Resea ch A icle
Men al Heal h P omo ion in School: Schoolchild en’s and
Families’ Viewpoin
K is iina Puolakka,1Anne Konu,2I ma Kiikkala,3and Eija Paa ilainen4
1Depa men o Psychia y, Sa akun a Hospi al Dis ic , Tal i ie 7, 29200 Ha ja al a, Finland
2Uni e si y o Tampe e, School o Heal h Sciences, 33014 Tampe e, Finland
3Uni e si y o Eas e n Finland, K¨
asi y¨
ol¨
aisen ie 18 S 67, 00750 Helsinki, Finland
4Uni e si y o Tampe e, School o Heal h Sciences, Nu sing Science/E el¨
a-Pohjanmaa Hospi al Dis ic , 33014 Tampe e, Finland
Co espondence should be add essed o K is iina Puolakka; k is iina.puolakka@sa shp. i
Recei ed 27 July 2014; Accep ed 15 Oc obe 2014; Published 19 No embe 2014
Academic Edi o : Linda Moneyham
Copy igh © 2014 K is iina Puolakka e al. This is an open access a icle dis ibu ed unde he C ea i e Commons A ibu ion
License, which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly
ci ed.
While de eloping men al heal h wo k in schools, i is e y impo an o conside he iewpoin o pupils. Pa en s can also gi e
ema kable in o ma ion on hei child en’s iewpoin . The pu pose o his s udy was o p oduce a desc ip ion o he concep s used
by schoolchild en aged 12–16 yea s and hei amilies associa ed wi h p omo ing men al heal h in schools. The esea ch ma e ial
comp ised in e iews wi h schoolchild en and mo he s, and e bal answe s om he school well-being p o ile su ey (𝑛 = 426).
The analysis was conduc ed by applying he g ounded heo y me hod as in oduced by S auss. The s udy was conduc ed in a
Finnish comp ehensi e school.
1. In oduc ion
Schoolchild en’s bigges heal h p oblems a e ela ed o men al
heal h. Acco ding o a ious es ima es, he p e alence o
men al heal h p oblems among adolescen s a ies be ween 10
and 30%. The mos common diso de s a e dep ession, sub-
s ance abuse, dis u bance o a en ion, and ea ing diso de s.
Emo ional p oblems a e mo e common among gi ls. Boys’
p oblems mani es in ou wa dly dis up i e beha iou [1–8].
Men al heal h is undamen al o he good heal h and
quali y o li e. I is de ined by WHO as a s a e o well-
beinginwhiche e yindi idual ealizeshiso he own
po en ial, can cope wi h he no mal s esses o li e, can wo k
p oduc i elyand ui ully,andisable omakeacon ibu ion
o he o his communi y [9]. Posi i e men al heal h is seen
as a esou ce which is essen ial o gene al well-being. The
p omo ion o men al heal h is a mo e ex ensi e concep han
me ely p e en ing men al heal h p oblems. Men al heal h
p omo ion s i es o ind and enhance ac o s and p ocesses
ha p o ec men al heal h and educe ac o s ha m ul o
i . Men al heal h p omo ion can imp o e people’s su i al
skills and abili y o eel empa hy and, consequen ly, p o ec
hei men al heal h and imp o e hei abili y o suppo o he
membe s o hei communi y wi h men al heal h p oblems.
The p omo ion o men al heal h no only consis s o he
suppo o he men al heal h o indi iduals and p o ision o
men al heal h se ices bu also includes ac i i ies a he com-
muni y and socie y le els [10–14]. Ac ions o p omo e men al
heal h include na ional men al heal h p og ammes, laws and
policies, de elopmen o men ally heal hy communi ies and
physical en i onmen s and p o iding o oppo uni ies o
leisu e ac i i ies [14]. As men al heal h is an in eg al pa o
heal h, men al heal h p omo ion is an in eg al pa o o e all
heal h p omo ion [11].
An en i onmen ha p omo es o hinde s schoolchil-
d en’s men al heal h in ol es he pe son’s en i e men al, phys-
ical, and social en i onmen , especially he school, home,
and iends [15]. The e is e idence o how men al heal h
p omo ion in schools has posi i e e ec s on he age g oup.
Taking in o accoun he whole o he school communi y
especially, en i onmen and he amilies o he pupils as well
as ocusing on posi i e men al heal h and adequa e leng hs
Hindawi Publishing Co po a ion
Nu sing Resea ch and P ac ice
Volume 2014, A icle ID 395286, 10 pages
h p://dx.doi.o g/10.1155/2014/395286
2Nu sing Resea ch and P ac ice
o he ea men s a e ac o s which con ibu e o he success
o men al heal h p omo ion. The e ec s a e pe sonal, social,
and economical [16–20]. P e en ing men al heal h p oblems
and doing men al heal h p omo ion ha e an e ec in one’s
success in school and well-being in li e in gene al. The men al
heal h and beha iou al p oblems o child en and adolescen s
cano enbeseenasdi icul iesinla e phaseso hei li es
[21–25].
Ba y and Jenkins [10]madeano e iewo hee idence
om sys ema ic e iews and se e al men al heal h p omo -
ing p og ammes. They named cha ac e is ics o success ul
school-based in e en ions. These a e high-quali y imple-
men a ion, e alua ion and sus ainabili y and such hings as
adop ing a whole-school and a social compe ence app oach,
pe o ming in e en ions o e mul iple yea s and ha ing
a s ong heo e ical base. Used heo e ical ounda ions a e
mos ly psychology heo ies such like child de elopmen he-
o yo cogni i ebeha iou al he apybu inmanyp og ams
he eisno heo ybasisa all[10,26].
Coope a ion and he pa icipa ion o all communi y
membe s in men al heal h p omo ion ha e been ound o
be signi ican ac o s o he success o planned men al
heal h p og ams [4,10,27,28]. Sel -exp ession and sel -
uling a e key ac o s o well-being; he e o e, jus being
hea d a ec s men al heal h and well-being [27–29]. WHO
Eu opean Minis e ial Con e ence also ocuses in i s Men al
Heal h Decla a ion os e ing awa eness o impo ance o
men al well-being (p io i y 1) and ecognizing knowledge
and expe iences o se ice use s and ca e s ( amily membe ,
iend, o ano he in o mal ca egi e ) as an impo an basis
on planning and de eloping men al heal h se ices (p io i y
5) [30]. Schoolchild en a e he main a ge o men al heal h
p omo ion, which makes hem key elemen s in he discussion
on p omo ing men al heal h a school. The amily plays a key
ole. I is he p ima y, mos impo an , and mos in luen ial
sys em o which he child belongs [31]. Schoolchild en and
hei amilies ep esen se ice use s in his s udy ma e ial.
