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Background  Mental health among adolescents is an important public health challenge. School health services perform central public health functions in Norwegian municipalities, where school nurses are uniquely positioned to educate and promote mental health among adolescents. MEST (MEST is not an acronym; MEST is a short version of the Norwegian word for coping) is a newly developed universal working strategy for school health services that aims to promote positive mental health literacy (MHL) and mental wellbeing in the adolescent population. The aim of this study was to investigate the potential outcome mean differences in positive MHL and mental wellbeing between adolescents who participated and those who did not participate in MEST over a school year.    Methods  This study is based on cohort data collected from 357 adolescents (aged 15–21 years) in five Norwegian upper secondary schools at the beginning and end of the 2016/2017 school year. The data were analyzed by describing mean scores and estimating the average treatment effect (ATE) of MEST on positive MHL and mental wellbeing.    Results  Positive MHL increased significantly more among the MEST participants compared to the non-MEST participants ( p  = .02). No significant change in mental wellbeing was found between MEST and non-MEST participants ( p  = .98). Estimating the ATE of MEST on positive MHL, the MEST participants showed a significant 2.1% increase ( p  = .04) in the potential outcome mean of positive MHL compared to the nonparticipants. Estimating the ATE of MEST on mental wellbeing, the girls who attended MEST exhibited a significant 9.7% increase ( p  = .03) in the potential outcome mean of mental wellbeing compared with the girls who did not attend MEST, while no significant change ( p  = .99) was detected among boys or the entire sample of both genders combined ( p  = .12).    Conclusion  This study found a significant ATE of MEST on positive MHL and on mental wellbeing among girls. The results support further investments in studying MEST as a promising work strategy for school health services to promote adolescent mental health. This initial study of MEST may be used as a foundation for investing in future evaluations of MEST.

bmc health services research

Exploring MEST: a new universal teaching strategy for school health services to promote positive mental health literacy and mental wellbeing among Norwegian adolescents