Correspondence on minimizing risk of harm in school-based interventions

This brief correspondence responds to concerns about potential iatrogenic harm from school-based mental health interventions. While acknowledging risks, the authors argue that the advantages of school-based universal interventions for addressing the global shortage of specialized mental health caregivers should be considered. Evidence from school-based research on Kenyan adolescents revealed clinically reliable worsening in 12.42% of participants for depression and 11.78% for anxiety, rates comparatively lower than estimates seen in clinical populations. The correspondence emphasizes that developing scalable, cost-effective interventions is essential given the worldwide mental health treatment gap, particularly in low- and middle-income countries where 95% of randomized controlled trials of youth psychotherapy have not been conducted.