n Empirische Arbeit Psychologie in Erziehung und Unterricht, 2023, 70, 293 -302 DOI 10.2378/ peu2023.art18d © Ernst Reinhardt Verlag Exploring teachers’ mental health literacy: An exploratory study on teachers’ experiences, cooperation partners, self-efficacy, and knowledge related to students’ mental health problems Franziska Greiner 1 , Poldi Kuhl 2 1 Universität Leipzig 2 Leuphana Universität Lüneburg Summary: In Germany, every fourth child and adolescent suffers from a mental disorder during their time at school. Due to the significant amount of time that students and teachers spend together, teachers play an important role in protecting and maintaining students’ mental health. Despite the importance of teachers for students’ well-being, research on teachers’ competencies in dealing with students’ mental health problems (MHP), and their mental health literacy (T-MHL), remains scarce. We addressed this research gap by providing insights into teachers’ experiences, cooperation, selfefficacy beliefs, and knowledge related to students’ MHP. All 70 surveyed teachers stated that they had experienced various mental disorders. Most of the teachers felt supported by their colleagues and school principals when dealing with students with mental disorders. The majority also stated that they knew who to contact in school if they needed support, and more than one-third indicated that they did not know which external school support systems they could contact. Moreover, participants reported cooperating most frequently with school support staff and social workers, while cooperation with the youth welfare office and school psychologists was rare. Considering the different facets of T-MHL, teachers felt highly self-efficacious in perceiving physical, emotional, and behavioral changes in students and moderately self-efficacious in dealing with students. Moreover, teachers moderately rated their action-related knowledge of the MHP indicators. The results showed that recognizing the indications for MHP was not statistically related to dealing with them. This exploratory study contributes to empirical investigations of T-MHL. The findings are discussed in relation to teacher professionalization. Keywords: Teacher education, mental health literacy, self-efficacy, knowledge, mental health problems Mental Health Literacy von Lehrkräften: Eine explorative Studie zu Erfahrungen, Kooperationen sowie Selbstwirksamkeit und Wissen von Lehrkräften im Zusammenhang mit psychischen Belastungen von Schüler: innen Zusammenfassung: In Deutschland leidet jede: r vierte Schüler: in an einer psychischen Störung. Da Schüler: innen und Lehrkräfte sehr viel Zeit miteinander verbringen, spielen Lehrkräfte eine wichtige Rolle hinsichtlich der Prävention und Förderung der psychischen Gesundheit ihrer Schüler: innen. Dennoch gibt es nur wenige Forschungsarbeiten zu den Kompetenzen der Lehrkräfte im Umgang mit psychischen Belastungen von Schüler: innen, der sog. Mental Health Literacy (T-MHL). Wir knüpfen an diese Forschungslücke mit dem Ziel an, einen Einblick in die Erfahrungen, die schulinternen und -externen Kooperationen, die Selbstwirksamkeitsüberzeugungen und das Wissen der Lehrkräfte in Bezug auf psychische Belastungen von Schüler: innen zu geben. 294 Franziska Greiner, Poldi Kuhl 1. Introduction Schools not only provide education but are also crucial for health promotion and prevention (KMK, 2012). When focusing on mental health, a distinction can be made between mental disorders, that is, clinical diagnoses, and mental health problems, which can be seen as subclinical precursors. This differentiation is particularly relevant for the educational context, as teachers are often confronted with mental health problems that are not necessarily directly linked to a diagnosis of a mental disorder. Schools play a pivotal role in the prevention of mental disorders, and mental health problems are particularly important in this context. Moreover, school age represents an important period to take a closer look at mental health, as approximately 75 % of all mental disorders have their onset in childhood or are first detected before the age of 14 years (Solmi et al., 2022). In Germany, every fourth school-age child and adolescent suffers from a mental disorder during school (Greiner et al., 2019). Viewed globally, Germany is a country with high numbers of children and adolescents suffering from mental health problems (Kieling et al., 2011). Moreover, children and adolescents were particularly vulnerable to the COVID-19 pandemic; they showed an increase in psychosomatic symptoms such as sleeping problems, headache, stomach pain, and feeling low. During the pandemic, the risk of mental health problems almost doubled (Ravens-Sieberer et al., 2021). Without adequate treatment, students with mental disorders face higher risks of school absenteeism, school dropout, delinquency, substance abuse, and suicide (Farrell & Barret, 2007; Moon et al., 2017; O’Neil et al., 2011). Moreover, students with mental disorders are less preferred as friends (Pérez-Parreño & Padilla- Petry, 2018); therefore, they were also more likely to be socially less included in their class. The fact that few children and adolescents with mental disorders receive psychotherapeutic treatment (Hintzpeter et al., 2014; Mulraney et al., 2020) needs to be considered seriously, as mental illness in childhood and adolescence, regardless of the diagnosis, significantly increases the risk of developing mental illness in adulthood (Castagnini et al., 2016). Research on mental illnesses in adulthood has