews, three activities structure the role of school nurses in mental health: 1) identifying clinical signs of mental health problems, 2) referring to specialised professionals, 3) promoting mental health through sexual education, showing that sexual health is used as a gateway to mental health. [file:1, p. ii, 26-28, 68-72]
A great variability of practices and incomplete recognition of the role
Nurses describe very heterogeneous practices from one environment to another, a significant workload (assignment to multiple schools, high volumes of young people) and partial recognition of their expertise in mental health, often perceived by partners as focused on physical health or vaccination. [file:1, p. 22-25, 29-30, 74-76]
Personal and organisational determinants of the role
The thesis highlights personal factors (attitude, confidence, motivation, mental health skills) and organisational factors (care model, available resources, collaborations, service structures, school policy) that concretely influence nurses' ability to identify, refer, and support adolescents. [file:1, p. 29-33, 73-76, 80-82]
Methodological limitations and implications for practice, training, and policies
The qualitative study with 15 nurses does not allow for statistical generalisation, but offers an in-depth understanding of the Quebec reality, rarely documented, and proposes action points for clinical practice, management, teaching, and policy to strengthen the role of the school nurse in frontline mental health. [file:1, p. 79-82, 84]
3. Action points for local stakeholders
Structure a systematic identification system in the school environment (p. 26-28, 68-70, 80)
School health teams can formalise mental health identification protocols (alert indicators, observation grids, vigilance criteria) based on practices described by nurses (clinical intuition, behaviour observation, signals from teachers), in order to move from informal identification to organised identification. [file:1, p. 26-28, 68-70]
Clarify and communicate the role of the school nurse in mental health (p. 13-17, 24-25, 74-76, 80-81)
School administrations, CISSS/CIUSSS, and prevention teams can develop role descriptions or collaboration charters that clarify the responsibilities of the nurse in mental health (identification, referral, follow-up, participation in support teams) and share them with teachers, psychoeducators, social workers, and parents. [file:1, p. 13-17, 24-25, 74-76, 80-81]
Use sex education as a lever for promoting mental health (p. 14, 27, 72)
Nurses and teachers can co-construct sex education sessions that explicitly integrate mental health dimensions (consent, healthy relationships, self-esteem, violence in relationships, emotional management), in accordance with the described practices, to foster safe discussions and prevent distress. [file:1, p. 14, 27, 72]
Strengthen nursing skills in adolescent mental health (p. 29-33, 73-75, 80-82)
School health managers and continuing education leaders can implement targeted training on adolescent mental health (motivational interviewing, suicide risk assessment, anxiety and depressive disorders, referral to resources) and clinical supervision spaces to strengthen the skills and confidence of nurses. [file:1, p. 29-33, 73-75, 80-82]
Strengthen interprofessional collaboration and links with specialised resources (p. 22-23, 30-31, 70-71, 76-82)
Local consultation tables and schools can structure formalised service corridors between schools, youth mental health services, and community organisations (referral processes, feedback, co-intervention), while taking into account the accessibility constraints in rural or remote areas highlighted in the literature. [file:1, p. 22-23, 30-31, 70-71, 76-82]
4. Additional References
🔍➕ For more information, see the articles referenced by "Pratiques en Santé" on the topic of sexual and emotional education ➡️🔗https://pratiquesensante.odoo.com/4-1-education-affective-sexuelle
National Association of School Nurses – "Elevating the Role of School Nurses in School-Based Mental and Behavioral Health" (consensus document, 2024)
Document specifying the contributions of school nurses in multi-tiered support systems (MTSS) for mental and behavioural health, with examples of interventions and school-health partnerships.https://www.health.state.mn.us/people/childrenyouth/schoolhealth/hco/mentalhlth.html
5. Cross-Sectional Analysis — Values of Pratiques en Santé
Literacy: The report does not propose a structured tool for literacy, but it describes health and sexuality education practices that adapt to the language and reality of adolescents during clinical interviews and group activities. [file:1, p. 14, 26-28, 72]
