Debate: Where to next for universal school-based mental health interventions? Addressing the mental health crisis among young people in low- and middle-income countries.

In their paper, Birrell et al. (Child and Adolescent Mental Health, 2025) are rightly concerned about the future of universal school-based mental health interventions. They highlight the successes and failings of these interventions and demonstrate that there is still much to learn about their potential in preventing or mitigating the onset of common mental health conditions like anxiety, depression, trauma and substance use. But encouragingly, and thanks in part to the potential these interventions hold for addressing the mental health gap in low and middle-income countries (LMIC), the authors advise that we as researchers need to take a step back in order to take a better step forward. They suggest that instead of abandoning ship altogether, we should critically examine the shortcomings of these interventions in their current format and work more closely with young people themselves to design and deliver interventions, which have long-term benefits for their communities. In this paper, we want to emphasise the urgency with which these interventions, developed in this way, are needed in LMIC. We emphasise the need to co-develop, adapt, test and evaluate school-based interventions, and the potential they hold for reducing the burden of mental health care in resource-constrained settings.