Children’s mental health promotion aims to create supportive living conditions and reduce harmful mental health risk factors (Klemera et al. 2017; Min et al. 2017; WHO 2001). Early childhood education and care and basic education are key development environments in which children’s well-being and mental health promotion can be significantly affected (Barry & Jenkins 2007). The promotion of mental health in the environments of everyday life affects the well-being of the individual in a long term; therefore, early intervention is particularly important in children's mental health problems (Cefai & Camilleri 2015). In a school environment an implementation of a structured and systematic plan for the health and well-being of all pupils and of teaching and non-teaching staff strengthens healthy settings for living, learning, and working (SHE Network 2020). In Finland, basic education is a single-structure system that provides compulsory schooling for all young people between 7 and 15 years and in grades 1–9 (Ministry of Education and Culture 2021). Finnish education system includes early childhood education and care, which refers to children’s planned education and care. It is an important step in a child’s growth and learning path. The right to participate in early childhood education and care is subjective, meaning that all children under school age can participate in it. (EDUFI 2021.)

Like many countries of Northern Europe, Finland is a parliamentary democracy with a majority in parliament (The Nordic Council and the Nordic Council of Ministers 2021). Municipal administration, in turn, is based on the self-government of municipalities. Municipalities have the overall responsibility for mental health promotion of children. Municipalities have a dual management system, which means that local authority management is characterized by division into political and professional management. Political management consists of decision-makers elected to municipal councils, boards, and committees. Professional management, in turn, consists of leading office holders who act as professional representatives of the administration and participate extensively in the various stages of the decision-making process in their area of administration, such as early childhood education and care, and basic education. (Local Government Act of Finland 410/2015; Constitution of Finland 731/1999.)

Public health nurses in child health clinics and schools assess the physical, mental, and social condition of children, provide vaccinations, support parents, and promote healthy growing environments for children and healthy family lifestyles (Student Welfare Act of Finland 1287/2013; Health Care Act of Finland 1326/2010; Government decree 338/2011). Although public health nurses generally aim to promote mental health in children, it is also important for them to identify the risks for potential mental disorders during childhood.

Knowledge on mental health promotion in children is widely available (Drange & Havnes 2019; Neuhaus et al. 2020). However, there is a need to obtain stronger and broader evidence about these issues from the perspective of political decision-makers and leading officeholders in municipal administrations, as well as professionals working with children, such as public health nurses (O’Reilly et al. 2018). The socioecological model of health promotion (Stokols 1996) formed a theoretical framework for this study. The model covers both risk and promotive factors at five levels of the socioecological environment (i.e., individual, interpersonal, organizational, community, and public policy). This study aimed to describe promotion of children’s mental health at the organizational level of the socio-ecological environment, specifically in the early childhood education and care, and basic education from the perspective of political decision-makers and leading officeholders, as well as public health nurses.

Using qualitative research methodology, open-ended semi-structured individual interviews were conducted in Finland interviewing public health nurses, who worked at maternity and child health services or at school health care (n=23), policymakers from municipal councils, municipal governments, and committees and leading officeholders from different service sectors as part of the city’s service organization, including social and health services, growth and learning, wellbeing promotion, and environment (n=25; Denzin & Lincoln 2008). Purposive sampling was used to identify potential participants who would produce rich, dense, and focused information on children’s mental health issues (Curtis et al. 2000). Potential participants’ contact information was obtained from nursing managers, public websites of the municipalities and municipal administrative services. The interview guide was developed based on previous literature and the socio-ecological model of health promotion (Stokols 1996). A pilot interviews confirmed the feasibility of the interview guide. The themes were provided to the participants one week before their interviews to familiarize them. In total, 48 participants were recruited in person, gave their consent, and were interviewed face to face or by telephone by the first author between September and November 2019. The Interviews continued until data saturation was reached. The interviews lasted between 21 and 68 minutes and were recorded and transcribed. Ethical approval for the study was obtained from the Ethics Committee of the university (statement 5/2019, 17.4.2019). In addition, a research permit was obtained separately from each municipal administration and organization involved in our study. Written informed consent was obtained from all participants. The data were analyzed using inductive content analysis (Vaismoradi et al. 2013). The transcribed texts were read several times to obtain an overall impression, and the data were reviewed for their content. Meaning units were sentences or phases (Graneheim & Lundman 2004), and they were chosen in line with the purpose of the study. Meaning units derived were condensed and coded for the identified categories. In the analysis, the similarities and differences between the meaning units were compared, and categories and subcategories were created based on the comparison. An initial reading of the transcripts was conducted by the first author. Preliminary coding and the final analysis were validated by all authors.

