A Review of Child Mental Health Awareness Initiatives in Southeast Asia: Implications for Integrating Mental Health Education into Teacher Training

A Review of Child Mental Health Awareness Initiatives in Southeast Asia: Implications for Integrating Mental Health Education into Teacher Training

Mohd Faiz Fansuri bin Mohd Affandy*, Azlinda binti Azman, Intan Nooraini binti Zainol

Social Work Department, School of Social Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia

ABSTRACT

This review synthesises child mental health awareness initiatives in Southeast Asia, focusing on the integration of mental health education into teacher training programmes. The study aimed to (1) identify existing initiatives across Southeast Asia, (2) examine their incorporation into teacher training curricula, and (3) explore how cultural factors and policy frameworks influence adoption and sustainability. A systematic review was conducted following PRISMA 2020 guidelines. Data from 27 publicly accessible documents were extracted using thematic synthesis. Quantitative indicators (e.g., prevalence rates, effect sizes) were combined with qualitative insights to elucidate trends in teacher preparedness, cultural stigma, and policy support. Our findings indicate robust awareness programmes and teacher training exist; however, challenges remain in continuous support, digital literacy among veteran teachers, and culturally tailored interventions. Recommendations include embedding mental health modules into preservice education, establishing ongoing mentorship frameworks, and leveraging digital innovations to overcome resource constraints.

Keywords: Child Mental Health, Teacher Training, Southeast Asia, Systematic Review, Cultural Adaptation

INTRODUCTION

Child mental health challenges are a growing concern in Southeast Asia, with estimates indicating that 10–20% of children experience mental health issues (UNICEF et al., 2022). Schools are uniquely positioned to serve as critical arenas for early detection and intervention. However, many low- and middle-income countries (LMICs) in the region face significant barriers, including limited infrastructure, pervasive cultural stigma, and under-resourced mental health services.

In Southeast Asia, factors such as academic pressures, traditional beliefs, and socio-economic constraints exacerbate the under-recognition of child mental health needs. Teachers, as frontline observers of student behaviour, are uniquely positioned to identify early warning signs and initiate support. Integrating mental health education into teacher training is an evidence-based strategy to address these challenges and promote early intervention (Kim et al., 2022; Nishimura et al., 2024).

Despite the existence of several mental health awareness programmes, there is a notable gap in continuous professional support and culturally tailored teacher training. Previous studies have often relied on Western frameworks, which lack adequate adaptation to local contexts (Munawar et al., 2022). This review addresses this gap by synthesising regional initiatives and offering actionable recommendations for policy and practice.

The purpose of this study is to synthesise child mental health awareness initiatives in Southeast Asia and examine their integration into teacher training programmes. The study aims to:

Identify and synthesise child mental health awareness initiatives in Southeast Asia.

Examine the incorporation of these initiatives into teacher training programmes.

Explore the influence of cultural factors and policy frameworks on the adoption and sustainability of these initiatives.

This research is critical for informing evidence-based policies and practices that address the unique socio-cultural and systemic challenges in Southeast Asia. By bridging the gap between awareness and implementation, this study contributes to the development of sustainable mental health initiatives in schools.

METHODS

Study Design

A systematic review was conducted following PRISMA 2020 guidelines (Page et al., 2021) to ensure transparency and reproducibility.

Data Sources and Search Strategy

The review included studies published between 2014 and 2024. Searches were performed across multiple databases, including ASEAN Citation Index, ERIC, PubMed, Scopus, and Google Scholar. Grey literature sources, such as government and NGO reports, were also included. Search strings incorporated Boolean operators and truncation to capture variations related to child mental health, teacher training, and Southeast Asian contexts (e.g., “child*,” “youth*,” “adolescen*”).

Eligibility Criteria

Studies were included if they:

Focused on child mental health (ages 0–18) in Southeast Asia.

Examined initiatives linking mental health awareness with teacher training or policy frameworks.

Were published in English or Malay between 2014 and 2024.

Addressed cultural adaptations or policy impacts.

Studies focusing solely on adult mental health or unrelated policy areas were excluded.

Screening and Quality Appraisal

Three independent reviewers screened titles and abstracts using Rayyan, achieving substantial agreement (Cohen’s Kappa = 0.78). Full-text articles were assessed against inclusion criteria, and quality was appraised using CASP and JBI tools. Additional criteria evaluated policy relevance and cultural sensitivity.

Data Extraction and Analysis

Data were extracted using a thematic synthesis approach. Initial coding identified recurring themes such as teacher capacity, cultural stigma, and policy support. A comparative matrix was developed to map interventions and best practices across countries. Quantitative data such as prevalence rates and effect sizes, were integrated with qualitative themes to provide a comprehensive overview.

Ethical Considerations

All sources were publicly accessible, and no additional ethical approval was required. Reflexivity was maintained through regular team discussions to ensure cultural sensitivity in data interpretation.

RESULTS

A total of 27 studies were included in the review (See Figure 1). The selected documents encompassed a range of study designs (systematic reviews, mixed-methods studies, cross-sectional surveys) and spanned various Southeast Asian countries, including Malaysia, Indonesia, Thailand, and Vietnam (See Table 1).

Figure 1: PRISMA 2020 flow diagram (Selection analysis)

Source: Page MJ, et al. BMJ 2021;372:n71. doi: 10.1136/bmj.n71.

