Access to mental health care for children and young people has become one of the most complex cross-sectoral challenges in Estonia. Between 2020 and 2025, the number of young people requiring mental health services increased by nearly a third, indicating a clear need for stronger prevention and early intervention.
To address this need, the Estonian Health Insurance Fund (EHIF), in collaboration with the Bullying-Free School Foundation, the National Institute for Health Development, and health promoters at county educational institutions, a pilot project called “Teejuht,” which aims to strengthen schools’ capacity to consciously address and prevent mental health risks, focusing primarily on the prevention of and response to school bullying.
When concerns are identified at school, help reaches the child sooner
Besides home, school is one of the most important developmental environments for a child, where self-esteem, communication skills, and the ability to manage one’s emotions are formed. If the school environment is not safe—whether due to learning difficulties, social tensions, or bullying—the risk of mental health problems worsening increases, and mental health support is often sought only once the difficulties have become more severe.
Developing prevention-oriented approaches in the school environment also broadly supports the availability of mental health care. If problems are identified early and addressed at the primary care level, the pressure on specialized care is reduced, and the child receives needs-based help from the right place at the right time. “The Teejuhi pilot project is part of the Health Insurance Fund’s broader movement toward strengthening prevention and primary care, and it also provides input for implementing the Health Insurance Fund’s new development plan,” explains Maivi Parv, a member of the Health Insurance Fund’s board. The experience and data collected during the pilot will help us better understand how mental health risks can be prevented within the education system and how to support children and young people before problems reach the healthcare system. “Mental health support cannot begin only at a specialist’s appointment. If educational institutions have the clarity and readiness to identify concerns early and respond to them knowledgeably, the child will receive needs-based support sooner,” adds Parv.
A Clear Framework and Focus on Prevention
“Teejuht” is not a ready-made anti-bullying program or training series, but rather a development process that strengthens the school’s own capacity, helping to assess current practices, clarify roles and responsibilities, and establish shared principles for the informed and systematic handling of bullying situations. "Schools have different capabilities and starting points, which means that a one-size-fits-all approach cannot be imposed on everyone in bullying prevention. However, a basic level of a safe school environment must be accessible to every child, regardless of the school’s size, budget, or organizational culture. “The Guide” offers a practical and cost-effective solution for this, one that fits the actual reality of schools and brings the Ministry of Education and Research’s soon-to-be-completed concept of a bullying-free educational path directly into school practice,” explains Triinu Purru, Executive Director of the Bullying-Free School Foundation, who says the goal is not to do more, but to act more wisely and thoughtfully.
The rise in mental health issues cannot be solved solely by increasing specialized medical care. It is important to strengthen prevention and primary care where concerns are first noticed. “From a health promotion perspective, mental health issues cannot be addressed only after they have already escalated into a crisis. We need systematic and informed prevention where children and young people spend their daily lives. “The ‘Roadmap’ helps schools assess their current situation, identify risks early on, and take thoughtful action before concerns escalate and reach the healthcare system,” says Evelin Kruusalu, Head of the Health Promotion Unit at the Health Insurance Fund.
Preparations for the pilot project have begun
The backbone of the project is health promoters in educational institutions, who are active in every county in Estonia. Health promoters in educational institutions serve as independent facilitators throughout the entire process. With the help of health promoters, at least 30 general education schools across Estonia will be involved in the pilot phase, and with their support, the “Teejuht” solution will be piloted during the 2026/2027 school year. The pilot project will conclude with an applied research study, the results of which will inform proposals for the sustainable and, if possible, nationwide implementation of “Teejuht” in Estonian schools.