Stakeholder perspectives on the development of a school based mental health programme in Bangladesh: a qualitative needs assessment

Bangladesh, a South Asian country where approximately one-third of the population comprises children and adolescents, has an estimated prevalence of mental disorder of 13.6% among this age group, while the treatment gap remains as high as 94.5%. A whole-school approach, grounded in the Health Promoting Schools (HPS) framework, emphasises school-community partnerships, supportive environments, curriculum integration, and enabling policy support. This study conducted a multi-level needs assessment to identify systemic gaps and capacities to inform the development of a universal school-based mental health programme (SBMHP) for adolescents.

A qualitative needs assessment was undertaken over a two-month period using sixteen focus group discussions and six key informant interviews with students (n = 48), teachers (n = 24), parents (n = 24), and mental health professionals (n = 6). Data were transcribed verbatim and analysed in NVivo 14 using a hybrid thematic approach. Deductive coding was guided by the research questions and interview guides, while inductive coding captured emergent contextual insights. Triangulation across stakeholder groups enhanced analytic rigour. The HPS framework was applied post-analysis as an interpretive lens.

A substantial mismatch emerged between adolescents' mental health promotion needs and schools' capacity to deliver coordinated preventive support. Despite stakeholder awareness, efforts were constrained by fragmented policies, limited institutional capacity, urban-centred tertiary services, and weak school-family-community collaboration. Mapping the findings onto the HPS framework indicated only partial alignment across the domains of governance, environment, curriculum, engagement, and service integration.

The study identifies structural and institutional determinants shaping adolescent mental health promotion in Bangladeshi schools and provides formative evidence to inform the future development of a culturally responsive and scalable school-based mental health promotion programme, contributing to the limited evidence base from low- and middle-income settings.