The purpose of this study was to examine the role of school nurses as providers of mental health support now and in the future.

The study was conducted in two phases. In the first phase, the role of the school nurse was examined through both the national (macro level) and organizational (mezzo level) perspectives. In the second phase, the role was examined through an individual (micro level) perspective. Sub-studies were conducted with a qualitative, descriptive design (Papers I & II); a descriptive, convergent mixed method (posttest only) design (Paper III); and a one-group quasi-experimental (pre- and posttest) design (Paper IV). Participants were the stakeholders in school health care (n=25), public health nurses (n=47), and public health nursing students (n=64). Additionally, feedback from learners (n=2 594) collected from an e-learning course platform was utilized as data.

The results of the first phase indicated that there is no unified future vision for the mental health support provided in school environments, and the role of the school nurse as a provider of this support is unclear. Several national- and organizational-level changes are needed, ranging from legislative amendments to the modeling of procedures. The results of the second phase indicate that school nurses are willing to implement mental health promotion, as well as the prevention and treatment of mental health problems, in their work. Competence in all these areas is needed when working as a school nurse. Participation in the developed e-learning course ‘Mental health promotion in school health care’ was good and the learners were well satisfied with the program. The e-learning course significantly increased participants’ self-efficacy, but more reliable study designs are needed to confirm these results.

The conclusion of the study is that a clear future vision needs to be established, and the macro and mezzo-level needs must be addressed before the potential of school nurses as providers of mental health support is optimally utilized. Because of their expertise in health promotion and prevention, the efforts of school nurses should be directed towards these areas. In line with their expertise, the most suitable role for school nurses would be to provide psychoeducation, involve parents, and promote – with evidence-based methods – health habits that promote mental health, prevent problems, and alleviate symptoms.