shown that affected people are burdened with stigma, Alle 70 befragten Lehrkräfte gaben an, dass sie bereits Erfahrungen mit verschiedenen psychischen Störungen gemacht haben. Die meisten Lehrkräfte fühlen sich im Umgang mit Schüler: innen mit psychischen Störungen von ihren Kolleg: innen und der Schulleitung unterstützt. Die Mehrheit gab an zu wissen, an wen sie sich in der Schule wenden können, wenn sie Unterstützung bräuchten. Hingegen berichtete mehr als ein Drittel, nicht zu wissen, welche externen Unterstützungssysteme genutzt werden könnten. Darüber hinaus gaben die Lehrkräfte an, dass sie am häufigsten mit Schulbegleiter: innen und Sozialarbeiter: innen zusammenarbeiten, während Schulpsycholog: innen und das Jugendamt nur sehr selten als Kooperationspartner: innen benannt wurden. Die Lehrkräfte fühlen sich tendenziell selbstwirksam in Bezug auf die Wahrnehmung körperlicher, emotionaler und verhaltensbezogener Veränderungen bei Schüler: innen. Mäßig selbstwirksam sind sie bzgl. des Umgangs mit psychisch belasteten Schüler: innen. Auch das handlungsbezogene Wissen über psychische Belastungen schätzen sie im Durchschnitt als mäßig ein. Es zeigt sich, dass das Erkennen von Hinweisen auf psychische Belastungen und der Umgang mit diesen nicht signifikant zusammenhängen. Die explorative Studie leistet einen wichtigen Beitrag zur empirischen Beleuchtung von T-MHL. Die Ergebnisse werden in Bezug auf die Professionalisierung von Lehrkräften diskutiert. Schlüsselbegriffe: Lehrkräfteprofessionalisierung, Mental Health Literacy, Selbstwirksamkeit, Wissen, psychische Belastungen Explorative Studie zur Mental Health Literacy von Lehrkräften 295 discrimination, and social exclusion (Corrigan et al., 2004; Hall et al., 2019; Stuart, 2006). This, in turn, can lead to poor well-being and self-esteem as well as less help-seeking and access to healthcare, which impedes recovery (Clement et al., 2015; Link et al., 2001). In summary, mental disorders not only affect students’ well-being but also hinder social inclusion in childhood, adolescence, and adulthood. 2. The role of teachers in student mental health According to the recommendations of the Standing Conference of the Ministers of Education and Cultural Affairs (KMK, 2012), teachers should be able to provide ageand developmental-psychologically appropriate approaches to deal with difficulties and conflicts at school and in the classroom. They should be aware of risks and potentials in childhood and adolescence, as well as prevention, intervention, and supporting strategies. These risks include mental health problems. Nearly every teacher has already taught students with mental health problems, such as affective and eating disorders (Dey et al., 2018). Teachers are in a special position because of the significant amount of time that students and teachers spend together. 1. Teachers can create safe havens within the school by offering their students social-emotional and physical safety (Joyce & Early, 2014; Thapa et al., 2013). For some students, teachers are their only source of social contact. Moreover, research has shown that social support from teachers can prevent the expression of psychosomatic complaints (Ritter et al., 2016) and may help reduce alienation, stigma, fear, and anxiety (Specht, 2013). 2. Teachers are often the first point of contact and can recognize changes in behavior earlier than other caregivers, as they observe students over an extended period. 3. As children have difficulties initiating professional help for themselves, teachers can act as gatekeepers who pave the way to professional help (Stiffman et al., 2004). In summary, teachers play a central role in protecting and maintaining students’ mental health. To fulfill this role, teachers need skills that can be summarized as Mental Health Literacy (T-MHL). Jorm et al. (1997) defined Mental Health Literacy (MHL) as “the knowledge and beliefs about mental disorders that aid their recognition, management, or prevention” (p. 182). According to this definition, MHL includes 1) knowledge and recognition of mental disorders, 2) attitudes that facilitate recognition and help-seeking, 3) knowledge of how to seek mental health information as well as knowledge and beliefs about 4) risk factors and causes, 5) professional help, and 6) self-help (Jorm, 2000). In their systematic review, Johnson et al. (2023) emphasized the differences in the presentation, management, and prevention of mental health problems across the lifespan, which requires a specific focus on children and adolescents. Miller et al. (2019) have shown that teacher depression literacy is associated with student depression literacy (Miller et al., 2019), highlighting the pivotal role of teachers in students’ mental health. In our study, we defined T-MHL as teachers’ knowledge and beliefs about students’ mental health that aid the recognition, management, and prevention of students’ mental health problems. By doing so, we mostly follow the definition of MHL by Jorm et al. (1997), but concentrate on the three aspects that are particularly relevant for our understanding of T-MHL. Regarding the role of teachers described above, recognizing mental disorders does not entail clinical diagnoses but rather an awareness of meaningful changes in students, such as social isolation and loss of interest. Teachers’ actions regarding the management of students’ mental health problems include cooperation with other teachers and parents, as well as with other professionals, such as school psychologists, school social workers, child and youth psychiatrists, and