Political decision-makers, officeholders, and public health nurses described promotion of children’s mental health in the early childhood education and care, and basic education. In the early childhood education and care, all participant groups pointed the importance of small group sizes, and adequate and qualified staff. Collaborating between early childhood education and care, child health clinic, social care, and parents/guardians was also seen as paramount. In addition, political decision-makers and officeholders highlighted that early childhood education and care promotes children’s mental health by responding to basic needs, enabling the development of social skills, organizing suitable facilities, setting safe boundaries, and maintaining circadian rhythms. Public health nurses described that enabling all children to participate in day care was important in itself from the perspective of children’s mental health. According to participants, taking care of friendship issues, tackling bullying, as well as multiprofessional collaboration within the school and between school and other parties working with children and parents promoted children’s mental health at school. Political decision-makers and officeholders raised also the importance of small group sizes, guided activities, promotion of inclusion and equality, prevention of exclusion, and teacher training and supervision. Public health nurses called for lessons and theme days for pupils on emotional and interaction skills, mental health, and about developmental phases. Based on results, political decision-makers, officeholders, and public health nurses had very similar thoughts related to the children’s mental health promotion in the early childhood education and care, and school. However, there were also differences in the responses of different groups. For example, public health nurses called for raising the mental health issues in the educational context. Thus, different perspectives should be taken into account in municipal decision-making to promote children’s mental health in the best possible way.

Klemera, E., Brooks, F.M., Chester, K.L., Magnusson, J. & Spencer, N. 2017. Self-harm in adolescence: protective health assets in the family, school and community. International Journal of Public Health, 62, 631-638. Min, K., Kim, H., Kim, H. & Min, J. 2017. Parks and green areas and the risk for depression and suicidal indicators. International Journal of Public Health, 62, 647-656. World Health Organization. 2001. Mental health: New understandings, new hope. The world health report. Available at https://www.who.int/whr/2001/en/whr01_en.pdf?ua=1. Barry, M.M. & Jenkins, R. 2007. Implementing mental health promotion. Edinburgh: Elsevier. Cefai, C. & Camilleri, L. 2015. A healthy start: promoting mental health and well-being in the early primary school years. Emotional and Behavioural Difficulties, 20(2), 133–152. Ministry of Education and Culture. 2021. Basic education. Available at https://okm.fi/en/basic-education. EDUFI. 2021. Finnish education system. Available at https://www.oph.fi/en/education-system. The Nordic Council and the Nordic Council of Ministers. 2021. Nordic Co-operation. Available at https://www.norden.org/en. Local Government Act of Finland 410/2015. Constitution of Finland 731/1999. Student Welfare Act of Finland 1287/2013. Health Care Act of Finland 1326/2010. Government decree on maternity and child health clinic services, school and student health services and preventive oral health services for children and youth 338/2011. Drange, N. & Havnes, T. 2019. Early childcare and cognitive development: Evidence from an assignment lottery. Journal of Labor Economics, 37(2), 581-620. Neuhaus, R., McCormick, M. & O’Connor, E. 2020. The mediating role of child-teacher dependency in the association between early mother-child attachment and behavior problems in middle childhood. Attachment & Human Development. doi:10.1080/14616734.2020.1751989 O’Reilly, M., Svirydzenka, N., Adams, S. & Dogra, N. 2018. Review of mental health promotion interventions in schools. Social Psychiatry and Psychiatric Epidemiology, 53(7), 647-662. Stokols, D. 1996. Translating social ecological theory into guidelines for community health promotion. American Journal of Health Promotion: AJHP, 10(4), 282-289. Denzin, N. K. & Lincoln, Y. (Eds.). 2008. The Landscape of Qualitative Research. SAGE Publications. Curtis, S., Gesler, W., Smith, G. & Washburn, S. 2000. Approaches to sampling and case selection in qualitative research: Examples in the geography of health. Social Science & Medicine, 50(7-8), 1001-1014. Vaismoradi, M., Turunen, H. & Bondas, T. 2013. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nursing & Health Sciences, 15(3), 398-405. Graneheim, U. H. & Lundman, B. 2004. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24(2), 105-112.