Enhancing rural youth mental health literacy: a case study on stakeholder perspectives on program delivery, outcomes, and strategies for improvement in rural schools

Abstract

Youth suicide remains a significant public health concern in the US, with rural youth experiencing higher rates of suicide and limited access to mental health resources. Schools are often the primary setting for prevention efforts, yet rural contexts face unique barriers to implementing evidence-based mental health literacy programs (MHL). This qualitative case study explored the perceptions of three different types of stakeholders involved in delivering evidence-based MHL programs, like Youth Aware of Mental Health (YAM), in rural Montana schools. The purpose of this study was to identify the essential personnel, resources, and community factors needed to implement and sustain evidence-based MHL programs, while also exploring program outcomes and strategies for improving delivery in rural educational settings. This study also provided an opportunity to explore the possible expansion of the PROSPER model when used to guide the delivery of evidence-based MHL programs for youth. Data were collected through semi-structured interviews with 16 YAM stakeholders. Findings revealed that effective program implementation relies on: the presence of designated and skilled personnel at a university-center and office to manage the program, along with community buy-in, local instructors, supportive community partnerships, and sufficient school resources as necessary elements for program delivery. Participants identified four program outcomes: increased student engagement and connection, improved access to credible mental health resources, greater help-seeking behaviors among youth, and a noticeable reduction in stigma surrounding mental health discussions within schools. Strong partnerships between schools, community organizations, and university-based centers were found to enhance funding stability, training quality, and program oversight. Participants also recommended allowing flexibility within program fidelity to strengthen local adaptation and expand the program's reach. However, challenges such as limited staffing, teacher turnover, and inconsistent resources were identified as barriers that threaten long-term sustainability. This study concludes that evidence-based MHL programs can be successfully implemented and continuously improved in rural schools when supported by designated program personnel at a university-based office (PROSPER+), local expertise, and stable resources. Findings emphasize the importance of investing in rural education personnel and community partnerships to ensure equitable access to high-quality MHL education for youth.