youth welfare workers. Teachers need to know who to turn to act as gatekeepers, and thereby best support their students with mental disorders. Teachers cooperate both within the college and with other profes- 296 Franziska Greiner, Poldi Kuhl sions and institutions. They use the support possibilities explicitly demanded within the framework of the KMK Standards (2004) for teacher education in educational sciences. Regarding prevention, teachers can contribute to students’ mental well-being by providing constructive feedback, promoting a positive classroom climate, and building stable relationships with students (Hornstra et al., 2021; Olivier et al., 2021; Pastore & Luder, 2021; Stroet et al., 2013). Initial efforts have been made to transfer the construct of MHL to the target group of teachers (Greiner & Kracke, 2022). However, to date, there is no shared model or adequate operationalization of T-MHL, although some studies have measured particular aspects of T-MHL with heterogeneous findings. 3. Previous research on T-MHL Most previous research on MHL is populationbased and investigates only the sub-components of recognition and knowledge concerning adults’ MHL (Johnson et al., 2023). The other components of MHL have been investigated scarcely. In addition, psychometrically validated instruments for assessing T-MHL are lacking (Anderson et al., 2019; Johnson et al., 2023; O’Connor et al., 2014; Wei et al., 2015), which hampers the interpretation and comparability of previous studies. Previous studies have reported that most teachers feel inadequately prepared to deal with mental health problems in the classroom (Gowers et al., 2004; Kitchener & Jorm, 2006; Reinke et al., 2011; Rothi et al., 2008). For instance, Bilz (2014) showed that teachers are rarely able to recognize mental problems in their students and have particular difficulties in identifying internalizing problems, such as anxiety and depression. In a case-based study focusing on students’ non-suicidal self-injurious behavior (NSSI), Greiner et al. (2023) showed that the majority of teachers already have experiences with students who self-injure. However, most of them were only able to recognize approximately half of the indications of students’ NSSI. In addition, gatekeeping - that is, referral to professional support systems such as school social work, school psychology, and child and adolescent psychiatry - does not seem to be part of teachers’ repertoire of actions in dealing with NSSI among students. Grabowski (2021) reported that teachers lack the knowledge of how to talk to students with depressive symptoms. Hartmann et al. (2020) showed that teachers feel particularly less confident in dealing with mental disorders, such as depression, eating disorders, or schoolrelated anxiety. Layne et al. (2006) found that teachers were generally accurate in distinguishing between anxious and non-anxious students. This finding was confirmed by the vignette study by Ní Chorcora and Swords (2021), who showed that most teachers could correctly label both anxiety and depression, and they were able to distinguish clinical and non-clinical severity. In summary, previous findings suggest that teachers can recognize mental health problems, which is one aspect of T-MHL. However, most teachers do not feel able to deal with students’ mental health problems in everyday school life, i.e. lack knowledge and experiences with regard to cooperation with relevant professionals. Therefore, there seems to be a discrepancy between recognizing students with mental health problems and appropriately dealing with them (Dods, 2016; Fortier et al., 2017; Whitley, et al., 2013). This discrepancy highlights the importance of self-efficacy beliefs as an action-initiating facet of teachers’ professional competence (Baumert & Kunter, 2006). Self-efficacy beliefs can be defined as the evaluation of one’s personal ability to cope with new or difficult situations (Bandura, 1997). As knowledge and self-efficacy beliefs are interrelated (Baumert & Kunter, 2006; Dods, 2016; Kormos & Nijakowska, 2017), the discrepancy between recognizing and dealing with mental disorders may be due to a lack of knowledge, self-efficacy, or both. As previous studies have focused on isolated aspects of T-MHL and were often limited to specific disorders, such Explorative Studie zur Mental Health Literacy von Lehrkräften 297 as ADHD (Johnson et al., 2023; Ohan et al., 2008), this discrepancy could not be explained yet, but might result in delayed interventions (Dods, 2016). Thus, to date, there is scarce data in which teachers’ self-efficacy beliefs and knowledge about mental health problems of students as components of T-MHL have been considered, and which do not only refer to one specific disorder. Given the high prevalence of mental health problems at school age, it can be assumed that the majority of teachers already have experiences with affected students. In previous studies, however, experiences with specific disorders such as ADHD (Ohan et al., 2008) or symptoms such as NSSI (Greiner et al., 2023) were often assessed. Against the background of the teachers’ task as gate-keepers, it is also relevant to know with whom teachers regularly cooperate. Therefore, in addition to T-MHL, this exploratory study also addresses experiences with various mental disorders as well as cooperation with other professionals inside and outside of school. 