Table 1 Extracted data

Author(s), Year	Study Type	Policy Frameworks/ Implementation Strategies	Specific Interventions (description, target population, outcomes)	Cultural Adaptations	Barriers and Enablers to Implementation	Key Findings and Recommendations
Brooks et al. (2019)	Mixed‑methods research	Aligned with WHO’s mhGAP and task‑shifting strategies	Developed and tested a High School Mental Health Action Checklist for Thai schools to guide annual mental health promotion	Checklist designed to reflect the local Thai school environment and cultural communication norms	Inhibiting factors include curriculum constraints and resource limitations; availability of trained personnel facilitates implementation	The checklist demonstrated robust psychometric properties and is recommended for structured, school‑based mental health planning
Firdausi (2019)	Literature review	Uses the PROSPER model as a framework for guidance and counselling services	Reviews the integration of the PROSPER model into school counselling programmes to improve student mental health outcomes	Adapted to Indonesian educational settings and local cultural norms	Challenges include the need for comprehensive training and systematic implementation; expert consultation is an enabler	PROSPER‑based interventions can enrich mental health promotion; recommends wider integration into school guidance services
Kok et al. (2019)	Meta‑synthesis review (quantitative studies)	Promotes family‑ and school‑based approaches to mental health support	Synthesises evidence on risk and protective factors (academic stress, relationship issues, socioeconomic challenges) affecting Malaysian youth’s mental health	Considers Malaysia’s multicultural context in examining stressors and protective social supports	Key stressors include academic pressure and socioeconomic disparities; connectedness and community support are enablers	Identifies the need for culturally responsive, family‑ and school‑oriented interventions to reduce vulnerability to mental health disorders
Nishio et al. (2019)	Comparative analysis	Reviews and compares school mental health policies across ASEAN countries	Analyses the range and quality of school‑based mental health programmes and support services across diverse ASEAN educational settings	Recognises varied cultural adaptations and resource allocations across different countries	Disparities in resources and inconsistent policy implementation pose challenges; coordinated strategies are an enabler	Highlights the need for harmonised context‑sensitive mental health strategies across ASEAN schools
Teo et al. (2020)	Overview/analysis	Reviews existing policies and support systems for Autism Spectrum Disorders (ASD)	Analyses educator awareness, training opportunities, and developmental support initiatives for ASD in Sarawak’s special needs education sector	Interventions are adapted to local cultural perceptions and social attitudes toward ASD in Sarawak	Barriers include lack of standardised guidelines and limited professional support; enhanced training and policy frameworks are enablers	Emphasises the need for structured policies, standard training guidelines, and improved support systems for ASD educators
Hidayati et al. (2021)	Instrument development research	– (Not applicable)	Developed and validated a mental health measurement instrument for high school students in Indonesia to screen for mental health issues	Instrument language and content were adapted for Indonesian adolescents	Challenges included ensuring theoretical validity and iterative refinement; expert panel review was an enabler	The instrument is valid and reliable for early identification of mental health problems in adolescents and is recommended for school use
Giang & Huynh (2022)	Hermeneutic phenomenological study	– (Not framed within a formal policy)	Explores how Confucian philosophy influences the social and emotional health of Vietnamese adolescents through in‑depth interviews	Grounded in Vietnamese cultural and religious traditions, blending Confucian ideals with local practices	Limited prior research on the topic; deep cultural embedment acts as both a challenge and a strength	Authentic engagement with Confucian values can boost self‑esteem and relationship‑building; suggests leveraging cultural strengths in mental health promotion
Le, Trang (2022)	Cross‑sectional prevalence study	– (Not applicable)	Evaluated the prevalence of adverse childhood experiences (ACEs) among 644 Vietnamese high school students using the WHO ACE‑International Questionnaire	Focused on the experiences typical in low‑and‑middle‑income Vietnamese contexts	Variability in ACE measurement and under‑recognition of abuse types pose challenges; high reported prevalence underscores urgency	Finds that 74% of students experienced ≥1 ACE and recommends targeted prevention programmes and further research on ACE risk factors
Liao et al. (2023)	Systematic review and meta‑analysis	Based on evidence‑based intervention frameworks for mental health literacy	Analysed controlled trials to assess the immediate and tracking effects of interventions aimed at improving teachers’ mental health literacy	Analysis indicates similar intervention effects across diverse cultural contexts	Low baseline mental health literacy and stigma are barriers; robust experimental designs are enablers	Interventions yield moderate to substantial improvements; recommends enhancing study designs to sustain long‑term gains
Phoa et al. (2023)	Cross‑sectional study	– (Not framed by a formal policy)	Examined mental health literacy among parents, guardians, and teachers in West Malaysia using the MAKS‑Malay Version	Tailored to address Malaysian sociocultural stigmas regarding mental health	Limited mental health knowledge and pervasive stigma are barriers; formal training and higher SES are enablers	Identifies key demographic predictors of mental health literacy; recommends targeted interventions for older and lower‑income groups
Wardani et al. (2023)	Mixed‑methods study	Based on Indonesia’s School‑Based Mental Health (SBMH) programme (education, screening, counselling)	Explored the implementation of the SBMH programme in public junior high schools in Jakarta, focusing on regular mental health education, screening, and counselling practices	Examined within the local Indonesian public-school context with consideration of regional disparities	Curriculum constraints and limited trained staff are key barriers; schools with awards and external collaborations are enablers	Recommends strengthening resources and developing collaboration networks with external mental health providers to improve SBMH effectiveness
Weiss et al. (2023)	Mixed‑methods needs assessment	– (Not linked to a formal policy but addresses implementation science)	Assessed barriers and facilitators for school‑based mental health interventions in Vietnam, focusing on building implementation science capacity	Tailored to the Vietnamese context with an emphasis on local stakeholder engagement and resource limitations	Contrary to expectations, limited stakeholder engagement—not financial constraints—was the major barrier; high interest in capacity building is an enabler	Highlights the importance of stakeholder engagement and IS capacity building for successful SBMH implementation in LMICs
Ahmad & Ismail (2024)	Systematic review	– Emphasis on integrating Social‑Emotional Learning (SEL) into teacher education programmes	Reviews how SEL frameworks incorporated into teacher training enhance emotional resilience and classroom management for better student outcomes	Tailored to the local context of Malaysian pre‑ and in‑service teacher education	Lack of formal SEL instruction in many training programmes; inadequate preparation is a barrier; clear SEL frameworks and professional development are enablers	SEL integration can boost teacher well‑being, reduce burnout, and improve classroom efficacy; recommends formalising SEL in teacher curricula
