Skolans samlade elevhälsa ska utgöra en helhet som bistår verksamheten med hälsofrämjande och förebyggande insatser. De ska bedriva ett målinriktat arbete och skapa lärmiljöer som både främjar elevers hälsa och lärande. Trots detta, finns det forskning som visar att elevhälsan står inför stora utmaningar rörande tillämpningar av hälsofrämjande insatser. Mot denna bakgrund är syftet med föreliggande studie att belysa hur elevhälsan arbetar hälsofrämjande med skolelevers psykiska hälsa. Studien har en kvalitativ metod och är baserad på semistrukturerade intervjuer. Genom ett målstyrt urval har fem personer intervjuats som arbetar med elevhälsa inom tre olika högstadieskolor i Västmanland. De tillför skolorna med olika arbetsinsatser och omfattar yrkestitlar som skolsköterska, specialpedagog och kurator. Det insamlade intervjumaterialet har analyserats med hjälp av en manifest innehållsanalys och försett studiens resultat med två kategorier; ”Skola som hälsofrämjande arena” och ”Utvecklingsbehov i elevhälsoarbetet”. Det framkomna resultatet visar att elevhälsan tillämpar insatser som syftar till att stärka elevernas delaktighet och arbetar aktivt för att de ska tillses med positiva bemötanden. Samtidigt visar resultatet att det föreligger ett flertal organisatoriska faktorer som försvårar det hälsofrämjande arbetets utformning. På grund av bristande tid och oklara mål hamnar arbetet snarare i åtgärdande arbetsgångar.

Mental health is a major child public health issue in Sweden. The overall aims of this thesis are to explore girls’ and boys’ perspectives on mental health and on mental health-promoting initiatives, and to deepen the knowledge of disclosure and support for ado-lescents at risk of abuse and neglect. Four studies are included in the thesis, and a qualitative descriptive design was chosen. In three of the studies (Studies I, II, and III), adolescents in Sweden were interviewed individually or in focus-groups. In the fourth study (IV) officials and politicians in nine municipalities in Sweden were interviewed, and documents were analysed in a multiple-case-study design. In study I the adolescents were asked about the mental health-promoting dialogue with the school nurse. The results reveal that what the adolescents found important were trustiness, attentiveness, respectfulness, authenticity, accessibility, and continuity. The adolescents also had certain views on what issues to talk about in the health dialogue; physical and psychological issues should be included. In Study II, the adolescents perceived “mental health” to be an emotional experience with positive and negative aspects of internal and relational feelings. Family, friends, and school were regarded as important determinants of mental health by the adolescents. Neither girls nor boys thought that there were any major differences in mental health between girls and boys, but did think they were subject to different expectations. In Study III the results show that adolescents with families with alcohol problems are unsure whether to disclose their home situation to an adult; the adolescents seem to make a risk assessment when looking for trustworthy adults. It is a disclosure process. Friends are confidants and supportive, and sometimes facilitators for contacting adults, when support from adults is needed. Study IV show that even small grants to municipalities for children-at-risk projects lead to more activities for these children and adolescents. But children or adolescents were not involved in the planning or decision-making of the activities. The studies in this thesis show that most important thing for adolescents’ mental health is the relation between adolescents and adults, foremost parents, and between adolescents and friends. In addition, gender and age, adolescents’ perspec¬tives and par-ticipation, and society’s support, including the implementation of the UN Convention on the Rights of the Child, have an impact on adolescents’ mental health, both for ado-lescents in general and for adolescents at risk of abuse and neglect. The results are viewed in relation to the bioecological model, to illustrate how all levels in society influence mental health among adolescents, on an individual and a population plane. The findings have implications for adults: to learn more about adolescents and puberty, and about the home situation for children and adolescents at risk of abuse and neglect; to listen to suggestions from children and adolescents; to include friends in support to adolescents at risk of abuse and neglect; and to include girls and boys in all matters concerning them.

School counsellors have been an occupation in Sweden since the 1940s but despite this, there is very little knowledge and research about school counsellors’ preconditions according to their work. This study aims to examine in what frequencies school counsellors’ use evidence-based methods in their work with students in senior high school. The result is based on a survey with N 215 respondents from all over Sweden and the analysis theoretical perspective is founded on evidence-based practice (EBP) and new institutional theory. The result indicates that school counsellors in Sweden do not use evidence-based methods to such an extent and that there are organisational and structural obstacles for school counsellors to base their work from evidence-based practice. There is a decoupling process where ideals of EBP do not match the reality as different kinds of logic appear and come into conflict with each other over whose legitimacy is the one that should dominate the organizational field. To increase the conditions, a school management that provides support and enables professional guidance and competence development is needed. The research field needs to start looking at the school counsellors’ practice from a bottom-up perspective to see what they do that works and develop EBP and the organizational field based on this. This is one way to give school counsellors’ more legitimacy.