4. Research questions Following a descriptive approach, we explored the relevance of students’ mental disorders to teachers based on the frequency of their experiences with affected students (RQ 1). Moreover, we asked about their cooperation partners inside and outside school (RQ 2). Most importantly, we investigated T-MHL along the dimensions of students’ self-efficacy and knowledge of how to deal with various mental health problems (RQ 3). 5. Methods 5.1 Sample and instruments A total of 70 teachers from nine secondary schools (71 % female, M age = 43.50 years [SD age = 9.24]) of the Protestant School Foundation in Central Germany were surveyed with an online questionnaire using SoSci Survey. On average, the participating teachers had approximately 15 years of professional teaching experience (SD = 9.17). About one third (28.6 %) were affected by a mental disorder themselves or have a family member with a mental disorder. Using self-developed items, we asked teachers to select all the students’ mental health disorders with which they already had been confronted. For better operationalizability, a multiple-choice format with reference to clinically differentiated disorder patterns in childhood and adolescence formed the basis of this question. This means that all externalizing as well as internalizing disorders were listed separately. Moreover, we asked them about cooperation partners inside and outside school. We measured how supported teachers felt by their colleagues and the school principal in dealing with students with mental disorders (2 items; 5-point Likert scale: 1 = completely disagree, 5 = completely agree), if teachers feel knowledgeable about school internal and external contact persons when they need support in dealing with students with mental disorders (2 items; 5-point Likert scale: 1 = completely disagree, 5 = completely agree), and with whom teachers cooperate regularly (1 item; 5-point Likert scale: 1 = never, 5 = daily). It was attempted to cover the relevant facets of T-MHL (Jorm, 1997) with self-constructed items. We used scales for teachers’ self-efficacy related to the recognition of social, emotional, and physical changes in students (3 items, α = .69; 5-point Likert scale: 1 = completely disagree, 5 = completely agree; e. g., “I am able to recognize changes in the social behavior of students.”) and dealing with students’ mental health problems including addressing affected students, psycho-education, and gate-keeping to professional help (7 items, α = .82; 5-point Likert scale: 1 = completely disagree, 5 = completely agree; e. g., “I am able to provide parents with information about professional counseling services.”). We also examined teachers’ action-related knowledge concerning indicators of mental health problems (5 items, α = .87; 5-point Likert scale: 1 = completely disagree, 5 = completely agree; e. g. “I know what to do when a student injures himself.”). 6. Results For RQ 1, all participants stated that they had experienced students with mental disorders. Moreover, 94 % of the teachers reported that they had dealt with more than two disorders, and 44 % reported experiences with more than six different mental disorders. 298 Franziska Greiner, Poldi Kuhl As shown in Figure 1, teachers most frequently reported experiences with students with AD(H)D, eating disorders, autism spectrum disorders, and depression. More than half of the participants had experience with students who self-injured, had anxiety, or showed antisocial behavior. A quarter of the teachers reported experiencing suicidal behavior, substance abuse, or obsessive-compulsive disorders. Regarding RQ 2, most of the surveyed teachers stated that they felt more likely or fully supported by their colleagues in dealing with students with mental disorders (75.7 %) and school principals (74.7 %). None of the teachers reported to not feel supported at all. Furthermore, 72.8 % said that they knew who to contact at school if they needed support. In contrast, more than one-third (42.9 %) stated that they did not know which support system outside school they could benefit from. Regarding the frequency of regular cooperation, participants reported cooperation most frequently (for at least one month) with school support staff (31.5 %) and social workers (27.2 %). More than half of the participants stated that they had never cooperated with school psychologists (51.4 %) or the Youth Welfare office (57.1 %). In addition, 38.6 % of the teachers do never cooperate with child and youth psychotherapists. Considering teachers’ MHL in terms of selfefficacy (RQ 3), teachers stated that they felt selfefficacious in recognizing physical, emotional, and behavioral changes in students (M = 3.99, SD = 0.60). To a slightly lesser degree, they felt moderately self-efficacious (M > 3.00) in dealing with various students’ mental health problems on average (M = 3.29, SD = 0.75). By analyzing the specific forms of students’ mental health problems, meaningful differences emerged. Teachers reported the highest self-efficacy related to seeking conversations if they noticed any change (M = 4.07, SD = 0.84). In turn, they reported the lowest self-efficacy values regarding the adaptation of teaching for students with autism (M = 2.94, SD = 1.17) and the psychoeducation of students (M = 3.00, SD = 1.12) and parents (M = 3.09, SD = 1.13), which means that they feel moderately self-efficacious concerning these aspects. In addition, teachers indicated that they knew how to deal with different mental health problems, such as non-suicidal selfinjury (M = 3.35, SD = 0.86). Figure 1: Teachers’ experiences with students’ mental disorders 0 % 10 % 20 % 30 % 40 % 50 % 60 % 70 % 80 % 90 % 100 % AD(H)D Eating Disorder Autism Depression