Despi e hela genumbe o p ojec sand ecommenda-
ions on he p omo ion o schoolchild en’s men al heal h,
he li e a u e does no o e a comp ehensi e heo e ical
desc ip ion o wha men al heal h wo k wi h schoolchild en
is as a whole [10,26]. Ha ing a heo e ical desc ip ion o
men al heal h p omo ion wo k helps in he de elopmen o
acili ies [10,26,28]. A heo y can be cons uc ed by combin-
ing and compa ing he iewpoin s o di e en pa ies— he
employees, he schoolchild en, and hei amilies—as well as
p e ious knowledge o he subjec [32].
This s udy is a pa o a mo e ex ensi e esea ch o p o-
ducea heo yo men alheal hp omo ionin heuppe le elo
comp ehensi e school. In hese schools, pupils’ ages a e om
12 o 16. This s udy aims a desc ibing he concep s e e ing o
he p omo ion o men al heal h om he schoolchild en’s and
hei amilies’ pe spec i e and, consequen ly, acili a ing he
de elopmen o he p ac ices o men al heal h p omo ion. In
his s udy, amilies’ pe spec i e was s udied by in e iewing
mo he s o schoolchild en.
In his s udy, i was in ended o especially highligh
he pe spec i e o he schoolchild en and hei amilies.
The e o e, he analysis was le on he le el o axial coding
o p oduce and desc ibe he concep s. A e ha , i is easie
o de elop p ac ices and suppo hei sel - uling abili y
[32]. Schoolchild en a e he main a ge s o men al heal h
p omo ion, which makes hem key elemen s in he discussion
on p omo ing men al heal h a school. Sel -exp ession and
sel - ule a e key ac o s o well-being; he e o e, jus being
hea d a ec s men al heal h and well-being [27–29].
The pu pose o his s udy was o ind he key aspec s and
equi emen s o p omo ing men al heal h in he way he
pupils and hei amilies see hem. The esea ch ques ion in
his s udy was he ollowing. Wha is men al heal h p omo-
ion om he schoolchild en’s and amilies’ pe spec i e?
2. Ma e ials and Me hods
2.1. Resea ch En i onmen . Thiss udywasconduc edina
Finnish uppe -le el comp ehensi e school wi h 446 pupils in
2005–2007. This is he only uppe -le el comp ehensi e school
in he qui e small ci y whe e he school is loca ed. In Finland,
child en s a he 9-yea comp ehensi e school a he age
o 7. The i s 6 g ades comp ise he p ima y school. These
schools a e usually smalle and close o he pupils’ homes.
The las h ee g ades o comp ehensi e school—a ended
om age o 12 o age o 16—a e usually, and also in his
case, loca ed in a bigge school u he away om he homes
[33]. The school o e s an excellen en i onmen o each he
whole age g oup because o he o e a ching school sys em. In
Finland, almos e e y child (99.7%) comple es he nine-yea -
long basic educa ion [34].
2.2. S udy Ma e ial. This s udy used wo ypes o esea ch
ma e ial. The i s ype consis ed o ma e ial ga he ed om
he in e iews wi h school pupils and hei pa en s. The
pa en s who ag eed o be in e iewed we e all mo he s, bu
hey we e asked o speak om he iewpoin o he whole
amily. The second ype consis ed o he pupils’ w i en eplies
o hewell-beingsu eyconduc edby hei school.The
school well-being p o ile is a ool ha is used o measu e
well-being in school communi ies. I consis s o 80 s uc u ed
ques ions and wo open ques ions. The open ques ions we e
as ollows: “wha is he bes ea u e in you school?” and
“wha hings in you school should especially be imp o ed?”
[35].Becauseposi i emen alheal hisanin eg alpa o
gene al well-being, i was assumed ha s a emen s ega ding
men al heal h could be ound in his s udy’s su ey ma e ial
[12]. In his s udy only he answe s o he open ques ions
we e used as a ma e ial. The esponses o hese wo ques ions
we e inco po a ed in o he o he da a se s and he s a emen s
d awn om hem we e analysed oge he wi h he es o
heda a.The esea che alsow o ememos,whichwe eused
o suppo he analysis [32]. The esea ch was conduc ed in
acco dance wi h uni e sal e hical p inciples [36].
The collec ion o ma e ial was ca ied ou in pa allel
wi h he analysis. A su icien amoun o da a was conside ed
ha ing been collec ed when he analysis no longe esul ed
in s a emen s ha did no i in o he ca ego ies [32]. The
in e iews wi h he schoolchild en and mo he s p oduced 54
pages o ex and he e bal answe s o he school well-being
Nu sing Resea ch and P ac ice 3
p o ile p oduced 436 s a emen s ha we e also added o he
esea ch ma e ial. A o al o 1523 s a emen s we e w i en up
as a esul o he in e iews and he su ey ques ions.
The hemes o he in e iews we e as ollows:
(i) he concep ions o he in e iewees o men al heal h
wo k in gene al and in his school;
(ii) school as a wo king en i onmen ;
(iii) pa icula conce ns, such as bullying and absences, and
ac ions o p e en hem;
(i ) ge ing help in men al heal h p oblem si ua ions; coop-
e a ion be ween he home o he pupil and he school;
( ) coope a ion be ween p ima y heal h ca e, social se -
ices, and special heal h ca e;
( i) he mos c ucial de elopmen needs in men al heal h
p omo ion o schoolchild en.
Twoboys, h eegi ls,and ou mo he spa icipa edin he
in e iews. The in e iews we e conduc ed by he esea che
and hey we e ca ied ou in he school du ing he school day.
