Voices from Schools and Experts: Qualitative Insights for Codesigning an Adolescent Mental Health Programme in Bangladesh

Background Globally, one in five adolescents experiences a mental health condition annually, yet in Bangladesh the treatment gap reaches 94.5%. A whole-school approach, grounded in the Health Promoting Schools (HPS) framework, emphasises school–community partnerships, supportive environments, curriculum integration, and enabling policy support. This study conducted a multi-level needs assessment to identify systemic gaps and capacities to inform the co-design of a universal school-based mental health programme (SBMHP) for adolescents. Methods A cross-sectional qualitative needs assessment was undertaken using sixteen focus group discussions and six key informant interviews with students (n = 48), teachers (n = 36), parents (n = 36), and mental health professionals (n = 6). Data were transcribed verbatim and analysed in NVivo 14 using a hybrid thematic approach. Deductive coding was guided by research questions and interview guides, while inductive coding captured emergent contextual insights. Triangulation across stakeholder groups enhanced analytic rigour. The HPS framework was applied post-analysis as an interpretive lens. Results A substantial mismatch emerged between adolescents’ mental health promotion needs and schools’ capacity to deliver coordinated preventive supports. Despite stakeholder awareness, efforts were constrained by fragmented policies, limited institutional capacity, urban-centred tertiary services, and weak school–family–community collaborations. Mapping of findings onto the HPS framework indicated only partial alignment across governance, environment, curriculum, engagement, and service integration domains. Conclusions The study identifies structural and institutional determinants shaping adolescent mental health promotion in Bangladeshi schools and informs the co-design of a culturally responsive, scalable SBMHP, contributing to limited evidence from low- and middle-income contexts.