Social Behavior Disorder NSSI Anxiety Suicide Attempt/ Suicide Substance Abuse Obsessive-compulsive Disorder 91.43 % 80 % 77.14 % 77.14 % 68.57 % 61.43 % 58.57 % 32.86 % 28.57 % 25.71 % Explorative Studie zur Mental Health Literacy von Lehrkräften 299 Moreover, we investigated the relationship between self-efficacy and teachers’ knowledge of how to deal with students’ mental health problems. Teachers’ self-efficacy regarding their ability to recognize mental health problems in their students and their self-efficacy beliefs regarding dealing with affected students were not significantly correlated (r = .08, p > .05). Teachers’ self-efficacy beliefs regarding recognition were also not meaningfully related to their action-related knowledge concerning the indicators of mental health problems (r = .10, p > .05). However, the intercorrelation between the scales self-efficacy beliefs regarding dealing with affected students and knowledge concerning the indicators of mental health problems was strong and positive (r = .57, p < .001). 7. Discussion Students’ learning success is significantly related to their well-being. Health promotion and prevention are central to schools. These tasks are becoming increasingly important, not least in view of the prevalence of mental health problems in childhood and adolescence (Greiner et al., 2019). Teachers particularly play a central role in the healthy development of children and adolescents and in healthpromoting school environments (Miller et al., 2019; Ritter et al., 2016). However, while the mental health of students, such as teachers, has already been the subject of many studies, research on teachers’ mental health literacy (T-MHL) is still scarce. When studying T-MHL, research has focused primarily on the T-MHL subcomponent of teachers’ abilities to recognize different mental health problems. However, the concept of T-MHL is broader, as it not only includes recognition of symptoms but also knowledge about support systems and the motivation to cooperate with other professions (Greiner & Kracke, 2022). Therefore, it is particularly important for teachers to transfer their knowledge about various mental health problems and feel confident about doing so. Our exploratory study contributes to the few studies on T-MHL. Based on recent data, we analyzed teachers’ experiences with students’ mental health problems, their cooperation inside and outside school, and their self-efficacy beliefs and action-related knowledge as important components of T-MHL. The wide range of experiences with mental health disorders reported by teachers surveyed in our study suggests areas where teachers need basic knowledge about students’ mental health and confidence in dealing with affected students. Similar to previous studies, our findings show that most teachers have experience with students with mental disorders. Considering the numerous mental disorders that teachers are confronted with, they reported only a few regular collaborations with school psychology and the youth welfare office. This may be due to a lack of knowledge about school external cooperation partners or a low need for such cooperation because there are no or very few affected children. With regard to the T-MHL subcomponents of self-efficacy beliefs and knowledge, it can be summarized that recognizing students’ mental health problems is a necessary but insufficient condition for dealing professionally with them. Teachers who reported knowledge of how to deal with students’ mental health problems perceived themselves as more capable of taking the necessary actions. Although this relationship is only correlational in nature, it seems plausible and in line with previous research (Dods, 2016; Kormos & Nijakowska, 2017) that having relevant knowledge might contribute to the feeling of being able to act appropriately. In summary, our empirical study highlights the specific needs for teachers’ professionalization with respect to dealing with students’ mental health problems. Teacher education should systematically provide knowledge about (proto)typical mental health problems of children and adolescents, support systems inside and outside of school to strengthen teachers in their role as gatekeepers, and counseling students and parents, respecting their professional boundaries as teachers. 300 Franziska Greiner, Poldi Kuhl Finally, it should be noted that the study has some limitations. The first, this was a small and selective sample. Only teachers from schools belonging to the Protestant School Foundation in Central Germany were surveyed. In Germany, private schools represent about 11 % of general education schools (Grossarth-Maticek et al., 2020), so the results cannot be generalized to teachers at other schools. Second, the questionnaire was self-developed and knowledge was captured through self-reports. The single items used in our study particularly complicate comparisons with other studies. Third, the teachers reported only their perspective on their students’ mental health problems. Our study contributes to the small body of research on T-MHL and provides a basis for a deeper and evidence-based understanding of the construct. Further research, such as longitudinal studies, is required to derive implications for future teacher professionalization. Additional qualitative studies may also make important contributions to the comprehensive exploration of T-MHL. Thus, it could be examined if the reflection of teachers’ professional boundaries is also a subcomponent of T-MHL (Pérez-Parreño & Padilla-Petry, 2018). In line with the call for 21st