Beyond health: A systematic review of cross-sector economic implications of school-based mental health programmes in Europe
1
Chair of Public Health and Health Services Research, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), LMU Munich, Faculty of Medicine, Munich, Germany
2
Pettenkofer School of Public Health, Munich, Germany
3
Care Policy and Evaluation Centre (CPEC), London School of Economics and Political Science (LSE), London, United Kingdom
4
Department of Health Economics and Health Services Research, University Medical Center Hamburg- Eppendorf, Hamburg, Hamburg, Germany
5
Department of Health Policy, London School of Economics and Political Science (LSE), London, United Kingdom
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Mental health problems in children and adolescents impose a substantial and lasting burden on individuals, families, and societies. Schools provide an important setting for prevention and mental health promotion, offering early and equitable access to support. Yet, evidence on their economic impacts beyond the health care sector remains underexplored.
METHODS:
A systematic review was conducted to identify and synthesise economic evaluations of school-based mental health prevention or promotion interventions for children and adolescents in Europe that adopted a societal perspective. Narrative synthesis was performed, assessing monetised outcomes across all societal sectors, with an additional analysis of non-monetised education outcomes. Quality was appraised using CHEERS and CHEC. The review protocol was registered with PROSPERO (CRD420251002160).
RESULTS:
Twenty studies met the inclusion criteria. Among these, four out of five (80%) cost-benefit analyses found that benefits exceeded costs, and nine out of ten (90%) cost-utility analyses reported cost-effectiveness ratios within commonly accepted thresholds. The included evaluations incorporated multiple societal domains—health, education, social care, criminal justice, productivity, and private expenditures. Pronounced cost savings were observed in productivity and health sectors, and improvements were observed in non-monetised educational outcomes
CONCLUSIONS:
School-based mental health interventions generate cross-sectoral economic benefits, supporting both short- and long-term returns on investment. Their impacts extend beyond health outcomes to encompass educational attainment, productivity, and social equity—reinforcing the importance of integrating mental health promotion into broader child and adolescent development policies. The findings underscore the need for rigorous, long-term, economic evaluations from a comprehensive societal perspective, as well as contextualised, policy-oriented studies to inform multisectoral funding and co-financing mechanisms, optimise resource allocation, and ultimately enhance equity in prevention and mental health promotion.
Mental health problems in children and adolescents impose a substantial and lasting burden on individuals, families, and societies. Schools provide an important setting for prevention and mental health promotion, offering early and equitable access to support. Yet, evidence on their economic impacts beyond the health care sector remains underexplored.
METHODS:
A systematic review was conducted to identify and synthesise economic evaluations of school-based mental health prevention or promotion interventions for children and adolescents in Europe that adopted a societal perspective. Narrative synthesis was performed, assessing monetised outcomes across all societal sectors, with an additional analysis of non-monetised education outcomes. Quality was appraised using CHEERS and CHEC. The review protocol was registered with PROSPERO (CRD420251002160).
RESULTS:
Twenty studies met the inclusion criteria. Among these, four out of five (80%) cost-benefit analyses found that benefits exceeded costs, and nine out of ten (90%) cost-utility analyses reported cost-effectiveness ratios within commonly accepted thresholds. The included evaluations incorporated multiple societal domains—health, education, social care, criminal justice, productivity, and private expenditures. Pronounced cost savings were observed in productivity and health sectors, and improvements were observed in non-monetised educational outcomes
CONCLUSIONS:
School-based mental health interventions generate cross-sectoral economic benefits, supporting both short- and long-term returns on investment. Their impacts extend beyond health outcomes to encompass educational attainment, productivity, and social equity—reinforcing the importance of integrating mental health promotion into broader child and adolescent development policies. The findings underscore the need for rigorous, long-term, economic evaluations from a comprehensive societal perspective, as well as contextualised, policy-oriented studies to inform multisectoral funding and co-financing mechanisms, optimise resource allocation, and ultimately enhance equity in prevention and mental health promotion.
| eISSN: | 2654-1459 |
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