The p incipal was awa e o he aims and me hods o he
s udyando he ac ha he ewasaneed o in e ie-
wees who ha e hings o say h ough hei own expe ience
and who ep esen he schoolchild en comp ehensi ely. The
in e iewees we e hus chosen wi h he choosing c i e ia o
quali a i e esea ch in mind [32]. She app oached a g oup o
pa en s and hese ou we e chosen o be he esponden s
due o hei willingness o pa icipa e. P incipal also sen
pe mission o ms and in o ma ion abou he s udy o he
pa en s. Finally, he in o ma ion was signed by he esea che .
The p incipal did no pa icipa e in he in e iew si ua ions.
The c i e ia o selec ing he pupils o be in e iewed we e
ha he pupils ep esen ed di e en g ades and we e o bo h
sexes.
The ela i ely open in e iew hemes helped o see he
wo ld om he pe spec i e o pa icipan s and o de elop
deepe unde s anding o hei iewpoin [32]. In he in e -
iew ma e ial o he pa en s, sa u a ion was achie ed easily,
because he ma e ial was e y ich. Fo he schoolchild en,
i seemed o be easie o p oduce s a emen s anonymously
in he su ey han i was in he in e iew. Wi h he su ey
ma e ial, i was possible o each many schoolchild en and
ge hei opinions on hei school. The open ques ions in he
su ey also p o ided a way o ind aspec s he schoolchild en
hemsel es ound impo an . In an in e iew si ua ion, he
answe s may some imes be in luenced by he in e iew
hemes and ques ions. The su ey was execu ed du ing a
school day. The school nu se handed ou and collec ed he
ques ionnai es. The su ey was di ec ed o all o he pupils
in he school. The school well-being p o ile su ey was
comple edby423ou o 426pupilsp esen inschoolon he
day o he su ey.
2.3. The Me hod: G ounded Theo y. The g ounded heo y
me hod was applied in he da a collec ion and analysis.
G ounded heo y is a sys ema ic me hod o ha pu pose.
I aims a c ea ing a subs an i e heo y, including concep s
and assump ions on he ela ionships among hem [32,37,
38]. G ounded heo y was selec ed because i is analysing
me hod ha akes accoun o people and hei expe iences.
In g ounded heo y, he esea che aims o come close o
he ac o ’s pe spec i e and ies o cap u e his o he iew-
poin [39]. This pe spec i e o schoolchild en and amilies
is needed o unde s and he men al heal h p omo ion in
school. To unde s and expe ience, i mus be loca ed wi hin
he la ge e en s in a social, poli ical, cul u al, e hnic and
gende ela ed, in o ma ional, and echnological amewo k.
These a e essen ial aspec s o g ounded heo y analysis.
G ounded heo y ele a es he e e yday empi ical knowledge
o a concep ual le el. Concep s p o ide ways o alking
abou and a i ing a sha ed unde s anding among p o-
essionals. De eloping knowledge helps o de elop p ac ice
[32,40].
The heo e ical backg ound o he g ounded heo y
me hod lies in symbolic in e ac ionism and p agma ism.
Symbolic in e ac ionism b ings a en ion o human
beha iou and in e ac ion by ocusing on he signi icance o
e en s and hings in people’s e e yday li es. I is use ul o
concep ualising complex si ua ions, unde s anding unsol ed
social p oblems, and unde s anding he impac o new
ideologies. P agma ism assumes ha knowledge is c ea ed
h ough ac ion and in e ac ion [32].
The objec i e o g ounded heo y is o gene a e basic
models as explana ions o social li e in gene al. The da a
a e collec ed om e e yday li e [32,37,41]. The e a e wo
main endencies ega ding he induc i eness o he analysis.
One, he pu ely induc i e me hod ep esen ed by Glase ,
de elops heo y pu ely on he basis o he ma e ial. The o he ,
a ou ed by S auss and applied in his s udy, inspec s he
exis ing heo e ical knowledge and combines i wi h he da a
gained h ough esea ch [32,37,39]. Because o he ela i ely
la genumbe o a iclesabou someaspec so men alheal h
p omo ion a school, i is easonable o examine and use
p e ious a icles abou he p omo ion o schoolchild en’s
men al heal h while p oducing a comp ehensi e heo e ical
desc ip ion. This is why he S auss me hod was selec ed
o his s udy [32,37,39]. The schoolchild en’s and amilies’
pe spec i e ha comes om he ma e ial o his s udy can
be compa ed o he exis ing knowledge and iewpoin s
[37,39].
2.4. E hical Aspec s Rela ed o he Resea ch. The esea ch was
conduc ed in acco dance wi h uni e sal e hical p inciples.
Some poin s should be aken in o accoun when unde -age
esponden sa eusedinas udy.Abo eall,i isimpo an
o acqui e all app op ia e pe missions [36]. In Finland,
esponden s aged 12 o 16 a e conside ed old enough o
pa icipa e in some cases e en wi hou pe mission om hei
pa en s. Such cases a e si ua ions whe e sensi i e ques ions
a eno askedandi isseen ha heques ionsdono con ulse
he youngs e s. Howe e , in his s udy, i was s ill ensu ed
ha he pupils’ pa en s we e awa e o he in e iews and
ga e hei consen . Le e s we e sen o he homes o he
in e iewed pupils o in o m hei pa en s o he in e iews.
Consen o ms we e sen wi h hese le e and he pa en s
we easked ogi e hei child hei consen opa icipa e
in he in e iew by signing he o m. Be o e he in e iew,
4Nu sing Resea ch and P ac ice
all esponden s ga e hei w i en consen o he use o he
in e iew as esea ch ma e ial. The pa icipa ing pupils and
pa en s ecei ed a b ie in oduc ion o he s udy and i s
objec i es. The ques ions we e designed in such a way ha
heobjec i eswe eapp oachedwi has amilia si ua ionsand
concep s as possible. The pupils we e also in o med o he
use o he well-being p o ile esponses in he p omo ion o
men al heal h and well-being a school. The pupils esponded
anonymously [36].
The s udy was endo sed by pe missions om he Join
Municipal Au ho i y o P ima y Heal hca e, he Social
Wel a e Boa d, he Boa d o Educa ion, and also he E hics
Commi ee o he local hospi al dis ic .
2.5. Analysis. G ounded heo y ocuses on concep o ma-
ion. Concep s illus a e he cha ac e is ics o he ca ego ies
hey con ain. They exp ess ime, place, people, and people’s
pa e ns o ac ion [32,42].