century schooling (Waters, 2011), schools should focus on children’s and adolescents’ positive development as a whole. Because teachers are often the first point of contact, they can recognize changes in students early and act as gatekeepers. Thus, teachers can make important contributions to the (mentally) healthy development of children and adolescents. Further conceptual and empirical research is required to promote T-MHL systematically in the context of teacher education. References Anderson, M., Werner-Seidler, A., King, C., Gayed, C., Harvey, S. B. & O’Dea, B. (2019). Mental health training programs for secondary school teachers: A systematic review. School Mental Health, 11, 489 - 508. https: / / doi.org/ 10.1007/ s12310-018-9291-2 Bandura, A. (1997). Self-efficacy: The exercise of control. W. H. Freeman/ Times Books/ Henry Holt & Co. Baumert, J. & Kunter, M. (2006). Stichwort: Professionelle Kompetenz von Lehrkräften [Keyword: Teachers’ Professional Competence]. Zeitschrift für Erziehungswissenschaft, 9, 469 - 520. https: / / doi.org/ 10.1007/ s116 18-006-0165-2 Bilz, L. (2014). Werden Ängste und depressive Symptome bei Kindern und Jugendlichen in der Schule übersehen? [Are Symptoms of Anxiety and Depression in Children and Adolescents Overlooked in Schools? ]. Zeitschrift für Pädagogische Psychologie, 28 (1 - 2), 57 - 62. https: / / doi. org/ 10.1024/ 1010-0652/ a000118 Castagnini, A. C., Foldager, L., Cafo, E. & Thomsen, P. H. (2016). Early-adult outcome of child and adolescent mental disorders as evidenced by a national-based case register survey. European Psychiatry, 38, 45 - 50. https: / / doi.org/ 10.1016/ j.eurpsy.2016. 04.005 Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N.,…Thornicroft, G. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45 (1), 11 - 27. http: / / dx.doi.org/ 10.1017/ S00332917 14000129 Corrigan, P. W., Markowitz, F. E. & Watson, A. C. (2004). Structural levels of mental illness stigma and discrimination. Schizophrenia Bulletin, 30 (3), 481 - 491. https: / / doi.org/ 10.1093/ oxfordjournals.schbul.a007 096 Dey, M., Marti, L. & Venzin, V. (2018). Nachbefragung des Schulpersonals in Ergänzung zur „Schweizer Befragung von Jugendlichen/ jungen Erwachsenen zur psychischen Gesundheitskompetenz und Stigma“. Erste Resultate zuhanden der an der Studie teilnehmenden [Follow-up survey of school staff in addition to the “Swiss survey of Adolescents/ young adults on mental Health Literacy and Stigma”. First results for the attention of the schools participating in the study]. Dods, J. (2016). Teacher candidate mental health and mental health literacy. Exceptionality Education International, 26 (2), 42 - 61. https: / / doi.org/ 10.5206/ eei.v26i2.7740 Farrell, L. J. & Barret, P. M. (2007). Prevention of childhood emotional disorders: Reducing the burden of suffering associated with anxiety and depression. Child and Adolescent Mental Health, 12 (2), 58 - 65. https: / / psycnet. apa.org/ doi/ 10.1111/ j.1475-3588.2006.00430.x Fortier, A., Lalonde, G., Venesoen, P., Legwegoh, A. F. & Short, K. H. (2017). Educator mental health literacy to scale: From theory to practice. Advances in School Mental Health Promotion, 10 (1), 65 - 84. https: / / doi. org/ 10.1080/ 1754730X.2016.1252276 Grabowski, F. C. (2021). Depression in childhood and adolescence. Development and piloting of a psychoeducational program for the professional development of teachers. Empirische Sonderpädagogik, 13 (4), 328 - 341. https: / / doi.org/ 10.25656/ 01: 24109 Greiner, F., Anding, E. & Kracke, B. (2023). Individuelle Professionalisierung von Lehrkräften für den Umgang mit nicht-suizidalem selbstverletzendem Verhalten von Schüler: innen [Individual professionalization of teachers for dealing with non-suicidal self-injurious behavior of students]. In R. Porsch & P. Gollub (Eds.), Professionalisierung von Lehrkräften im Beruf. Stand und Perspektiven der Lehrkräftebildung und Professionsforschung (pp. 91 - 106). Waxmann. Greiner, F. & Kracke, B. (2022). Gesundheitskompetenz, psychische Gesundheit und schulische Inklusion [Health literacy, mental health and educational inclu- Explorative Studie zur Mental Health Literacy von Lehrkräften 301 sion]. In K. Rathmann, K. Dadaczynski, O. Okan & M. Messer (Eds.) Gesundheitskompetenz. Springer Reference Pflege - Therapie - Gesundheit [Health Literacy] (pp. 1 - 9). Springer. https: / / doi.org/ 10.1007/ 978-3- 662-62800-3_133-1 Greiner, W., Batram, M. & Witte, J. (2019). DAK Kinder- und Jugendreport 2019. Gesundheitsversorgung von Kindern und Jugendlichen in Deutschland Schwerpunkt: Ängste und Depressionen bei Schulkindern [DAK Children and Youth Report 2019. Health care for children and adolescents in Germany Focus: Anxiety and depression among school children]. In A. Storm (Ed.), Beiträge zur Gesundheitsökonomie und Versorgungsforschung [Contributions to health economics and health services research]. https: / / www.dak.de/ dak/ download/ dak-kinder--und-jugendreport-2019-2168 336.pdf, Last access: 3. 7. 2023. Grossarth-Maticek, J., Kann, K. & Koufen, S. (2020). DE- STATIS KONTEXT. Privatschulen in Deutschland - Fakten und Hintergründe. Destatis. https: / / www.de statis.de/ DE/ Themen/ Gesellschaft-Umwelt/ Bildung- Forschung-Kultur/ Schulen/ Publikationen/ Down loads-Schulen/ privatschulen-deutschland-dossier- 2020.pdf, Last access: 3. 7. 