Empowerment: Adolescents are involved through needs-based identification, individual interviews, and referral processes aimed at supporting them in seeking help, but their participation in the design of services is poorly described. [file:1, p. 7, 26-27, 70-72]
Participation: The document describes few formal mechanisms for co-construction with young people, but mentions the creation of trust relationships and spaces for expression, particularly during nurse-adolescent meetings and classroom interventions. [file:1, p. 26-27, 72]
Community health: The collective dimension is addressed through the presentation of nursing practice as part of public and community health in schools, with a focus on promoting and preventing mental health for all students. [file:1, p. 13-15, 24-25]
Ethics: Issues related to confidentiality, respect for young people, and the limits of competencies are present, but cultural or social biases are not explicitly discussed as objects of systematic analysis. [file:1, p. 67-68, 73-76]
Human rights: The report is framed within a perspective of accessibility and equity of access to mental health care for adolescents, but human rights are not addressed as an explicit framework (references to care models, primary care, and accessibility). [file:1, p. 6-9, 13, 80-82]
Intersectorality: The text describes collaborations between schools, health services, social services, and community resources, but these partnerships are often fragile and dependent on local contexts. [file:1, p. 8-10, 22-23, 30-31, 76-82]
Partnership: Collaboration models are described more descriptively (collaboration with teachers, psychologists, social workers) than formally (protocols, agreements), highlighting a margin for progress towards more structured partnership frameworks. [file:1, p. 22-23, 30-31, 76-82]
Combating discrimination: The document does not directly address the issue of discrimination (gender, origin, sexual orientation, disability) or explicit practices of non-judgment, even though the supportive posture and respect for adolescents' experiences is present in the background. [file:1, p. 26-27, 72-73]
Points of caution in facilitation
The document addresses adolescent mental health, distress, possible disorders, and referral to specialised services, but it does not explicitly and in detail address themes such as sexual violence, HIV/PrEP, chemsex, or unaccompanied minors, even though sexual education content may touch on sensitive experiences. [file:1, p. 6-8, 14, 27, 68-72]
Risks of emotional triggering:
Discussions around psychological distress, suicidal thoughts, or the suffering of adolescents can revive personal experiences among participants. [file:1, p. 6-8, 26-28, 68-70]
Exchanges on the limits of access to care, organisational difficulties, and the overload of nurses can generate feelings of helplessness or anger among professionals. [file:1, p. 22-25, 74-76, 79-82]
Themes related to relationships, consent, and potential violence in romantic or sexual relationships can be sensitive for some participants. [file:1, p. 14, 27, 72]
It is therefore recommended to provide debriefing times, reminders of support resources, and emotional safety rules during activities based on this document. [file:1, p. 67-68, 80-82]
6. Assessment of the reliability of the resource
Scientific relevance
The report is based on a systematic review of the literature over twenty years (2003–2023), resulting in 13 selected studies, including qualitative studies, literature reviews, cross-sectional surveys, and a mixed study, with a structured thematic analysis. [file:1, p. 18-22]
The methodology of the empirical study (descriptive interpretative, semi-structured interviews with 15 nurses from different regions, analysis through thematic coding) is described transparently, with ethical considerations and a discussion of strengths and limitations (notably transferability). [file:1, p. 36, 65-67, 79-80]
The coherence between the problem statement, objectives, methods, results, and discussion is good, and the bibliography includes recent works, including those published after 2019. [file:1, p. ii-iii, 18-22, 79-82, 86-93]
Operational relevance
The document is very useful for understanding concretely what school nurses do in mental health in Quebec (screening, referral, promotion through sexual education), under what organisational conditions they operate, and what factors facilitate or hinder these roles. [file:1, p. 26-33, 68-76, 80-82]
It provides transferable elements for field practices (the importance of trust, integration of mental health into school health activities, the need to clarify roles and strengthen interprofessional collaboration), even though directly ready-to-use tools (grids, checklists) are not provided. [file:1, p. 26-28, 70-72, 80-82]
7. MCQ — 5 questions
Part 1 — Questions (without answers)
Question 1 (p. ii-iii, 6-8)
What is the main objective of Joelle Elias's research project?