Theo e icalsensi i i yisanimpo an issueing ounded
heo y [37]. I means being sensi i e abou wha da a a e
impo an in de eloping he g ounded heo y. The heo y
has o be sensi i e o he da a as disco e ed du ing he
esea ch. Familia i y wi h ele an li e a u e can enhance he
sensi i i y. In his s udy, he esea che also spen a lo o
ime discussing wi h he school pe sonnel o do so. Ge ing
amilia wi h he school con ex and wi h he li e a u e
also enhanced he esea che ’s p eunde s anding abou he
subjec [32,38].
Bo h ma e ials, he ansc ibed in e iew ma e ial and he
w i en answe s o he su ey, we e analysed oge he . Fi s ,
he ex ual ma e ial was ead se e al imes. The analysis began
by open coding. S a emen s he in o man s used o illus a e
men al heal h p omo ion we e picked om he ex [32,38].
Then he esea che analysed he collec ed ma e ial wi h
he cons an compa a i e me hod o iden i y simila i ies
and di e ences be ween he s a emen s. Each s a emen was
compa ed wi h o he s a emen s. The aim was o classi y da a.
The ques ions ha we e used o suppo he ca ego isa ion o
he ma e ial included he ollowing: “wha is happening he e?
Who is doing some hing? Wha does his depic ? Wha is he
consequence o his?” [32,38,40].
The p ocess o g ouping concep s which seem o pe ain
o hesamephenomenaiscalledca ego izing.Asa esul o
he eg ouping and compa ison, all o he s a emen s we e
placed in a ca ego y o s a emen s pe aining o he same
heme and a sha ed concep illus a ing he phenomenon was
iden i ied. Each ca ego y included mo e han 100 s a emen s
[38,40]. Table 1 p esen s an example o how he s a emen s
we e placed in o ca ego ies and subca ego ies and shows he
concep s used o name he ca ego ies.
Da a analysis occu ed simul aneously wi h da a collec-
ion. Du ing he da a collec ion ca ego ies de eloped in e ms
o hei p ope ies and dimensions. The codes p oduced by
he analysis de e mined he di ec ion o he da a collec ion.
Following he p inciple o sa u a ion, he amoun o da a was
conside ed su icien when no new u e ances eme ged om
he da a collec ed bu he same hemes began o ecu [32].
Su icien sampling was de e mined o occu when ca ego ies
o e ed conside able dep h and b ead h o unde s anding
abou he phenomenon and ela ionships o o he ca ego ies
we e clea [32].
In he nex phase, he axial coding, he da a was examined
o iden i y s uc u al ac o s, con ex ual ac o s, and ac o s
ela ed o he phenomenon, ci cums ances, and ac ion [32].
Thisway, he i ekeyconcep swhich hepa en sand he
schoolchild en used in desc ibing he p omo ion o men al
heal h in he uppe -le el comp ehensi e school eme ged [32,
40].
A his s age o he esea ch, i was impo an o highligh
he pe spec i e o he pupils and hei amilies. The e o e, he
analysis was le on he le el o axial coding. On his le el i is
possible o o m causal condi ions, con ex , phenomena, and
ac o s ela ed o ac ion and in e ac ion om he ma e ial.
Finally, he gene a ed concep s we e compa ed wi h he
exis ing esea ch in o ma ion on he opic [32].
3. Resul s: Concep s o Men al Heal h
P omo ion as Desc ibed by he
Schoolchild en and Thei Families
Wi h ega d o men al heal h p omo ion, i e key con-
cep swe edisco e edin hema e ial:“schoolen i onmen ,”
“school iends and eache s,” “coope a ion,” “ac ions o
p omo e well-being and men al heal h,” and “ge ing help
wi h p oblems.” Table 2 shows he key concep s ela ed o
p omo ing men al heal h and p ope ies and desc ibes hem
om he schoolchild en’s and hei pa en s’ pe spec i e.
“School en i onmen ” comp ises he physical condi-
ions and educa ional equipmen in he school—including
esou ces, eaching, ules, and se ices o pupils, such as
school lunch—and hei impac s on he pupils. This concep
also comp ises he equi emen s o he eaching, he lexibil-
i y and indi iduali y o he eaching, and he cha ac e is ics
o he pupils hemsel es.
The pupils had a lo o hough s on he school en i on-
men . They we e pleased wi h he high-quali y eaching ools
and spacious class ooms bu hough ha he ecesses should
o e mo e ac i i y oppo uni ies; jus s anding a ound is no
enough. On he o he hand, he ules go e ning ecess- ime
ac i i ies and school p ac ices a oused di e gen opinions:
some we e agains hese ules and some wan ed hem o be
adhe ed o and con olled mo e ac i ely. Also, he pa en s
conside ed ha he school en i onmen in luences child en’s
well-being and hey had made e o s o imp o e he school
p emises, o example, ia he pa en s’ associa ion.
“Theschoolya dcouldusesomeimp o ing, he e
has been some opinions abou ha . Abou ha
some hing should be done he e he e (sic).”
“Thea mosphe eisgood.”
“Needs o be imp o ed: ules”
Lea ning was conside ed o be a posi i e hing. The pupils
we e happy wi h he idea o op ional subjec s, bu , on he
o he hand, hey wan ed o ha e mo e non heo e ical subjec s
such as physical exe cise, music, and home economics. Also
Nu sing Resea ch and P ac ice 5
Table 1: Example o s a emen classi ica ion.
Concep o co-ope a ion
S a emen s, phenomenon S a emen g oup
The e’s one (pa en s’ mee ing) in he au umn
Gene al communica ion
He e he school makes a ui ion plan, a bookle dis ibu ed o all homes
Rep esen a i es o he police we e he e his au umn o alk abou gene al sa e y
Someone may also ha e alked abou subs ance abuse
We ha en’ had one (a pa en s’ mee ing), a leas du ing he se en h g ade
Eigh -g ade s ha e had some, like, pa en s’ mee ings
The e was one open house day when I was in some class
And I do hink ha hey will be in con ac wi h he pa en s qui e a lo
Child-speci ic con ac s
I hink i ’s wo king well now, he sys em ha we make con ac whene e some hing is oubling us,
bu , su e, he e could be mo e communica ion be ween he school and home
In my opinion i de ini ely needs o be mo e compac
Iwan hings obeso edou s aigh away
I he e’ssome hing o ell, heywill elli ( omschool ohome)
I he pa en s ha en’ in o med he school abou missing classes in ad ance, we mus b ing an explana o y no e o absence
I pe sonally eel ha he school’s con ac s wi h my home ha e been e y poo ,
and I use e-mail, you know
I he e’s some hing hey should know a school, hey will be old.
