Purpose Adolescent mental health issues are on the increase, in particular depression, which is now a major public health concern globally. Mental health education is important and young people’s awareness of mental health is potentially limited. This is one factor that creates barriers to seeking support. School nurses and educational professionals recognise that they do not necessarily have the required skill base to support emotional health concerns with young people. The purpose of this paper is to synthesise qualitative evidence related to the nurse’s role in supporting adolescents. Design/methodology/approach A literature review using a systematic approach was undertaken, predominantly through collection of primary qualitative research studies. In total, 22 published studies are included in this review, extracted from four databases – CINAHL, Embase, Medline and Scopus. Findings This review shows that awareness of mental health is needed early in adolescence, while at school, to encourage young people to access support and have knowledge of their own emotional health. The need for further mental health education and provision is asserted. Practical implications Young people benefit from someone who is accessible and familiar to them in schools so that they can access emotional support as and when needed. Careful involvement of families (including extended families) is noted. It is proposed that this role should be a mental health nurse role, who should be accessible within the school environment. Originality/value This paper is original and adds to existing knowledge that mental health challenges are increasing, and more needs to be done in schools to promote mental health and reduce the stigma associated with seeking support.