a) To evaluate the effectiveness of a systematic screening programme for mental disorders in schools
b) To understand, from the perspective of school nurses, their role in mental health for adolescents aged 14 and over in secondary schools in Quebec
c) To describe the prevalence of mental health disorders among all primary and secondary students in Quebec
d) To compare school health models between Quebec and Norway
Question 2 (p. 18-22)
How many studies were included in the literature review of this thesis?
a) 7
b) 10
c) 13
d) 20
Question 3 (p. ii, 26-28, 68-72)
Among the following activities, which one is part of the three central activities of the nursing role in mental health identified in the thesis?
a) Conducting intensive sports workshops to prevent depression
b) Referring adolescents to mental health specialists
c) Prescribing psychotropic medications in primary care
d) Administrative management of school records
Question 4 (pp. 22-25, 29-30, 74-76)
Which of the following findings regarding school nurses emerges from the literature and the results of the thesis?
a) They work almost exclusively in a single school with few students
b) They are mainly perceived as mental health experts by all partners
c) They are often assigned to multiple schools and are mainly seen as responsible for physical health and vaccination
d) They have no contact with teachers or school psychologists
Question 5 (pp. 79-82)
Among the identified outcomes, which specifically concerns the level of policy?
a) The creation of a new profession of school nurse independent of the health system
b) The development of strategies to clarify and strengthen the role of school nurses in mental health within health and education policies
c) The requirement for all school nurses to undergo 5 years of training in psychiatry
d) The elimination of collaborations with community organizations
Part 2 — Commented correction
Question 1
What is the main objective of Joelle Elias's research project?
✅ Correct answer: b) To understand, from the perspective of school nurses, their role in mental health for adolescents aged 14 and over in secondary education in Quebec.
📝 Explanation: The summary specifies that the aim of the project is to understand, from the perspective of school nurses, the role they play in mental health for adolescents aged 14 and over in secondary schools in Quebec, and not to evaluate a programme or compare countries. [file:1, p. ii-iii, 35]
Question 2
How many studies were included in the literature review of this thesis?
✅ Correct answer: c) 13.
📝 Explanation: The 'Results' section of the literature review indicates that a total of 13 studies were included (12 from academic literature and 1 from grey literature), covering the period 2010–2023. [file:1, p. 21-22]
Question 3
Among the following activities, which one is part of the three central activities of the nursing role in mental health identified in the thesis?
✅ Correct answer: b) Referring adolescents to specialised mental health professionals.
📝 Explanation: The results identify three activities: identifying clinical signs of mental health problems, referring to specialised professionals, and promoting mental health through sexual education; prescribing medication and organising sports workshops are not part of the described role. [file:1, p. ii, 26-28, 68-72]
Question 4
Which of the following findings regarding school nurses emerges from the literature and the results of the thesis?
✅ Correct answer: c) They are often assigned to multiple schools and are mainly perceived as responsible for physical health and vaccination.
📝 Explanation: The studies reviewed and the results show that school nurses are often assigned to multiple schools, with a large number of students, and that partners primarily perceive them as resources for physical health and vaccination, with their expertise in mental health being less recognised. [file:1, p. 22-25, 29-30, 74-76]
Question 5
Among the identified outcomes, which specifically concerns the level of policy?
✅ Correct answer: b) The development of strategies to clarify and strengthen the role of school nurses in mental health within health and education policies.