I I had o wo k ou some hing like ha , I’d make he call
The school and home al eady co-ope a e as such pa ne s in upb inging
Pa ne ship in upb inging
Co-ope a ion be ween he school and home is impo an wi h hese hings, suppo ing and s ee ing and encou aging
The eache body gi es ou he message ha hey a e he e jus o educa e o he s’ child en
Teache ssay ha pa en sdon’ ca e.
he pa en s wished he cu icula o be mo e a ou able o
pupils who a e mo e inclined owa ds a is ic pe o mance
han heo e ical lea ning. The pupils and pa en s wan ed
o add indi idual aspec s and lexibili y o he eaching
and eaching me hods wi h an inc eased deg ee o s uden
pa icipa ion. Indi idualism was conside ed o be a men al
heal h-p omo ing ac o in he o m o p omo ing he sel -
es eem and eelings o success.
“I ’s ha suppo ing o g ow h and inding hose
posi i e capabili ies.”
“Thebes hingin hisschoola e(sic) heelec i es.”
Lea ning di icul ies, andalism, and absences we e u -
he issues associa ed wi h he school en i onmen al hough
o a lesse ex en . In gene al, ac o s ela ed o he pupils’ age
and pe sonal p ope ies we e essen ial in his espec . The
a ailable human and inancial esou ces we e b ough up as
po en ial obs acles o de ec ing and esol ing p oblems.
“Well, he cu a o -si ua ion has been inadequa e.”
“The school nu se is ne e heless always a ailable
e e y day.”
“School iends and eache s”includesocial ela ionships
in school and he whole school communi y. They ha e a g ea
in luence on schoolchild en’s well-being. Bo h he child en
and he pa en s ound he eache ’s ole e y impo an .
F iends we e also conside ed o be impo an and o make
heschool eellikeacom o ableplace.B eakingupg oupso
iends when ans e ing om p ima y school o he uppe -
le el comp ehensi e school is an issue ha a oused much
hough , especially in he ans e phase. Sa e y in he school
communi y was also conside ed impo an .
“I hink i ’s ha he eache s ea he pupils
equally.”
“Nice school iends”
The pa en s placed high expec a ions on he class eache .
The class eache was expec ed o no ice pupils’ needs o
suppo and espond o hem. The pupils o en complimen ed
hei eache s as being nice, skilled, and good eache s.
Howe e , he e we e also commen s abou oo high demands
and dic a o -like and un ai beha iou .
“Teache s ha e he expe ise o see in my opinion.”
“I wished emedial educa ion o my son in some
o he subjec s and he eache did ca y my wish
o wa d hen.”
“And he eache sa equi enice.”
Co-ope a ion and communica ion be ween pa en s and
employees we e hings ha he pa en s pa icula ly expec ed.
This concep also includes coope a ion be ween employees
and be ween child en and adul s and su icien amoun
o in o ma ion. The pa en s expec ed close coope a ion,
especially wi h he class eache . The pa en s conside ed ha
hei ask is o ake an in e es in he child’s li e, moni o
he child’s heal h and mo i a ion, and ensu e su icien es
and nu i ion. Child upb inging was seen as a join p ojec in
which pa en s and eache s unc ion as pa ne s, bo h elying
on hei own expe ise; pa en s know he child’s pe sonali y

6Nu sing Resea ch and P ac ice
Table 2: Key concep s and hei con en .
School en i onmen School iends and
eache s Coope a ion
Ac ions o p omo e
well-being and men al
heal h
Ge ing help wi h p oblems
Teaching, subjec s
(i) Quali y o eaching
(ii) Fas pace o eaching
(iii) Indi iduali y in eaching
(i ) Encou aging
( ) Wo kload
( i) Possibili ies o pa icipa e
Physical school p emises/ esou ces
(i) Cosiness and cleanliness
(ii) Lunch p emises
(iii) Ven ila ion and hea ing
School schedules
(i) Leng h o school days
(ii) F ee pe iods, lunch pe iods, and
b eaks
(iii) Time o s a ing school in he
mo ning
Food
(i) Do pupils like he ood?
(ii) Signi icance o he lunch b eak and
lunch i sel
(iii) Possibili y o buy snacks and snack
quali y
School ules
(i) Fai ness
(ii) Con ol
(iii) Sa e y
Resou ces
(i) Coope a ion be ween au ho i ies
(ii) Human esou ces and di e en
p o essions a school
(iii) Tu o ing
(i ) School nu se and pupil wel a e
g oup
( ) Time esou ces
( i) Financial esou ces
Pupils’ si ua ion in li e
(i) Age, p ope ies, and capabili ies
(ii) T ansi ion o he uppe -le el
comp ehensi e school
(iii) Heal h
(i ) Lea ning di icul ies
( ) Bullying
Teache s
(i) Teaching skills
(ii) Fai ness
(iii) Demands se o
pupils
(i ) Being nice/bo ing
( ) Subjec eache s
( i) P incipal’s
impo an ole
Class eache
(i) Will he/she emain
dis an i he/she does no
each he class?
(ii) Class eache ’s classes
(iii) Teache s’ men al
s eng h and ime
esou ces
(i ) Conside ed
impo an
( ) Will hey in e ene
in p oblem si ua ions?
F iends
(i) F om he
neighbo hood
(ii) F om hobbies
(ii) F om school
(i ) Class spi i
( ) Nice, good, and
elaxed
( i) Class g oup and
communi y
( ii) Enjoying being
oge he
( iii) Can you be
you sel ?
