Publications

Authors:

Inmaculada C. Rodríguez-Rojo, Associate professor of nursing and Director of health promotion and emotional wellbeing, University of Alcalá (Spain)

Raquel Luengo-González, Associate professor of nursing, University of Alcalá (Spain)

Montserrat García-Sastre, Assistant professor of nursing, University of Alcalá (Spain)

Carlos Alberto da Cruz-Sequeira, Full professor of nursing, University of Porto (Portugal)

Ana Ventosa-Ruiz, Lecturer in nursing, University of Barcelona (Spain)

Sara Sanchez Balcells, Lecturer in nursing, University of Barcelona (Spain)

Jaisalmer de Frutos-Lucas, Policy manager, European Public Health Alliance (Belgium)

Europe has made mental health a priority. The next step is building it

Adolescent mental health has rightly become one of Europe’s most pressing public health priorities. The increasing prevalence of anxiety, emotional distress and other mental health difficulties among young people has driven important policy initiatives across health and education sectors. The World Health Organisation and the European Commission – A Comprehensive Approach to Mental Health both recognise that promoting mental wellbeing during adolescence is essential for healthier, more equitable societies.

However, most current policies and school-based initiatives still share a common limitation: they focus primarily on identifying problems, managing symptoms and referring young people to specialist services. These actions are essential, but they largely begin once vulnerability has already emerged, and by then, the opportunity to build resilience has already passed.

If Europe wants to reduce the future burden of mental health problems, it must invest not only in preventing the onset of mental health conditions, but also in systematically building Positive Mental Health (PMH) from an early age.

Positive Mental Health is more than the absence of mental illness

Mental health is often defined by what is missing or around deficit: depression, anxiety, behavioral disorders or psychological distress.

PMH invites us to ask a different question: What enables young people to thrive? In this sense, PMH encompasses emotional regulation, resilience, autonomy, problem-solving, positive relationships, self-confidence and the capacity to adapt successfully to life’s challenges. Crucially, these are not fixed personality traits; they are competencies that develop through experience, supportive relationships and well-designed learning environments, which means they can be intentionally cultivated.

This strengths-based perspective is increasingly reflected in European public health thinking, which calls for measuring and promoting wellbeing, not merely monitoring illness. Recent European initiatives, including the OECD Well-being Framework and the EPHA Building Better Indicators for Mental Health and Wellbeing report, argue that improving population mental health requires complementing illness indicators with measures that capture wellbeing, resilience and PMH. In the same vein, the EPHA’s open letter Shifting the Focus: A Case for a Positive Mental Health Framework in Europe, states that European Union has an opportunity and a responsibility to lead this paradigm shift. Schools are a natural starting point.

Why schools matter

Schools are one of the few settings capable of reaching virtually every adolescent, regardless of socioeconomic background, cultural identity or previous mental health status. This universal reach makes them uniquely positioned to reduce inequalities while avoiding the stigma often associated with targeted clinical interventions.

This does not mean turning schools into mental health services, expecting teachers to act as therapists. Their role is different, but equally valuable.

Schools can create environments that strengthen emotional wellbeing, foster supportive relationships and help students develop the psychological resources that protect them throughout life. Embedding these competencies into everyday classroom practice is likely to have a greater population impact than relying exclusively on referral pathways after difficulties have already emerged. This approach also aligns with the growing recognition, highlighted by UNESCO and UNICEF’s global initiatives on child and adolescent mental health that schools, families and health systems must work together to strengthen the social determinants of mental wellbeing.

From evidence generation to real-world implementation

Across Spain and Portugal, our research teams have contributed to this field from complementary perspectives.

Researchers at the University of Barcelona have played a leading role in the conceptual development of PMH and its translation into nursing practice and community health promotion over more than two decades, building the theoretical foundations that now underpin much of the field.

The University of Porto has generated internationally recognized evidence on Mental Health Literacy and PMH measurement, developing and validating instruments that allow reliable assessment across populations and cultural contexts.

At the University of Alcalá, research has focused on understanding how psychosocial and lifestyle factors shape adolescent wellbeing, exploring mechanisms that influence PMH, and translating this knowledge into feasible school-based interventions.

What this collective experience makes clear is that the evidence base is strong, but implementation remains the central challenge. Teachers are willing to contribute to students’ wellbeing, but many report lacking practical tools, structured training and institutional support. Improving Mental Health Literacy is an essential first step, yet sustainable change requires implementation strategies that fit the realities of everyday educational practice.

This highlights an important evolution for European research. Alongside demonstrating whether interventions work, we must also understand how they can be implemented, scaled, adapted and sustained across diverse educational systems, languages, curricula and resource environments.

What should Europe do next?

The evidence increasingly points in the same direction, and the policy moment is right.

Europe should move beyond an illness-centered approach and adopt PMH as a complementary pillar of education and public health policy. This means:

• • • Embedding PMH into education policies, recognizing wellbeing promotion as a universal educational objective, not as an add-on or a response crisis, but as a core component of educational excellence and student development.
    • Strengthening teachers’ capacity through evidence-based Mental Health Literacy training, practical resources and ongoing implementation support. Teachers cannot be expected to act without the tools and knowledge to do so effectively.
    • Measuring PMH alongside mental illness indicators, allowing policies to capture both risk and wellbeing, and generate the harmonized and disaggregated data needed to take evidence-based action.
    • Investing in implementation science, ensuring that effective interventions can be adapted, sustained and scaled across different educational systems.
    • Promoting cross-sectoral collaboration between education, health and public health sectors, recognizing that adolescent wellbeing is a shared societal responsibility.

A healthier Europe starts in the classroom

Europe has already demonstrated its commitment to improving adolescent mental health. The next challenge is not simply to respond earlier when problems appear. It is to create the conditions in which more young people can flourish before those problems arise.

PMH should therefore be recognized not as an optional addition to existing mental health strategies, but as one of their foundations.

Building PMH is not solely an educational responsibility; it is a public health investment that will shape the wellbeing, resilience and social participation of Europe’s next generation. The classroom is where that investment begins.