Cong & Oyam (2024)	Mixed‑methods study	– (Not tied to a specific policy framework)	Explored teacher training programmes aimed at enhancing preparedness to identify and address student mental health issues in the classroom	Findings discussed in relation to local educational practices in the Philippines	Inadequate current training and limited resources hinder effective intervention; ongoing support and practical modules are enablers	Enhanced teacher training is critical to improving intervention effectiveness; recommends revising training modules and increasing support resources
Le et al. (2024)	Cross‑sectional study	– (Not linked to a specific policy)	Assesses psychological difficulties and the need for psychological services among high school students in Vietnam	Contextualised to Vietnamese educational settings and the evolving mental health needs of adolescents	Challenges include high prevalence of stress, stigma, and reliance on non‑professional support; availability of school-based services is an enabler	Highlights significant psychological challenges among students; calls for expanded, accessible mental health services in schools
Gestiardi et al. (2024)	Systematic literature review (PRISMA‑guided)	– (No explicit policy framework)	Examines “teacher noticing” in assessing student anxiety and engagement by synthesising 65 articles; identifies observational skills and teacher interventions	Analysis reflects on post‑COVID‑19 and distance learning contexts in Southeast Asia	Barriers include insufficient teacher training in noticing subtle anxiety signs; facilitators include targeted professional development	Emphasises the critical role of teacher observational skills; recommends incorporating “noticing” techniques in teacher training to enhance student well‑being
Hussin et al. (2024)	Review article	Advocates online‑based suicide prevention strategies guided by Human Ecological Theory	Provides an overview of online interventions targeting suicide prevention among Malaysian adolescents during crises (e.g., COVID‑19, MCO)	Strategies are tailored to Malaysian socio‑cultural and digital usage contexts	Barriers include technological limitations and persistent stigma; high internet penetration and adaptive digital platforms are enablers	Culturally tailored, accessible online suicide prevention programmes are urgently needed; recommends multi‑level support mechanisms
Muniandy (2024)	Mixed‑methods study	– (Aligned with local public health guidelines)	Conducted a needs assessment for developing school‑based mental health implementation science capacity in Vietnam	Tailored to the Vietnamese school context with attention to local stakeholder engagement	Limited local IS capacity and stakeholder engagement are major barriers; high interest in capacity building is an enabler	Provides insights for building IS capacity in LMIC school settings; recommends prioritising stakeholder engagement
Nguyen & Mai (2024)	Review article	Reviews policies and legal frameworks addressing child sexual abuse (CSA)	Discusses school‑based education, legal interventions, and community initiatives aimed at preventing CSA among Vietnamese children	Emphasises overcoming cultural taboos and low awareness in Vietnam	Cultural stigma and underreporting hinder effective implementation; improved laws and educational efforts are enablers	Calls for a multidimensional, culturally sensitive approach to prevent CSA and enhance support services
Ojio et al. (2024)	Intervention development study	Uses an international interdisciplinary framework to promote mental health literacy	Developed engaging video educational materials to boost mental health literacy among Filipino adolescents	Content adapted to be culturally relevant and relatable to Filipino youth	Resource constraints and complex interdisciplinary collaboration are challenges; strong institutional partnerships facilitate success	Video‑based interventions effectively enhance mental health literacy; broader implementation is recommended
Punneng et al. (2024)	Original research (instrument/tool development)	Aligns with public health guidelines for school mental health promotion	Developed a High School Mental Health Action Checklist to guide annual mental health promotion activities in Thai schools	Designed to reflect the local Thai school environment and communication norms	Challenges include ensuring student readiness and effective teacher–student communication; strong tool reliability is an enabler	The checklist has strong psychometric properties and is recommended for structured, annual school mental health planning
Putri & Kristiana (2024)	Scoping review	– (No explicit policy framework)	Reviews teacher training programmes aimed at preventing mental disorders in school students (e.g., mindfulness, teacher-parent collaboration)	Reviews interventions implemented within Indonesian schools with attention to local educational challenges	Limited mental health training for teachers is a major barrier; collaborative programmes and targeted training are enablers	Teacher training programmes show promise in preventing mental disorders; calls for enhanced capacity building and collaboration with mental health professionals
Regalado (2024)	Descriptive research	– (Not applicable)	Investigated academic stress and coping self‑efficacy among senior high school students engaged in distance learning during the COVID‑19 pandemic in the Philippines	Contextualised to the unique challenges of Philippine distance learning and socio‑cultural academic pressures	High workload and self‑expectations are major barriers; effective problem‑solving strategies are enablers	Reveals an inverse relationship between academic stress and coping self‑efficacy; recommends targeted interventions to support student well‑being
Roshan et al. (2024)	Scoping review	Utilises the Consolidated Framework for Implementation Research (CFIR) to map facilitators and barriers	Reviews evidence on teacher‑led school mental health programmes and maps contextual factors affecting implementation	Applies the flexible CFIR framework to diverse LMIC school contexts	Barriers include limited stakeholder engagement and organisational readiness; positive school culture and committed leadership facilitate implementation	Highlights the need for early contextual assessments and stakeholder engagement to ensure successful implementation of teacher‑led SMHP
Saputra et al. (2024)	Systematic literature review	Explores strategies for school counsellors to integrate digital literacy in mental health promotion	Reviews interventions linking digital literacy skills with adolescent mental health outcomes and the role of school counsellors in mitigating risks	Considers Indonesian adolescents’ digital media usage patterns and local socio‑cultural factors	Cyberbullying and excessive social media use are barriers; structured digital literacy training programmes are enablers	Digital literacy is a key indicator of adolescent mental health; recommends enhancing school counsellor roles in prevention and intervention
Singh & Gautam (2024)	Review article	Calls for educational policies to prioritise teacher well‑being	Analyses the impact of job satisfaction on teacher mental health amidst the COVID‑19 shift to online education; reviews factors such as workload, compensation, and work environment	Discusses implications for teachers in diverse cultural and economic settings in India and beyond	High workload, stress, and inadequate support are major barriers; effective mental health support programmes are enablers	Urges policymakers to implement measures that enhance teacher job satisfaction and mental health to sustain quality education
Lea et al. (2024)	Experimental study	– (Not explicitly tied to a policy framework)	Evaluated targeted practice sessions aimed at improving students’ ability to recognise mental health disorders; involved situational questions with high school students in Vietnam	Intervention materials were culturally tailored to reflect Vietnamese educational contexts	Traditional stigma and limited access to mental health services impede effectiveness; hands‑on practice sessions act as an enabler	Targeted practice sessions significantly improved disorder recognition among students; supports the use of interactive, culturally adapted interventions