(ix) Sa e y
(x) B eaking up classes
when ans e ing o
uppe -le el school is sad
Gene al coope a ion be ween home and
school
(i) Communica ion
(ii) Open house e en s
(iii) Pa en s’ mee ings
(i ) Bulle in on school ma e s
( ) Visi o s, o example, om he police
Child-speci ic coope a ion
(i) Discussions wi h class eache
(ii) Recip oci y desi able
(iii) E-mail and elephone
(i ) Up- o-da e in o ma ion
( ) Things a e so ed ou as soon as hey
appea
( i) In he mos se ious cases he school
con ac s he home
( ii) Could be mo e, ee- o m
( iii) Con ac home when he e a e
p oblems
(ix) Discussion ace o ace
Expe iences o coope a ion
(i) Insecu i y abou making he con ac
(ii) Di icul y o each
(iii) The school canno con ac pa en s
wi h e e y issue
(i ) Being hea d/ge ing opinions c ashed
( ) Expec a ions do no always mee
( i) Does he con ac en ail ques ioning
he o he ’s ac i i ies?
Pa ne ship in upb inging
(i) Mu ual pa ne ship
(ii) Coope a ion in suppo ing and
encou aging
(iii) Di e ences o opinion a e so ed ou
(i ) Do he eache s eel ha oo much
esponsibili y alls on hem?
Coope a ion be ween pa en s
(i) The pa en s’ associa ion is a channel o
in luence and gain in o ma ion
(ii) Do he pa en s know each o he ?
(iii) Exchanging hough s
(i ) Ac i eness o pa en s
( ) Fund- aising e en s
Pupils’ ac ions
(i) In luencing he
ci cums ances h ough he
pupils’ union
(ii) Hobbies
Pa en s’ associa ion
ac ions
(i) To enhance he cosiness
o p emises
(ii) Financial suppo
(iii) Social skills
(i ) Suppo o well-being
( ) Suppo o pa en hood
Teache s’ ac ions
(i) In o ma ion abou
men al heal h; heal h
in o ma ion lessons and
heal h educa ion
(ii) Lis ening and aking
indi iduali y in o accoun
(iii) Lis ening o pupils’
sugges ions
(i ) Including he pupils in
enhancing cosiness
( ) Including he pupils in
decision making
( i) Taking he school
ansi ion in o accoun ,
ge ing o know each o he ,
and “coaching”
( ii) In o ma ion o pa en s
( iii) Equali y
No much in o ma ion on
p omo ing men al heal h
(i) Especially sca ce
in o ma ion o cases whe e
he e a e no p oblems
Desi ed
A mosphe e su eys,
equali y
No icing
(i) Can you see a pupil’s p oblems
i you do no each him/he ?
(ii) Dis up i e beha io is easy o
de ec du ing eaching
(iii) The quie ones o en go
unno iced
(i ) Youngs e s do no ell hei
pa en s e e y hing
( ) Home li e is busy, hobbies,
and so o h.
( i) I may be ha no one no ices
he p oblems
Seeking and ge ing help
(i) The h eshold o seeking help
(ii) P e en lessons
(iii) Help is a ailable
(i ) Re e al o u he ins ances
( ) The school nu se is easy o
app oach
( i) The pupil’s own ini ia i e
( ii) Ea ly in e en ion is
impo an
( iii) Teache no ices when
eaching is dis u bed
(ix) Pupil seeks help him/he sel
(x) Goes o alk
(xi) Help is o e ed
(xii) Slow in e en ion
Expe iences
(i) Examina ion o symp oms
was no a ailable in ime
(ii) Pa en s demand
(iii) Join mee ings
Imp o emen sugges ions
(i) Add essing bullying
(ii) Help should be o e ed
au oma ically in isk cases
Nu sing Resea ch and P ac ice 7
and backg ound, whe eas eache s a e compe en a issues
ela ed o lea ning.
“I (a mo he ) mysel y o look a e es ing, bed-
imes.”
“Pa en s a e no p o essionals o educa ion.”
Acco ding o he pupils, con ac s be ween hei homes
and he school we e sca ce, bu hey belie ed ha in o ma ion
will be elayed whene e necessa y. The pa en s said ha
hey ge in o ma ion on he school wo k om bulle ins and
pa en s’ mee ings. One speci ic channel o in o ma ion is
he pa en s’ associa ion which ga he s in o ma ion on he
school and ies o con ibu e o he school en i onmen ’s
de elopmen by, o example, a anging und- aising e en s.
“The e’s no much con ac ing om home, bu
he school, howe e , con ac s e en o smalle
ma e s.”
“When i ’s needed, e e y hing is old. Like, when
some hing comes up ha needs o be old, he
school is in o med o i .”
“Ac ions o p omo e well-being and men al heal h”a e
ela ed o ha ing an e ec on enhancing he school’s condi-
ions and social en i onmen . When alking abou he ac o s
ha in luence men al heal h, bo h he pa en s and he pupils
men ioned iendship and s ess. Fu he mo e, he pa en s
belie ed ha lea ning expe iences in luence adolescen ’s sel -
con idence and, consequen ly, men al heal h. The esul s indi-
ca ed ha he school had paid a en ion o he de elopmen
o iendships and communi y spi i , as well as p epa ing o
o he changes ela ed o he ansi ion om lowe -le el o
uppe -le el comp ehensi e school.
“In sp ing, hey ( he new s uden s ge ing o know
hei u u e school) al eady isi ed his place mo e
han once. And hen hey had hei u u e class
oge he and hey, like, al eady go o know each
o he .”
Wi h ega d o well-being and eeling well in gene al,
he e was a lo o discussion ela ed o he abo e-men ioned
school en i onmen ac o s, esou ces, and social ela ion-
ships. Ensu ing a sensible ea ing ou ine and a su icien
amoun o sleep, imp o ing he sa e y and cosiness o he
school en i onmen , ai ea men and possibili ies o in lu-
ence school ma e s we e b ough up as a ge s o ac ion.
Acco ding o he s a emen s, hese hings can be in luenced
by hepa en sand hepupils, o example, ia hepupils’
council.
“Well hisisp e ygood,youknow,because he e
is a well a anged pupils’ council in he e. I has
imp o ed he cosiness.”
The pupils said hey had ecei ed some in o ma ion
abou men al heal h- ela ed issues om hei eache s. Heal h
educa ion lessons we e men ioned as one channel in lea ning
o ake ca e o you well-being. The pa en s s a ed ha hey
go in o ma ion abou he school’s p ac ices and se ices in
pa en s’ mee ings.