📝 Explanation: In the policy outcomes, the author emphasises the importance of developing strategies aimed at better recognising and supporting the role of nurses in mental health in frontline services, rather than creating a new profession or eliminating partnerships. [file:1, p. 80-82]
8. Frequently Asked Questions (FAQ)
Who is the primary audience for this report? (p. ii-iii, 13-15)
It is primarily aimed at school nurses, school health programme managers, youth service managers (CISSS/CIUSSS), school administrators, and researchers/teachers in nursing and public health. [file:1, p. ii-iii, 13-15, 80-82]
Why is adolescent mental health presented as a priority? (p. ii-iii, 6-8)
Because the mental health needs of adolescents have increased, especially since the COVID-19 pandemic, and the consequences on school, social, and family functioning are significant, making this age group a priority target for prevention and intervention. [file:1, p. ii-iii, 6-8]
What types of mental health problems are mentioned in the report? (p. 3-5, 6-7, 26-28)
The document distinguishes between mental health, mental health problems, and mental disorders, and refers to common manifestations in adolescents (anxiety, depression, distress, suicidal thoughts) without focusing on diagnosis, but rather on identifying signs and the need for guidance. [file:1, p. 3-5, 6-7, 26-28, 68-70]
How do school nurses identify struggling adolescents? (p. 26-28, 68-70)
They rely on their observations, the confidences of young people, signals from teachers or other professionals, and their clinical experience, with this identification often being informal and based on intuition. [file:1, p. 26-28, 68-70]
What is the link between sex education and mental health in this report? (p. 14, 27, 72)
Sex education is presented as a privileged space to address mental health, as the themes of relationships, consent, violence, and self-esteem allow difficulties to emerge and work on prevention. [file:1, p. 14, 27, 72]
What are the main limitations of the study? (p. 79-80)
The limitations include the sample size (15 nurses), the qualitative nature which limits generalisation, and the specificity of the Quebec context, which requires caution when transferring the results to other contexts. [file:1, p. 79-80]
What recommendations does the report propose to improve practices? (p. 80-82, 84)
It suggests better defining and recognising the role in mental health, strengthening training and clinical supervision, structuring interprofessional collaborations, supporting workload management, and integrating the school nurse into the mental health care policies and models for young people. [file:1, p. 80-82, 84]
9. Rewriting in Easy Language
Easy Language Title
The mental health of teenagers and the work of nurses in schools
Easy Language Summary
Teenagers today have more mental health problems. [file:1, p. ii-iii, 6-8]
Teenagers spend a lot of time at school. [file:1, p. ii-iii, 13]
At school, nurses often see teenagers. [file:1, p. 13-15, 26-28]
The nurse listens, observes, and can see when a teenager is not doing well. [file:1, p. 26-28, 68-70]
She can refer the teenager to a doctor or a psychologist. [file:1, p. ii, 26-28, 70-71]
She also talks about sexuality, respect, and relationships to help mental health. [file:1, p. 14, 27, 72]
Key Points in Easy Language
More needs among teenagers
Mental health problems are increasing among teenagers. [file:1, p. ii-iii, 6-8]
Covid-19 has made the situation more difficult. [file:1, p. ii-iii, 6-8]
School is an important place.
Teenagers spend almost their entire day at school. [file:1, p. ii-iii, 13]
School is a good place to talk about mental health. [file:1, p. 13-15, 26-28]
What the nurse does
She checks if the teenager shows signs of distress. [file:1, p. 26-28, 68-70]
She helps the teenager find the right person to get help. [file:1, p. ii, 26-28, 70-71]
She provides sex education to also discuss emotions. [file:1, p. 14, 27, 72]
What helps or hinders the nurse
Her attitude, experience, and training can help. [file:1, p. 29-33, 73-75]
Lack of time, too many schools, and little recognition can hinder. [file:1, p. 22-25, 74-76]
Why this work is important
It can help teenagers talk about their problems earlier. [file:1, p. ii-iii, 68-70]
It can improve access to mental health care. [file:1, p. ii-iii, 70-72, 80-82]