Mental health promotion in school: Schoolchildren's and families' viewpoint

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 . Re e ences [1] J. Hoo man, G. M. Houck, and M. C. King, “Inc eased men al heal h needs and new oles in school communi ies,” Jou nal o Child and Adolescen Psychia ic Nu sing, ol.16,no.3,pp.93– 101, 2003. [2] P. P¨ ossel, A. B. Ho n, G. G oen, and M. Hau zinge , “School- based p e en ion o dep essi e symp oms in adolescen s: a 6- mon h ollow-up,” Jou nal o he Ame ican Academy o Child and Adolescen Psychia y, ol.43,no.8,pp.1003–1010,2004. [3] J. A. Rønning, B. H. Handegaa d, A. Sou ande , and W.-T. 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