Source: Authors’ own illustration

Thematic Synthesis

Awareness and Accessibility: Studies revealed that mental health awareness programmes vary in format—from media campaigns and digital platforms to school-based psychoeducational sessions. In Malaysia, government-led initiatives frequently incorporate tele-counselling and self-screening tools (Phoa et al., 2023; Hussin et al., 2024). In rural Indonesian districts, NGOs often partner with local media to disseminate information (Firdausi, 2019; Putri & Kristiana, 2024). Digital literacy and online interventions have also been highlighted as critical enablers for mental health promotion (Saputra et al., 2024; Ojio et al., 2024).

Teacher Capacity and Professional Development: Teacher preparedness is inconsistent across the region. Structured training programmes, such as those in Thailand integrating mindfulness-based practices, have demonstrated improved teacher efficacy (Brooks et al., 2019; Punneng et al., 2024). However, in many settings, training remains sporadic, leading to diminished long-term benefits (Ahmad & Ismail, 2024; Singh & Gautam, 2024). In the Philippines, enhanced teacher training has been recommended to improve intervention effectiveness (Cong & Oyam, 2024).

Socio-Cultural and Policy Environment: The review highlighted how cultural beliefs and policy frameworks shape the implementation of mental health initiatives. For example, in Vietnam, Confucian values influence the framing of mental health interventions, emphasising personal discipline over formal counselling (Giang & Huynh, 2022; Nguyen & Mai, 2024). Meanwhile, policies in Malaysia and Thailand mandate basic screening, though follow-up support is often lacking (Nishio et al., 2019; Muniandy, 2024). Cultural stigma and underreporting remain significant barriers across the region (Teo et al., 2020; Le et al., 2022).

Programme Implementation and Delivery: Effective programme delivery relies on resource allocation and ongoing support. Urban schools generally report more consistent funding and programme sustainability compared to their rural counterparts, where external grants are common and formal monitoring is limited (Wardani et al., 2023; Weiss et al., 2023). In Indonesia, the School-Based Mental Health (SBMH) programme has been identified as a promising model, though regional disparities persist (Wardani et al., 2023). Similarly, in Malaysia, the integration of Social-Emotional Learning (SEL) into teacher training has been recommended to enhance classroom management and student outcomes (Ahmad & Ismail, 2024).

Stakeholder Collaboration: Collaborative efforts among teachers, parents, mental health professionals, and community leaders enhance programme effectiveness. In the Philippines, youth-led advocacy and teacher–parent committees have contributed to greater community acceptance and reduced stigma (Regalado, 2024; Roshan et al., 2024). Stakeholder engagement has also been identified as a critical enabler for successful implementation in Vietnam and other low- and middle-income countries (Weiss et al., 2023; Muniandy, 2024).

DISCUSSION

The synthesis of 27 studies highlights both progress and persistent challenges in advancing child mental health awareness and school-based interventions across Southeast Asia. Commendable strides are evident in raising awareness and piloting programmes, yet systemic gaps remain in implementation, cultural adaptation, and policy support. When benchmarked against high-income countries such as the UK, Australia, Japan, and Canada, these findings reveal not only shared global challenges but also specific shortfalls in regional practice. The following discussion compares key themes from Southeast Asia with international best practices, underscoring implications for policy and practice in the Southeast Asian educational context.

Teacher Training and Continuous Professional Development

Embedding mental health modules into pre-service teacher education in Southeast Asia has improved teacher preparedness and confidence in addressing student mental health needs. However, training in the region is often fragmented and sporadic, with limited follow-up or integration into ongoing professional development. Teachers frequently receive one-off workshops without systemic support to sustain and refine their skills. In contrast, high-income countries emphasise continuous professional learning as a cornerstone of effective school mental health intervention. For example, in the UK, the government has committed to offering senior mental health led training to all schools by 2025, embedding expertise and leadership for mental health in the education (Scott, 2024). Moreover, British teachers are increasingly provided with brief, simulation-based web trainings that have been shown to improve their ability to identify and respond to student mental health (Soneson et al., 2024).