“In pa en s’ mee ings, i ’s old how hey do ac
in hese si ua ions which, o example, conce n
bullying.”
“Ge ing help wi h p oblems” includes skills o no ice
men al heal h p oblems and possibili ies o ge p ope and
imely help. The esponden s had a li le knowledge o
ins ances ha o e ac ual men al heal h ca e se ices. The
school heal h ca e was seen as he p ima y ins ance o con ac
such ma e s and i was conside ed o be easy o access. Some
esponden s we e awa e o he exis ence o he pupil wel a e
g oup bu no o i s ac i i ies o membe s. The esponden s
belie ed ha he main esponsibili y o seeking help was
wi h he indi idual conce ned. They did no belie e ha
he chances o de ec ing p oblems we e g ea , especially
wi h quie , socially wi hd awn pupils. The esponden s’ iews
on men al heal h wo k we e mainly based on expe ienced
p oblem si ua ions, such as p oblems and nega i e eelings
ela ed o lea ning di icul ies and expe iences o o e ing
help in s ess ul si ua ions. Coope a ion and communica ion
be ween he home and he school we e conside ed impo -
an and p e e able ac o s wi h ega d o men al heal h
p oblems.
“Well, we ha e a school nu se who’s spezialised
(sic)inmen alheal h.Yeah,like,Iwasimmedi-
a elyaskedwhe he Iwouldlike ogo he e o alk
o him/he because I wo y a lo abou he exams.”
“Well, in my opinion, i wo ks well now ha
people con ac each o he immedia ely. Like, he
o m eache con ac s he pa en s when he e’s
some hing ha ’s puzzling him o he , and he
pa en s do he same i hey a e puzzled.”
4. Discussion
4.1. Resea ch Resul s in Ligh o P e ious Resea ch In o ma ion.
In g ounded heo y, p e ious li e a u e is used o suppo
and o alida e he indings[38]. The ounded li e a u e did
no p o ide a comp ehensi e desc ip ion o men al heal h
p omo ion in school, bu he e was a good amoun o s udies
and a icles ela ed o he indi idual ca ego ies. P e ious
s udies we e sea ched wi h such e ms as “men al heal h
p omo ion” and “school,” “child en,” o “adolescen s” in
se e al da abases. Se e al s udies a gued abou he same kind
o aspec s being impo an as hese s udy esul s did. This
suppo s he conclusion ha concep s disco e ed om s udy
ma e iala eac ually hings ha a eessen ialinp omo ing
men al heal h. “School en i onmen ” and “school iends
and eache s” especially we e men ioned in many s udies.
Ba y and Jenkins [10], Konu e al. [29], Konu and Lin onen
[35],andGoodmane al.[43]w o eabou heimpo ance
o de eloping an en i onmen ha suppo s he well-being
o he pupils. In hei s udies on men al heal h p omo ion
p ojec s and e iews he eo , hey ound s ong e idence
o he social compe ence app oach, which b ings ocus on
he p omo ion o esou ce ulness and gene ic coping and
compe ence skills.
8Nu sing Resea ch and P ac ice
Also “coope a ion” was ea u ed in he li e a u e. Bickham
e al. [31] see he amily as a signi ican ac o in child en’s se -
ices. Hopia e al. [44] ound amily in ol emen impo an
when child en we e ill. Family membe s should help he nu s-
ing s a o gain a clea e pic u e o he dep h and he di e si y
o he amily heal h and suppo he esou ces ha p omo e
amily heal h. Coope a ion in men al heal h p ojec s is also
a key elemen in Poole’s [45]p ojec onp e en i emen al
heal h wo k, in which amilies, schools, municipali ies, and
au ho i ies wo ked in ex ensi e coope a ion o de elop a
model o pa ne ship be ween he school and he amilies.
Adelman and Taylo [46,47]named hecollabo a i e
wo k o school s a , heal h p o essionals, and he com-
muni y esou ces as one e y impo an pa o success ul
men al heal h p omo ion wo k in hei e iews o school
men al heal h p omo ion. Acco ding o Deschesnes e al.
[48] coope a ion be ween he amily, school, and communi y
was a signi ican ac o in he p omo ion o schoolchild en’s
men al heal h. In his s udy i was no ed ha he coope a ion
encompasses bo h pupils and hei amilies. This is why i was
impo an o include he adolescen s’ and amilies’ iewpoin .
“Ac ions o p omo e men al heal h” in school ise om
hose impo an ac o s. The in luence o he en i e social
school en i onmen , including he eache s and hei majo
ole, is s a ed in he esul s and enhancing hese elemen s
is seen impo an in many s udies [10,29,35,43]. Ba y
and Jenkins [10]w o eabou hesigni icanceo socialand
p oblem-sol ing skills o well-being. In he ligh o Ba y’s
[10] esul s,i iseasy ounde s andhowimpo an ole he
schoolchild en and hei pa en s gi e o human ela ions and
co-ope a ion.
The esul s o “ge ing help wi h p oblems” especially
e lec he iewpoin s o he pupils and hei amilies. In
p e ious s udies his aspec could no be di ec ly seen.
Anyway, p e ious esul s o co-ope a ion [31,44,45,48],
men al heal h and social skills aining [10]andbeinghea d
[49,50] a e hings ha also suppo his inding.
The impo ance o being hea d and possibili ies o ha e
in luence in one’s own school ma e s can be seen in he
esul so hiss udy.So sae al.[49]w o ein hei s udyon
child en’s iewpoin s on child psychia ic ca e ha ela ion-
ships wi h o he child en seem o be o ex eme impo ance.
Acco ding o The UNICEF’s Con en ion on he Righ s o he
Child [50], child en ha e a igh o exp ess hei opinions
and oha e hei iews akense iouslyandgi endueweigh .
Child en also ha e a esponsibili y o espec he igh s o
o he s, especially hose o hei pa en s. The con en ion
e e s o he amily as he undamen al g oup o socie y and
he na u al en i onmen o he g ow h and well-being o
child en [50].