2023. Gowers, S., Thomas, S. & Deeley, S. (2004). Can primary schools contribute effectively to tier I child mental health services? Clinical Child Psychology and Psychiatry, 9 (3), 419 - 425. https: / / doi.org/ 10.1177/ 1359104504 043924 Hall, T., Kakuma, R., Palmer, L., Minas, H., Martins, J. & Kermode, M. (2019). Social inclusion and exclusion of people with mental illness in Timor-Leste: A qualitative investigation with multiple stakeholders. BMC Public Health, 19, 702. https: / / doi.org/ 10.1186/ s128 89-019-7042-4 Hartmann, A., Rückmann, J. & Tannen, A. (2020). Individuelle Gesundheitskompetenz von Lehrkräften und deren (Un)Sicherheit im Umgang mit chronisch erkrankten Schulkindern und Notfallsituationen [Individual teacher’s health literacy and their safety in dealing with chronically ill pupils and emergencies]. Bundesgesundheitsblatt, 63, 1168 - 1176. https: / / doi.org/ 10. 1007/ s00103-020-03207-7 Hintzpeter, B., Metzner, F., Pawils, S., Bichmann, H., Kamtsiuris, P., Ravens-Sieberer, U. & Klasen, F. (2014). Inanspruchnahme von ärztlichen und psychotherapeutischen Leistungen durch Kinder und Jugendliche mit psychischen Auffälligkeiten [Medical and psychotherapeutic health care utilization of children and adolescents with mental health problems: Results of the BELLA Study]. Ergebnisse der BELLA-Studie. Kindheit und Entwicklung, 23, 229 - 238. https: / / doi. org/ 10.1026/ 0942-5403/ a000148 Hornstra, L., Stroet, K. & Weijers, D. (2021). Profiles of teachers’ need-support: How do autonomy support, structure, and involvement cohere and predict motivation and learning outcomes? Teaching and Teacher Education, 99, 103257. https: / / doi.org/ 10.1016/ j.tate. 2020.103257 Johnson, C. L., Gross, M. A., Jorm, A. F. & Hart, L. M. (2023). Mental health literacy for supporting children: A systematic review of teacher and parent/ carer knowledge and recognition of mental health problems in childhood. Clinical Child and Family Psychology Review, 26 (2), 569 - 591. https: / / doi.org/ 10.1007/ s10567- 023-00426-7 Jorm, A. F., Korten, A. E., Jacomb, P. A., Christensen, H., Rodgers, B. & Pollitt, P. (1997). “Mental health literacy”: A survey of the public’s ability to recognise mental disorders and their beliefs about the effectiveness of treatment. Medical Journal of Australia, 166 (4), 182 - 186. Jorm, A. F. (2000). Mental health literacy: Public knowledge and beliefs about mental disorders. British Journal of Psychiatry, 177 (5), 396 - 401. https: / / doi.org/ 10.1192/ bjp.177.5.396 Joyce, H. & Early, T. (2014). The impact of school connectedness and teacher support on depressive symptoms in adolescents: A multilevel analysis. Child Youth Services Review, 39, 101 - 107. https: / / doi.org/ 10.1016/ j.childyouth.2014.02.005 Kieling, C., Baker-Henningham, H., Belfer, M., Conti, G., Ertem, I., Omigbodun, O., Rohde, L. A., Srinath, S., Ulkuer, N. & Rahman, A. (2011). Child and adolescent mental health worldwide: evidence for action. Lancet, 378 (9801), 1515 - 1525. https: / / doi.org/ 10. 1016/ S0140-6736(11)60827-1 Kitchener, B. A. & Jorm, A. F. (2006). Mental health first aid training: Review of evaluation studies. Australian and New Zealand Journal of Psychiatry, 40, 6 - 8. https: / / doi.org/ 10.1080/ j.1440-1614.2006.01735.x Kormos, J. & Nijakowska, J. (2017). Inclusive practices in teaching students with dyslexia: Second language teachers’ concerns, attitudes and self-efficacy beliefs on a massive open online learning course. Teaching and Teacher Education, 68, 30 - 41. https: / / doi.org/ 10.10 16/ j.tate.2017.08.005 The Standing Conference of the Ministers of Education and Cultural Affairs (KMK) (2004). Standards für die Lehrerbildung: Bildungswissenschaften (Beschluss der Kultusministerkonferenz vom 16. 12. 2004 i. d. F. vom 7. 10. 2022) [Standards for Teacher Education: Educational Sciences]. https: / / www.kmk.org/ fileadmin/ veroeffentlichungen_beschluesse/ 2004/ 2004_12_16- Standards-Lehrerbildung.pdf, Last access: 3. 7. 2023. The Standing Conference of the Ministers of Education and Cultural Affairs (KMK) (2012). Empfehlung zur Gesundheitsförderung und Prävention in der Schule (Beschluss der Kultusministerkonferenz vom 15. 11. 2012) [Recommendation on health promotion and prevention in schools]. https: / / www.kmk.org/ fileadmin/ ver oeffentlichungen_beschluesse/ 2012/ 2012_11_15- Gesundheitsempfehlung.pdf, Last access: 3. 7. 2023. Layne, A. E., Bernstein, G. A. & March, J. S. (2006). Teacher awareness of anxiety symptoms in children. Child Psychiatry and Human Development, 36 (4), 383 - 392. https: / / doi.org/ 10.1007/ s10578-006-0009-6 Link, B. G., Struening, E. L., Neese-Todd, S., Asmussen, S. & Phelan, J. C. (2001). Stigma as a barrier to recovery: The consequences of stigma for the self-esteem of people with mental illnesses. Psychiatric Services, 52 (12), 1621 - 1626. https: / / doi.org/ 10.1176/ appi.ps. 52.12.1621 Miller, L., Musci, R., D’Agati, D., Alfes, C., Beaudry, M. B., Swartz, K. & Wilcox, H. (2019). Teacher mental health literacy is associated with student literacy in the adolescent depression awareness program. School Mental Health, 11 (2), 357 - 363. https: / / doi.org/ 10.1007/ s12310-018-9281-4 Mulraney, M., Hiscock, H., Sciberras, E., Coghill, D. & Sawyer, M. (2020). Mental health difficulties across childhood and mental health service use: Findings 302 Franziska Greiner, Poldi Kuhl from a longitudinal population-based study. The British Journal of Psychiatry, 217 (1), 364 - 369. https: / / doi. org/ 10.1192/ bjp.2019.32 Moon, J., Williford, A. & Mendenhall, A. (2017). Educators’ perceptions of youth mental health: implications for training and the promotion of mental health services in schools. Children and Youth Services Review, 73, 384 - 391. https: / / doi.org/ 10.1016/ j.childyouth.2017. 