In Australia, a nationwide initiative called Be You, supported by the Australian government, delivers online professional development to educators at scale, with 72% of schools registered in the programme (Hoareet al., 2020). Evaluation of Be You indicates that over 90% of participating educators feel confident recognising early signs of mental health issues in students, and 80% report actively assisting families to address children’s social-emotional or behavioural (ACER, 2024).

These international examples illustrate that systematic and ongoing training, supported by policy mandates and online platforms, leads to greater teacher efficacy in supporting student mental health. Southeast Asia’s current ad hoc approach to teacher training could be strengthened by adopting similar models of sustained professional development. Aligning with global best practices, the region should prioritise structured mentorship programmes, refresher trainings, and incentives that encourage teachers to continually develop mental health competencies (Brooks et al., 2019; Ahmad & Ismail, 2024). By institutionalising continuous training, rather than one-time workshops, Southeast Asian schools can build a workforce of teachers who are equipped and confident to serve as frontline mental health supporters.

Cultural Adaptation and Local Relevance

Culturally sensitive interventions are crucial for the success of mental health initiatives in any context. Mental health remains a stigmatised topic in many Southeast Asian communities, which necessitates tailoring language and approaches to local values. The review found that reframing mental health in culturally resonant terms, such as “emotional well-being” or “family harmony,” increases acceptance and reduces stigma in countries like Vietnam and Malaysia​. This underscores that evidence-based programmes must be adapted to fit local beliefs and social norms.

High-income countries likewise recognise the importance of cultural context, although their strategies differ by cultural landscape. Notably, Japan integrates mental health monitoring into a longstanding school culture of daily health checks. Under Japan’s School Health and Safety Act, teachers conduct daily health observations of students to detect physical and mental health issues early​ (Nishimura et al., 2024). By leveraging this culturally ingrained practice, Japanese schools normalise the monitoring of well-being as part of routine education. Recent digitalisation of Japan’s daily health logs, accelerated by the GIGA School Program that provided every student with a tablet, has enhanced early identification of mental health concerns while respecting the traditional context (Kawahata et al., 2023).

This example shows how aligning mental health initiatives with existing cultural frameworks, in this case, a focus on daily health and hygiene in schools, can facilitate acceptance and sustainability. In multicultural societies like Canada and the UK, cultural adaptation often involves ensuring materials are inclusive of diverse communities and involving parents and community leaders to overcome stigma. Southeast Asian initiatives should similarly be co-designed with local stakeholders: engaging families, religious/community figures, and using indigenous concepts of well-being to frame mental health education. By doing so, programmes can embed themselves in local culture rather than being seen as imports.

The core lesson from global practice is that cultural relevance is not a secondary consideration but a fundamental component of effective mental health education. Interventions that align with local languages, values, and norms are more likely to be embraced by teachers, students, and communities (Giang & Huynh, 2022; Hussin et al., 2024). Thus, Southeast Asia must continue to adapt international best practices to fit local realities, ensuring that efforts to raise mental health awareness resonate deeply within each community.

Policy Support and Infrastructure

Policy frameworks play a pivotal role in the adoption and scalability of school-based mental health initiatives. This review noted that within Southeast Asia, countries with clear national policies, for instance, Thailand’s and Malaysia’s education plans, demonstrate more consistent implementation of mental health programmes in schools. Yet, even where policies exist, the absence of dedicated funding, intersectoral coordination, and accountability mechanisms often undermines long-term impact​.

High-income countries provide instructive models of how strong policy support can institutionalise mental health in education systems. In England, mental health in schools has been elevated through government strategy: aside from training mental health leads, mental well-being content is now part of the national curriculum and inspectorate frameworks, backed by resources from the Department for Education and the National Health Service (Deighton et al., 2025). Japan’s legislative mandate for school health monitoring ensures that every school systematically attends to student mental health as a matter of policy compliance​ ​ (Nishimura et al., 2024).

Meanwhile, Canada has developed comprehensive frameworks at the provincial level, notably in Ontario, where the Ministry of Education created positions for Mental Health Leaders in each of the 72 school districts to design and implement district-wide mental health strategies​ (Weist et al., 2023). This province-wide policy infrastructure is supported by School Mental Health Ontario, a dedicated team that provides districts with evidence-based programmes and implementation support, ensuring coherence across thousands of schools​ (Crooks et al., 2022).

The outcomes in these countries make clear that policy commitment must be coupled with practical support: funding streams for training and staff, integration of mental health services into schools such as school counsellors or links to health professionals, and monitoring and evaluation to track progress. Southeast Asian nations can draw on these lessons by formulating or updating policies that designate mental health as a core component of education. This includes allocating budgets for training and resources, enacting guidelines for schools to follow such as minimum hours of mental health instruction or support services per school, and establishing multi-sector task forces (education, health, social welfare) to oversee implementation.

The evidence echoes prior research on the critical role of government support in scaling up interventions​. In short, strong policy architectures in high-income settings have enabled systematic mental health education; similar commitment in Southeast Asia will be necessary to move from isolated pilot projects to sustainable, nationwide programmes.

Digital Innovation and Accessibility

Digital tools are emerging as powerful enablers for mental health education and support in schools, especially to overcome geographic and resource limitations. In Southeast Asia, our review found growing use of tele-counselling platforms, online teacher training modules, and self-screening apps in countries like Malaysia, Indonesia, and Singapore. These innovations show promise in expanding access to knowledge and services – for example, Malaysia’s tele-counselling initiatives and Indonesia’s digital literacy programmes have broadened reach beyond urban centres​. However, significant barriers persist, such as limited digital literacy among older teachers and inadequate technology infrastructure in rural or remote areas​.

