Can Place-Based Approaches Improve Adolescent Mental Health? The Evidence is (Surprisingly) Thin

by Jon Scaccia March 26, 2025

What if the secret to better adolescent mental health wasn’t found in a therapist’s office, but in the streets, schools, and parks of a community? That’s the promise of place-based approaches (PBAs)—collaborative efforts between multiple sectors, like public health officials, schools, and community groups, to improve health by changing the environments where young people live.

It makes sense on paper. If we know that poverty, lack of green spaces, and limited access to community resources contribute to poor mental health, wouldn’t targeting these root causes be an effective solution?

A recent systematic review set out to answer this question, analyzing whether PBAs have successfully improved adolescent mental health or reduced substance use. The results? While some PBAs showed promise in reducing alcohol use, the evidence for improving mental health is, at best, underwhelming.

So what’s going wrong? And does this mean we should abandon PBAs altogether? Let’s take a closer look.

What the Research Says

The review examined 33 studies evaluating 22 PBAs that targeted adolescent mental health or substance use. These initiatives, implemented in high-income countries over the past 40 years, ranged from urban revitalization projects to school-based programs and substance prevention campaigns.

Here’s what the evidence suggests:

• Mental Health Outcomes: Higher-quality studies found little to no improvement in adolescent mental health, even after years of implementation. Depression, anxiety, and overall well-being remained largely unchanged.
• Substance Use Outcomes: Some PBAs had positive effects on alcohol use—particularly delaying the first drink and reducing occasional use. However, evidence was mixed for binge drinking and drug use.
• Longevity of Impact: Most of the positive effects on substance use diminished after five years.

These findings challenge the widely held assumption that community-level interventions can meaningfully improve adolescent mental health. But before we dismiss PBAs, it’s important to explore why they might not be working as expected.

Why Haven’t PBAs Worked for Mental Health?

If PBAs have successfully reduced alcohol use, why haven’t they helped with mental health? The review suggests several possible reasons:

• Lack of Evidence-Based Mental Health Interventions: Unlike substance use programs, which often rely on proven prevention strategies (like limiting alcohol availability to minors), mental health interventions at the community level are less established. Schools and communities might be implementing well-intentioned but unproven initiatives.
• Difficulties in Measurement: Mental health is complex. Unlike substance use, which can be tracked with surveys on drinking habits, measuring improvements in well-being or resilience is more subjective and long-term. Many PBAs may not be assessing the right metrics or looking at impacts over a long enough period.
• Structural Barriers: Addressing mental health at the community level requires tackling deep-rooted inequalities—poverty, unstable housing, and systemic stressors. A park renovation or community program, while helpful, might not be enough to move the needle on large-scale mental health trends.
• Implementation Challenges: Many PBAs rely on local governments and organizations working together. Collaboration is messy—some programs may struggle with leadership turnover, funding limitations, or poor coordination.

What PBAs Have Done Well

While the findings on mental health are discouraging, PBAs aren’t a lost cause. Some strategies have shown potential, particularly in substance use prevention.

• Delaying Alcohol Use: Programs like Communities That Care and the Icelandic Prevention Model have successfully delayed the age at which teens start drinking, which is linked to lower risk of alcohol-related problems later in life.
• Community Engagement: PBAs that actively involve local youth and residents in shaping interventions tend to perform better than top-down initiatives imposed by external organizations.
• Holistic Approaches: Programs that address multiple aspects of a young person’s environment—family, school, and community—are more likely to see positive effects.

What’s Next?

So where do we go from here? If PBAs haven’t significantly improved adolescent mental health, should we stop investing in them? Not necessarily. But the research suggests we need to rethink how they are designed and evaluated.

• Develop Stronger Mental Health Interventions: Community initiatives should incorporate more evidence-based mental health strategies, such as resilience-building programs or early intervention services.
• Improve Measurement and Evaluation: Instead of only looking at broad mental health outcomes, programs should track intermediate steps, like improvements in social connections, self-efficacy, or stress reduction.
• Address Systemic Barriers: PBAs alone might not be enough. Real change may require policies that tackle poverty, housing instability, and educational disparities alongside community-based efforts.
• Use a Systems Approach: Mental health interventions should consider how different factors—education, housing, employment—interact. Viewing communities as dynamic systems, rather than isolated interventions, may yield better results.

Join the Conversation

Do these findings surprise you? Have you seen successful place-based mental health programs in your community? What do you think is the missing ingredient for making PBAs work?

Share your thoughts in the comments or join the discussion on social media. Let’s talk about how we can better support young people’s mental health where they live, learn, and grow.

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