01.006 Ní Chorcora, E. & Swords, L. (2021). Mental health literacy and help-giving responses of Irish primary school teachers. Irish Educational Studies. https: / / doi.org/ 10. 1080/ 03323315.2021.1899029 O’Connor, M., Casey, L. & Clough, B. (2014). Measuring mental health literacy: A review of scale-based measures. Journal of Mental Health, 23 (4), 197 - 204. https: / / doi.org/ 10.3109/ 09638237.2014.910646 Ohan, J. L., Cormier, N., Hepp, S. L., Visser, T. A. W. & Strain, M. C. (2008). Does knowledge about attention-deficit/ hyperactivity disorder impact teachers’ reported behaviors and perceptions? School Psychology Quarterly, 23 (3), 436 - 449. https: / / doi.org/ 10.1037/ 1045-3830.23.3.436 Olivier, E., Galand, B., Morin, A. J. S. & Hospel, V. (2021). Need-supportive teaching and student engagement in the classroom: Comparing the additive, synergistic, and global contributions. Learning and Instruction, 71, 101389. https: / / doi.org/ 10.1016/ j.learninstruc.2020. 101389 O’Neil, K. A., Conner, B.T. & Kendall, P. C. (2011). Internalizing disorders and substance use disorders in youth: Comorbidity, risk, temporal order, and implications for intervention. Clinical Psycholog y Review, 31 (1), 104-112. https: / / doi.org/ 10.1016/ j.cpr.2010.08.002 Pastore, G. & Luder, R. (2021). Teacher-student-relationship quality in inclusive secondary schools: Theory and measurement of emotional aspects of teaching. Frontiers in Education, 6, 643617. https: / / doi.org/ 10.3389/ feduc.2021.643617 Pérez-Parreño, M. & Padilla-Petry, P. (2018). Mental health and inclusion seen from the children’s and teachers’ perspectives: A case study in Spain. Educational Research and Reviews, 13 (6), 188 - 196. https: / / doi.org/ 10.5897/ ERR2018.3469 Ravens-Sieberer, U., Kaman, A., Otto, C., Adedeji, A., Napp, A.-K., Becker, M., Blanck Stellmacher, U., Löffler, C., Schlack, R., Hölling, H., Devine, J., Erhart, M. & Hurrelmann, K. (2021). Seelische Gesundheit und psychische Belastungen von Kindern und Jugendlichen in der ersten Welle der COVID-19-Pandemie - Ergebnisse der COPSY-Studie. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz [Mental health and psychological burden of children and adolescents during the first wave of the COVID-19 pandemic - results of the COPSY study]. https: / / doi.org/ 10.1007/ s00103-021-03291-3 Reinke, W. M., Stormont, M., Herman, K. C., Puri, R. & Goel, N. (2011). Supporting children’s mental health in schools: Teacher perceptions of needs, roles, and barriers. School Psychology Quarterly, 26 (1), 1 - 13. https: / / doi.org/ 10.1037/ a0022714 Ritter, M., Bilz, L. & Melzer, W. (2016). Schulische und außerschulische Unterstützung als Ressource für die psychische Gesundheit von Schülerinnen und Schülern [In-school and out-of-school support as a resource for student mental health]. In Bilz, L., Sudeck, G., Bucksch, J., Klocke, A., Kolip, P., Melzer, W., Ravens-Sieberer, U. & Richter, M. (Eds.), Schule und Gesundheit. Ergebnisse des WHO-Jugendgesundheitssurveys „Health Behaviour in School-aged Children“ (pp. 181 - 199). Beltz Juventa. Rothi, D. M., Leavey, G. & Best, R. (2008). On the frontline: Teachers as active observers of pupils’ mental health. Teacher and Teacher Education, 24, 1217 - 1231. https: / / doi.org/ 10.1016/ j.tate.2007.09.011 Solmi, M., Radua, J., Olivola, M., Croce, E., Soardo, L., Salazar de Pablo, G., Il Shin, J., Kirkbride, J. B., Jones, P., Kim, J. H., Kim, J. Y., Carvalho, A. F., Seeman, M. V., Correll, C. U. & Fusar-Poli, P. (2022). Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry, 27 (1), 281 - 295. https: / / doi.org/ 10.1038/ s41380- 021-01161-7 Specht, J. (2013). Mental health in schools: Lessons learned from exclusion. Canadian Journal of School Psychology, 28 (1), 43 - 55. https: / / doi.org/ 10.1177/ 08295735124 68857 Stiffman, A. R., Pescosolido, B. & Cabassa, L. J. (2004). Building a model to understand youth service access: The gateway provider model. Mental Health Services Research, 6 (4), 189 - 198. https: / / doi.org/ 10.1023/ b: mhsr.000 0044745.09952.33 Stuart, H. (2006). Mental illness and employment discrimination. Current Opinion in Psychiatry, 19 (5), 522 - 526. https: / / doi.org/ 10.1097/ 01.yco.0000238482.27 270.5d Stroet, K., Opdenakker, M.-C. & Minnaert, A. (2013). Effects of need supportive teaching on early adolescents’ motivation and engagement: A review of the literature. Educational Research Review, 9, 65 - 87. https: / / doi. org/ 10.1016/ j.edurev.2012.11.003 Thapa, A., Cohen, J., Guffey, S. & Higgins-D’Alessandro, A. (2013). A review of school climate research. Review of Educational Research, 83 (3), 357 - 385. https: / / doi. org/ 10.3102/ 0034654313483907 Waters, L. (2011). A review of school-based positive psychology interventions. The Australian Educational and Developmental Psychologist, 28 (2), 75 - 90. https: / / doi. org/ 10.1375/ aedp. 28.2.75 Wei, Y., McGrath, P. J., Hayden, J. & Kutcher, S. (2015). Mental health literacy measures evaluating knowledge, attitudes and help-seeking: A scoping review. BMC Psychiatry, 15 (1), 291. https: / / doi.org/ 10.1186/ s128 88-015-0681-9 Whitley, J., Smith, J. D. & Vaillancourt, T. (2013). Promoting mental health literacy among educators: Critical in school-based prevention and intervention. Canadian Journal of School Psychology, 28 (1), 56 - 70. https: / / doi. org/ 10.1177/ 0829573512468852 Dr. Franziska Greiner Universität Leipzig Marschnerstr. 31 04109 Leipzig E-Mail: franziska.greiner@uni-leipzig.de Prof. Dr. Poldi Kuhl Leuphana Universität Lüneburg Universitätsallee 1 21335 Lüneburg E-Mail: poldi.kuhl@leuphana.de