High-income countries have likewise harnessed technology to bolster school mental health, particularly during the COVID-19 pandemic which necessitated remote approaches. Australia’s Be You programme exemplifies how digital delivery can achieve scale: the platform provides webinars, e-learning modules, and virtual coaching, making professional development on mental health accessible regardless of location​ (Victorian Government, 2024). The fact that a majority of Australian schools engage with this online platform demonstrates how internet-based models can surmount barriers of distance.

In Japan, as mentioned, digitising the daily health observation system has modernised a traditional practice and enabled the analysis of student well-being data at an unprecedented scale​ (Nishimura et al., 2024). Other innovations in high-income contexts include web-based simulations for teacher training, as in the UK, and integrated data systems that connect schools with mental health professionals, as seen in some Canadian districts. These examples show that digital solutions can amplify the impact of mental health initiatives by providing flexible, on-demand resources and by connecting school communities to a wider support network.

For Southeast Asia, investing in technology for mental health education is a high-yield strategy. Policymakers should consider dedicated funding for improving internet connectivity in schools, training educators in digital tool use, and developing localised e-health content, for instance, videos or mobile apps in local languages addressing common psychological issues. Importantly, adopting digital innovation goes hand-in-hand with addressing equity: ensuring that rural or under-resourced schools are not left behind in the digital rollout. High-income countries are actively addressing the digital divide such as Japan’s one-tablet-per-student policy to ensure equitable access​ (Nishimura et al., 2024), and Southeast Asia could pursue similar initiatives.

By leveraging technology, Southeast Asian education systems can overcome shortages of mental health professionals and provide teachers and students with support that is scalable and cost-effective. Digital platforms, when integrated thoughtfully, can connect even the most isolated schools with training, expertise, and emergency mental health services, thereby democratising access to mental health support across the region.

Implications from Global Best Practices

Overall, the comparisons above reveal that Southeast Asia’s efforts, while on the right track, often lack the scale and integration achieved in high-income settings. International models underscore the importance of whole-school approaches, sustained capacity-building, and robust policy backing for mental health in education. Southeast Asian countries will need to adapt these lessons to their specific contexts, balancing resource constraints with innovative strategies.

Notably, this review aligns with prior literature emphasising culturally sensitive, evidence-based interventions (Munawar et al., 2022; Kim et al., 2022) but extends those insights by explicitly linking regional findings to global standards. The imperative now is to translate awareness into concrete action, learning from what has worked elsewhere to inform context-appropriate solutions. Policymakers and educators in Southeast Asia should view global best practices not as one-size-fits-all prescriptions, but as guideposts for strengthening their own mental health education frameworks.

Limitations

Despite its contributions, this review has several limitations. First, the reliance on English-language and publicly accessible documents may have excluded valuable insights from locally published studies in vernacular languages. This limitation is particularly relevant in a region as linguistically diverse as Southeast Asia. Second, the heterogeneity in study methodologies and reporting standards poses challenges for generalisability. While the thematic synthesis approach mitigates some of these issues, future research should aim to standardise reporting practices to facilitate cross-study comparisons.

Future Research Directions

To address the identified gaps and build on the findings of this review, future studies should:

Employ mixed methods designs to assess both the immediate and long-term impacts of teacher training programmes on student mental health outcomes.

Develop and evaluate digital literacy interventions tailored for veteran teachers, particularly in rural and resource-limited settings.

Conduct comparative trials across different Southeast Asian contexts to identify universally effective strategies and culturally specific adaptations.

Explore the role of community-based approaches, such as parent-teacher collaborations and youth-led advocacy, in reducing stigma and enhancing programme sustainability.

CONCLUSION

This review demonstrates that integrating mental health education into teacher training is a critical step toward fostering early intervention and support for child mental health in Southeast Asia. While significant progress has been made, particularly in raising awareness and piloting innovative programmes, systemic gaps in continuous professional support, digital literacy, and cultural adaptation remain.

To address these challenges, policymakers and educators must prioritise the following strategies:

Embedding mental health modules into preservice teacher education to build foundational knowledge and skills.

Establishing structured mentorship and professional development programmes to provide ongoing support for teachers.

Leveraging digital innovations, such as telehealth platforms and e-learning modules, to expand access to mental health resources, particularly in rural and underserved areas.

Designing culturally sensitive interventions that align with local values and norms to reduce stigma and increase community acceptance.

By implementing these strategies, Southeast Asian countries can enhance teacher efficacy, promote sustainable mental health initiatives in schools, and create supportive learning environments that foster resilience among young populations. These efforts are not only essential for improving child mental health outcomes but also for advancing the broader goal of equitable and inclusive education in the region.

ACKNOWLEDGMENT

The authors wish to thank the anonymous reviewers for their insightful feedback and constructive suggestions. We also extend our gratitude to the Editor for their guidance throughout the review process and to all contributors involved in the development of this work.

