Scaling School Mental Health in PreK–12 : Implementation Strategies, Systematic Review and Evidence Map in the Middle East and North Africa ( MENA ) Region*

BACKGROUND: Children and adolescents in the Middle East and North Africa (MENA) experience a high burden of mental health problems, yet school-based services remain fragmented. Schools offer a strategic platform for prevention and early intervention, but implementation evidence in MENA is limited. METHODS: We conducted a systematic review and evidence map of PreK-12 school-based mental health and related health-promoting interventions in MENA countries. Searches were conducted from database inception to August 2025. Implementation strategies were coded using the ERIC framework, and implementation outcomes were classified using Proctor's taxonomy. FINDINGS: Twenty-four studies met inclusion criteria. Interventions included targeted mental health programs, universal promotion initiatives, health-promoting curricula with psychosocial components, and digital safety interventions. Common strategies were training school staff, cultural adaptation, and integration into existing routines. Adoption and feasibility were frequently reported; fidelity, sustainment, cost, and equity outcomes were rarely assessed. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Strengthening school mental health in MENA requires policy integration, structured workforce support, equity-focused implementation metrics, and sustainable financing mechanisms. CONCLUSIONS: School-based mental health interventions are increasing across MENA, but systematic implementation planning is essential for long-term scale and impact.