Background and Objective:
Schools are ideal settings to promote mental health and well-being in youth, but not all schools offer mental health-promoting interventions (MHPIs). Our objectives were to identify school context correlates of MHPI availability in elementary schools, and to characterize MHPIs implemented in study schools according to alignment with evidence-based practices.

Methods:
Data were collected in structured telephone interviews with school principals participating in PromeSS, a cross-sectional study of 171 public elementary schools in Quebec, Canada (2016-19). We examined the association between each of 17 variables related to school context and MHPI availability in multivariable logistic regression models. Cross-case analysis of a convenience sample of 25 MHPIs was used to classify interventions into one of 6 groupings based on a combination of high/moderate/low alignment with the Health Promoting Schools (HPS) framework (i.e., a whole-school approach in conjunction with changes to school culture and environment) and high/low adaptation to school context. Effective implementation practices (formal team, guidelines, training, process and outcome evaluation) were described for each grouping.

Results:
Of 171 schools, 41% reported ≥1 MHPI in the past year. Seven factors were associated with MHPI availability: higher student body socioeconomic status, English language of instruction, mental health issues perceived as important in the school, higher scores for parent/community engagement with the school, and high teacher turnover. Only four (16%) MHPIs were categorized as high alignment with HPS, but three of these were external interventions with low adaptation to school context. Although most other MHPIs had high adaptation to school context, few used a whole-school approach or aligned with evidence-based implementation practices.

Conclusion:
MHPI availability is uneven across schools and is associated with social inequalities and school culture. Future research should investigate how to strengthen school capacity to identify and implement MHPIs that are aligned with evidence-based practices.