REFERENCES

1. (2024). Mental health initiative shows benefits for educators and children. https://www.acer.org/au/discover/article/mental-health-initiative-shows-benefits-for-educators-and-children
2. Ahmad, A. S., & Ismail, H. N. (2024). Social‑emotional learning and teacher competency: A systematic review of emotional resilience. Journal of Contemporary Social Science and Education Studies, 4(3, Special Issue), Article 9. https://doi.org/10.5281/zenodo.13883420
3. Brooks, H., Irmansyah, I., Lovell, K., Savitri, I., Utomo, B., Prawira, B., … Bee, P. (2019). Improving mental health literacy among young people aged 11–15 years in Java, Indonesia: Co‑development and feasibility testing of a culturally‑appropriate, user‑centred resource (IMPeTUs) – a study protocol. BMC Health Services Research, 19, 484. https://doi.org/10.1186/s12913-019-4328-2
4. (2018). CASP (Qualitative) checklist. https://casp-uk.net/casp-tools-checklists/
5. Cong, F., & Oyam, D. M. (2024). The role of teacher training in addressing student mental health issues in the classroom. International Journal of Social Science and Humanities Research, 12(2), 313–318. https://doi.org/10.5281/zenodo.12591677
6. Crooks, C. V., Fortier, A., Graham, R., Hernandez, M. E., Chapnik, E., Cadieux, C., & Ludwig, K. A. (2022). Implementing a brief evidence-based Tier 2 school mental health intervention: The enablers and barriers as seen through a clinical team supervisor lens. Canadian Journal of Community Mental Health, 41(3), 139-156. https://doi.org/10.7870/cjcmh-2022-017
7. Deighton, J., Thompson, A., Humphrey, N., Thornton, E., Knowles, C., Patalay, P., … & Boehnke, J. R. (2025). Effectiveness of school mental health and wellbeing promotion: Universal approaches in English primary and secondary schools. Project Report. Department for Education. https://www.gov.uk/government/publications/education-for-wellbeing-programme-findings
8. Firdausi, K. (2019). A literature review: The use of the PROSPER model in guidance and counseling services for improving students’ mental health. SHEs: Conference Series, 2(2), 24–33. Retrieved from https://jurnal.uns.ac.id/shes
9. Gestiardi, R., Mustakim, S. S. B., Subanji, T. N., & Alfan, M. (2024). Teacher noticing in reviewing student anxiety and engagement in the classroom: A systematic literature review. Journal of Institutional Research South East Asia, 22(3), 99–119.
10. Giang, T.-V., & Huynh, V.-S. (2022). The impact of Confucianism on social and emotional health of Vietnamese adolescents: A phenomenological study. Acta Psychologica, 229, 103700. https://doi.org/10.1016/j.actpsy.2022.103700
11. Hidayati, H. N., Bahrul Hayat, B., & Rahayu, W. (2021). Assessment of the validity and reliability of mental health instruments of high school students in Indonesia. European Journal of Educational Research, 10(2), 729–742. https://doi.org/10.12973/eu-jer.10.2.729
12. Hoare, E., Thorp, A., Bartholomeusz-Raymond, N., McCoy, A., Butler, H., & Berk, M. (2020). Be you: a national education initiative to support the mental health of Australian children and young people. Australian & New Zealand Journal of Psychiatry, 54(11), 1061-1066. http://doi.org/10.1177/0004867420946840
13. Hussin, N. A. M., Othman, A., Awang Bono, S., Syed Jamaluddin, S. S., May Yee, L., & Ee Woon, K. (2024). Challenges in implementing online‑based suicide prevention strategy for Malaysian adolescents from a human ecological perspective. Malaysian Journal of Medicine and Health Sciences, 20(Supp3), 111–117. https://doi.org/10.47836/mjmhs20.s3.17
14. (2020). JBI critical appraisal tools. https://jbi.global/critical-appraisal-tools
15. Kawahata, Y. (2023, October). Transitioning to the Digital Generation: An Examination of the GIGA Initiative (2019-) and Usage Patterns of Educational Smartphone Apps: A Case Study of Anonymous Students’ Learning in the COVID-19 Vortex. In 2023 IEEE/WIC International Conference on Web Intelligence and Intelligent Agent Technology (WI-IAT) (pp. 616-623). IEEE. http://doi.org/10.1109/WI-IAT59888.2023.00101.
16. Kim, J., Kim, D. G., & Kamphaus, R. (2022). Early detection of mental health through universal screening at schools. Georgia Educational Researcher, 19(1), 62. https://doi.org/10.20429/ger.2022.190104
17. Kok, J. K., & Low, S. K. (2019). Risk factors contributing to vulnerability of mental health disorders and the protective factors among Malaysian youth. International Journal of School & Educational Psychology, 7(2), 102–112. https://doi.org/10.1080/21683603.2018.1499573
18. Le, T., Dang, H.-M., & Weiss, B. (2022). Prevalence of adverse childhood experiences among Vietnamese high school students. Child Abuse & Neglect, 128, 105628. https://doi.org/10.1016/j.chiabu.2022.105628
19. Lea, S. Q., Buib, D. T. T., Hoang, H. T., Leb, D. T., & Luc, H. T. T. (2024). Experimental mental health understanding program for high school students. Multidiscip. Sci. J., 6, e2024253. https://doi.org/10.31893/multiscience.2024253
20. Liao, Y., Ameyaw, M. A., Liang, C., Li, W., Ji, Y., & An, Z. (2023). Effects of evidence‑based intervention on teachers’ mental health literacy: Systematic review and a meta‑analysis. Sustainability, 15, 8981. https://doi.org/10.3390/su15118981
21. Munawar, K., Mukhtar, F., Choudhry, F. R., & Ng, A. L. O. (2022). Mental health literacy: A systematic review of knowledge and beliefs about mental disorders in Malaysia. Asia‐Pacific Psychiatry, 14(1), e12475. https://doi.org/10.1111/appy.12475
22. Muniandy, P. (2024). Examining the role of mental health literacy programs in schools in enhancing help‑seeking behaviors among adolescents in Malaysia: A systematic literature review. Asia‑Pacific Journal of Business, Humanities and Education, 75 – 92. https://apjbhe.segi.edu.my/index.php/segi/article/view/117