4.2. Reliabili y o he Resea ch. In quali a i e esea ch, alidi y
and eliabili y a e no add essed in he same way as in
quan i a i e esea ch. Da a gene a ed using he g ounded
heo y me hod can be assessed in e ms o c edibili y,
con o mabili y, and u h alue [38,40].
The iews and opinions o he pa en s and youngs e s,
on which ma e s a e impo an , can be conside ed c edible.
This s udy ea u es in e iews wi h ou youngs e s and
a su ey among a la ge g oup o schoolchild en on hei
opinions o hei school. The ma e ial om he in e iews
wi h pa en s was ich and e sa ile and desc ibed he pa en s’
hough s on hei child en’s schooling om a ious angles.
Combining se e al ypes o da a p o ed o be a help ul way
o ind mo e in o ma ion and a iche desc ip ion abou he
s udied phenomenon. Fo example, using he open ques-
ions om he su ey supplemen ed he in e iew ma e ial
ema kably.
As he ma e ial collec ion p oceeded, ce ain s a emen s
became mo e equen , which means ha he ma e ial i sel
can be conside ed in o de o con i m i s own c edibili y.
Fu he mo e, simila s a emen s we e ound in di e en
ma e ials. The schoolchild en’s iews on men al heal h p o-
mo ion we e clea ly isible [32].
The imp ession o he p omo ion o schoolchild en’s
men al heal h gained om he ma e ial p o ides a e sa ile
insigh in o he youngs e s’ and pa en s’ iewpoin s om
a ious angles. This was also he pu pose o his esea ch.
A pa icula objec i e o his s udy was o b ing ou human
expe iences, which was well achie ed wi h he in e iew
ma e ial. The schoolchild en’s iews on men al heal h p omo-
ion we e clea ly isible [32,40].
4.3. Limi a ions. A subs an i e heo y p oduced by g ounded
heo ycanbesaid obe alidonly o hes udiedpopula ion.
One conce n is whe he he mo he s’ iewpoin s can be
ex apola ed o he gene al amily, e en hough hey we e
old o ep esen he whole amily. No a he s ag eed o
be in e iewed, bu mo he s we e asked o speak om he
iewpoin o he whole amily. A leas hei iewpoin can be
seen o be a ema kable pa o amily iewpoin s. Howe e ,
a quali y heo y will ine i ably iden i y a basic p ocess ha is
also ele an mo e gene ally [40].
De ails ela ed o he school’s p ac ices and human
esou ces a y be ween schools and coun ies, which is
why de ailed p ac ices, such as g oup- o ma ion on an-
si ion o he uppe -le el school, canno be gene alised
in o a desc ip ion o men al heal h p omo ion p ac ices in
schoolsasawhole.Ins ead, hep ocesso collec ingand
analysing he pupils’ iewpoin s used in his s udy, as well
as he ounded key aspec s o men al heal h p omo ion in
school, can be conside ed o apply o a wide con ex and
in e na ionally.
5. Conclusions
G ounded heo y p o ed o be an e ec i e mean o elici ing
people’s pe sonal iewpoin s. When heo y is de eloped
om he pe sonal desc ip ions o he ac o s and he objec s
o ac ion, i is easily ansla able in o a de elopmen ool.
Pupils and hei amilies a e he key a ge s o men al heal h
p omo ion wo k in schools and b inging up hei iewpoin s
is impo an and o ms a signi ican esea ch esul . The
ounded iewpoin s help he school pe sonnel de elop hei
wo k and selec he ocus a eas o de elopmen , e en in
schools wi h di e en human esou ces and p ac ices [10,26,
51].
Nu sing Resea ch and P ac ice 9
6. Recommenda ions o
P ac ice and Resea ch
Schools a e one o he mos impo an se ings o p omo -
ing men al heal h o young people. Acco ding o p e ious
li e a u e, he e m “men al heal h” is o en misunde s ood
andmisused.E enp o essionalsmigh onlyusei when
discussing men al diso de s. In eali y, men al heal h is a
b oad concep which conce ns e e yone in socie y. Pupils and
pa en s, as well, need knowledge o men al heal h p omo ion
andp oblemsol inginschool.Thiss udy,bygi ingnames
and con en s o di e en ields o men al heal h p omo ion,
helps he whole school communi y o ind key de elopmen
a eas. Communi ies and amilies should be included in he
de elopmen o se ices. This should lead o se ices being
be e ailo ed o people’s needs and be e used.
The esul s indica e ha he pupils ind eaching and
eache s o be e y impo an ac o s a school. Wi h hese
ac o s in mind, i is impo an o pay a en ion o he
oppo uni ies o inc ease lexibili y and indi iduali y. Finding
compe en eache s would also make he school wo k seem
mo e wo hwhile o he pupils.
Founded li e a u e highligh s he signi icance o heo y-
based p e en i e ac i i ies in hei s udy. The school s a
needs guidance in men al heal h p omo ion and heo y-
based means o he p ac ical implemen a ion he eo . I
is o en he case ha he ope a o s a e no awa e o he
unde lying heo y behind de elopmen p og ammes, which
makes he p ac ical applica ion mo e di icul . Th ough he
pe spec i es o di e en ac o s, i is easie o ind an unde -
s andable and p ac ical desc ip ion o he ac ion. Wi h he
help o he p oduced concep s, he men al heal h p omo ion
o schoolchild en can hus be obse ed and p omo ed, which
is he cen al bene i o his s udy.
Howe e , co-ope a ion be ween he amilies and he
school s a , as well as inc easing he pupils’ possibili ies o
in luence, could help in his espec as well. The whole school
communi y mus be aken in o conside a ion. Combining
iewpoin s o child en, amilies, and p o essionals and hen
discussing and de eloping men al heal h p omo ion ac i i ies
in coope a ion would no only inc ease awa eness bu also
enable de elopmen ha akes all iewpoin s in o accoun .
The nex phase o he esea ch is o combine hese
di e en iewpoin s in o a subs an i e heo y on men al
heal h p omo ion in school. A e his, he co e ca ego y
canbe o med[32,38]. The heo y which will be buil will
help he whole school communi y o de elop men al heal h
p omo ing wo k by gi ing a amewo k and helping o ind
key de elopmen a eas.
Con lic o In e es s
The au ho s decla e ha he e is no con lic o in e es s
ega ding he publica ion o his pape .
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