Barriers to Mental and Social Health Programs in Schools: A Qualitative Study

Najmeh Baghian; Mohsen Shati; Ali Akbari Sari; Adel Eftekhari; Atefeh Rasolnezhad; Farhad Nanaei; Batoul Ahmadi

doi:10.18502/ijps.v18i2.12360

Najmeh Baghian Health Management and Policy Research Center, Department of HealthCare Services Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Mohsen Shati Mental Health Research Center, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran.
Ali Akbari Sari Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Adel Eftekhari Health in Emergencies and Disasters, Department of Nursing, Meybod School of Nursing, Shahid Sadougi University of Medical Sciences, Yazd, Iran.
Atefeh Rasolnezhad Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Farhad Nanaei Department of Anesthesiology, School of Medicine, Dezful University of Medical Sciences, Dezful, Iran.
Batoul Ahmadi Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/ijps.v18i2.12360

Keywords: Mental Health; Mental Health Services; Qualitative Study; Schools

Abstract

Objective: In order to achieve development goals, in addition to providing students with physical health, their mental and social health should be considered as a necessity and priority in development programs. This program, called the Nemad Project in Iran was formally established in 2015. This study aims to explore the challenges of the Nemad project in Iranian schools based on stakeholders' views.

Method: The present qualitative study, with a contractual content analysis approach, was conducted on 21 experts in the field of social harm prevention and mental health promotion at the senior, intermediate, and operational levels in educational institutions and schools, Ministry of Health, the Judiciary and the Planning and Budget Organization. These experts also included project technical officers. Participants were selected using snowball and purposeful sampling methods. Data were collected through semi-structured interviews and analyzed by coding, classification, and extraction of the main themes.

Results: Six main themes were derived that included inefficiency in resource management (with subcategories of inadequate facilities and equipment, inadequate human resource management, and information management system deficiencies), weakness in program organization (with subcategories of poor cross-sectoral and weak inter-sectoral subgroups), challenges of laws/regulations/policies (with sub-categories of defective protocols and guidelines and lack of specific task descriptions), barriers and challenges to implementation of policies (with macro and school policy implementation subcategories), structural factors (with subcategories of financial resources allocation problems, inconsistency in managerial levels, and deficiencies in decision-making principles), weaknesses in educational processes (with subcategories of inadequate teacher education, weaknesses in parenting courses, and weaknesses in student education), and ultimately, weaknesses in monitoring and evaluation (with the subcategory of lack of a monitoring and evaluation system).

Conclusion: According to experts, implementation of mental and social programs in schools is not in a desirable situation and is faced with certain challenges. To enhance the management of the Nemad project in Iranian schools, it is necessary to compile flowcharts of service delivery and inter-device communication, allocate resources to meet the expectations of each organization, do performance-based budgeting, take a comprehensive look at parental issues, and design a system of monitoring and evaluating the requirements.