Effectiveness of the program
mental illness
The program was effective in reducing schoolteachers’ difficulty in supporting children of parents with mental illness. The effect sizes were as large as –0.90 (FAS) and –0.86 (PPS). Goal attainment was also effective for over one month. Few studies on mental health interventions for schoolteachers have been conducted using RCTs [Although exploratory in nature, this program was found to be particularly effective for those with higher scores (higher difficulty in support) on the Sense of Coping Difficulty subscale. The program included what children appreciated about their schoolteachers, such as staying close to them and listening to them. In the analysis of the open-ended text response, many schoolteachers planned to continue to stay close to the children. Staying close to children does not require schoolteachers to develop any specialized skills in dealing with mental illness. This may have given schoolteachers the confidence to provide support.Knowledge was effective up to the T3; the correct response rate of “mental illness affects 1 in 5 people in their lifetime (no. 1),” and “half of those affected by mental illness develop the illness by their mid-teens (no. 6).” These items were objective measures of the onset timing and probability of onset. However, no significant effects were found for items not expressed numerically (no. 4, 5, 7, 8, 10). Many previous programs on schoolteachers’ mental health literacy have also been effective in increasing knowledge [For actual behaviors and attitude, only “looked at children from the perspective of a child in need of support” had a significant effect in the past month, whereas “recognized the presence of a child(ren) in need of support” and “consulted within the school about a child(ren) in need of support” had no significant effect. There were significant effects on goal attainment related to confidence at the behavioral level (nos. 4–7). In the analysis of the open-ended text response, “the importance of staying close to children” was the most common impression (21 participants), and “continue to stay close to children” was also the second most common action plan (20 participants). The “view of the children's background” also changed their outlook (16 participants), and they were willing to “look carefully at the children's background” (22 participants). Therefore, it is thought that, although they were able to look at the children from the viewpoint of children in need of support, this was not reflected in changes in their behavior (e.g., recognizing the existence of the children or consulting with the children at school). One possible reason is that the child(ren) in need of support could not be detected in a month. Therefore, a long-term evaluation may help schoolteachers recognize such a child(ren). Another possible reason could be that children are wary of their surroundings because they do not want their parents to be known. A total of 55% of adult children of parents with mental illness reported that they did not show signs that those around them could recognize when they were in elementary school [All program goal achievement scores remained effective up to one month later. We believe that the effect took hold for one month, not only due to the program content but also because of how it was structured. While developing this program, we considered the current lack of social awareness regarding the existence of children with parents having mental illness. Referring to the TTM, the program included self-re-evaluation, and we asked the following questions before providing new knowledge, “Have you ever met a child like this?” Baseline participants’ information indicated that more than half of them had experience working with parents having mental illness. Therefore, it is assumed that the participants recalled children they had met in the past and reflected on their own responses at that time. Furthermore, after watching the independent adult in the video, they may have thought about the aftermath of their own support. It is believed that they could become more confident in their support and more willing to provide support with hope. Though this program involved a short 30-min video, we believe that the structure of this program was also effective in that its effect lasted for one month.