23. Nguyen, T. N., & Mai, L. H. (2024). Child sexual abuse in Vietnam: A review of prevalence, risk factors, and prevention strategies. Multidiscip. Rev., 7, e2024269. https://doi.org/10.31893/multirev.2024269
24. Nishimura, T., Wakuta, M., Osuka, Y., Tsukui, N., Hirata, I., Takahashi, M., … & Senju, A. (2024). Early detection of students’ mental health issues from a traditional daily health observation scheme in Japanese schools and its digitalization. Frontiers in Public Health, 12, 1430011. https://doi.org/10.3389/fpubh.2024.1430011
25. Nishio, A., Tempongko, S. B., & Kobayashi, J. (2019). Current situation and comparison of school mental health in ASEAN countries. Pediatrics International. https://doi.org/10.1111/ped.14137
26. Ojio, Y., Shiozawa, T., Gregorio, E. J. R., & Hernandez, P. M. (2024). An international interdisciplinary approach to developing video educational materials promoting mental health literacy among adolescents in the Philippines. Early Intervention in Psychiatry. https://doi.org/10.1111/eip.13545
27. Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., … & Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 372(71), 1 – 9.  https://doi.org/10.1136/bmj.n71
28. Phoa, P. K. A., Ab Razak, A., Kuay, H. S., Ghazali, A. K., Ab Rahman, A., Husain, M., Bakar, R. S., & Abdul Gani, F. (2023). Predictors of mental health literacy among parents, guardians, and teachers of adolescents in West Malaysia. International Journal of Environmental Research and Public Health, 20(1), 825. https://doi.org/10.3390/ijerph20010825
29. Punneng, S., Arphorn, S., Thanachoksawang, C., Bangkadanara, G., Tangtong, C., Maruo, S. J., Chantra, N., Yogyorn, D., & Ishimaru, T. (2024). Developing a high school mental health action checklist in Thailand: Insights on perception and communication. Frontiers in Public Health, 12, 1437957. https://doi.org/10.3389/fpubh.2024.1437957
30. Putri, I. N. E. H., & Kristiana, I. F. (2024). Teacher training programs in preventing mental disorders for school students: A scoping review. In ICPSYCHE Conference Proceedings (pp. [1–8]). European Alliance for Innovation. http://dx.doi.org/10.4108/eai.24-7-2024.2354395
31. Regalado, R. A. (2024). Academic stress and coping self‑efficacy of senior high school students attending distance learning during the SARS‑CoV‑2 pandemic. Malaysian Journal of Learning and Instruction, 21(1), 39–66. https://doi.org/10.32890/mjli2024.21.1.2
32. Roshan, R., Hamid, S., Kumar, R., Hamdani, U., Naqvi, S., Huma, Z.-E., & Adeel, U. (2024). Utilizing the CFIR framework for mapping the facilitators and barriers of implementing teacher‑led school mental health programs – a scoping review. Social Psychiatry and Psychiatric Epidemiology. https://doi.org/10.1007/s00127-024-02762-7
33. Saputra, N. M. A., Muslihati, M., Ramli, M., Sobri, A. Y., Madihie, A., & Fitriyah, F. K. (2024). Digital literacy as an indicator of adolescent mental health and implementation for the role of school counselor: A systematic literature review. South Eastern European Journal of Public Health, 23(3), 221-234. http://doi.org/10.70135/seejph.vi.841
34. Scott, E. (2024). Mental health, wellbeing and personal development in schools. House of Lords. https://lordslibrary.parliament.uk/mental-health-wellbeing-and-personal-development-in-schools/#:~:text=government%20has%20also%20committed%20to,places%20to%20educational%20mental%20health
35. Singh, Y. K., & Gautam, D. N. S. (2024). The impact of job satisfaction on teacher mental health: A call to action for educational policymakers. Open Education Studies, 6, 20240008. https://doi.org/10.1515/edu-2024-0008
36. Soneson, E., Howarth, E., Weir, A., Jones, P. B., & Fazel, M. (2024). Empowering school staff to support pupil mental health through a brief, interactive web-based training program: mixed methods study. Journal of Medical Internet Research, 26, e46764. https://doi.org/10.2196/46764
37. Teo, J. X., Lau, B. T., & Then, P. (2020). Autism spectrum disorders in Sarawak: An overview and analysis of educator awareness, training, development opportunities, and challenges. International Journal of Disability, Development and Education. https://doi.org/10.1080/1034912X.2020.1731433
38. UNICEF, National Institutes of Health Malaysia, & Burnet Institute. (2022). Strengthening Mental Health and Psychosocial Support Systems and Services for children and adolescents in the East Asia and Pacific region. UNICEF Malaysia. https://www.unicef.org/eap/reports/strengthening-mental-health-and-psychosocial-support-systems-and-services
39. Victorian Government. (2024). Be You. https://www.vic.gov.au/be-you
40. Wardani, R. K., Paek, S. C., Ratanawijitrasin, S., & Phukhao, D. (2023). Exploring the implementation of the school-based mental health program for adolescents in Indonesia: A mixed-methods study. Public Health of Indonesia, 9(4), 164-176. https://doi.org/10.36685/phi.v9i4.751
41. Weist, M. D., Hoover, S. A., Daly, B. P., Short, K. H., & Bruns, E. J. (2023). Propelling the Global Advancement of School Mental Health. Clinical Child and Family Psychology Review, 26(4), 851–864. https://doi.org/10.1007/s10567-023-00434-7
42. Weiss, B., Dang, H.-M., Le, G., Vu, V., & Forman, S. (2023). Mixed‑methods needs assessment for development of school‑based mental health implementation science capacity in low‑ and middle‑income countries: Vietnam as a case example. Manuscript submitted for publication. https://dx.doi.org/10.1037/spq0000586
43. (2015). Regional mental health trends in Southeast Asia: A baseline study. WHO Press.