By Ellie Ashford
06/28/05 -- A school health official tells of a high-achieving ninth-grade girl who, for no apparent reason, began doing poorly in school and made a suicide attempt. Her parents had no idea what was wrong.
After she took part in a voluntary mental health screening program, it was revealed that she had been raped a year earlier and had told no one about it. The screening allowed the student to get immediate assistance from a mental health professional.
It is stories like this that proponents of mental health screening point to in illustrating the benefits of screening seemingly healthy teenagers.
Yet, there is growing opposition to mental health screening, with one school health expert calling the practice “as controversial as sex education.”
Among the anti-screening groups are the Church of Scientology, which is opposed to psychiatry and psychotropic drugs, and Christian conservative groups, who oppose governmental usurpation of parental authority and view screening as a plot by pharmaceutical companies to expand their markets to schoolchildren.
Concerned Women for America, for example, says “medicating children for behavioral problems could easily become a form of social control. . . . School authorities could use medication to prevent behavior of which they simply disapproved, such as rebelliousness.”
The group refers to screening as the first step toward the practice used by Soviet and Chinese communists to label political dissidents as mentally ill.
Pressure by anti-screening forces has led to legislation restricting mental health screening in schools to be proposed in 10 states, the National Mental Health Association reports.
Those who support screening liken it to health services already carried out in schools, such as vaccinations and vision and hearing tests. And they say screening is an important tool in promoting mental health and preventing suicide.
A federally funded study recently reported that more than 46 percent of all Americans will have at least one mental disorder at some point in their life, such as depression, anxiety disorders, impulse-control disorders, or drug or alcohol dependency.
Half of all mental illnesses begin by age 14, and three-fourths by age 24. Yet these disorders often go undiagnosed, which means many children aren’t getting the treatment they need to live healthy lives.
Much of the controversy over mental health screening stems from an endorsement of the practice by the President’s New Freedom Commission on Mental Health.
The commission’s report, issued in 2003, includes among its many recommendations one to: “Improve and expand school mental health programs.”
According to the report, “Quality screening and early intervention will occur in both readily accessible, low-stigma settings, such as primary health care facilities and schools, and in settings in which a high level of risk exists for mental health problems, such as criminal justice, juvenile justice, and child welfare systems.”
Federal legislation
Last fall, President Bush signed into law a suicide prevention bill proposed by Sen. Gordon H. Smith (R-Ore.) that authorizes mental health screening.
The Garrett Lee Smith Memorial Act, named for Smith’s son, who took his own life in 2003, includes a 10-state pilot program that allows states to develop youth suicide prevention and intervention programs, including screening. This program was funded at $10 million this year.
Rep. Ron Paul (R-Texas), a vocal critic of mental health screening, has proposed an amendment to the House appropriations bill to ban the use of federal funding for screening. A similar amendment he proposed last year failed to pass.
Jeff Deist, a spokesperson for Paul, calls mental health screening “another way for the government to interfere with the role of parent and child. It’s a privacy issue.”
He also raises concerns about having private information on a child’s school record and increasing the number of children given psychotropic drugs.
“It is important to understand that powerful interests, namely federal bureaucrats and pharmaceutical lobbies, are behind the push for mental health screening in schools,” Paul writes in his weekly column to constituents. “The pharmaceutical industry is eager to sell psychotropic drugs to millions of new customers in American schools.”
Teen Screen
Even though the proponents of mental health screening say it should always be voluntary and should never be done without parental consent, the opponents of screening continue to talk about “mandatory, universal screening.”
“We’re not aware of any group in favor of mandatory, universal screening,” says Robert Caruano, co-director of Teen Screen. “Right-wing anti-government groups and anti-public school groups deliberately spread rumors that there is a plot to carry out mandatory screening without parental consent purely to make a political point, to send a political message to scare people.”
Teen Screen is “not part of a nefarious, sinister plan,” Caruano says. “We’re not connected with the drug companies or the Bush Administration.”
Teen Screen, created by Columbia University in New York City, is the most widely used mental health screening program. It is being used in more than 350 sites across the United States, two-thirds of them schools, Caruano says.
Teen Screen, designed for youths ages 11-18, is solely aimed at preventing teen suicide. He points to research by the Centers for Disease Control and Prevention that shows 17 percent of youths in grades 9-12 have had thoughts about killing themselves, 9 percent have attempted suicide, and 3 percent have taken actions so serious, they required medical attention.
He says 1,700 youths ages 15-19 commit suicide every year. Among youths ages 10-24, the number rises to 3,000. Suicide is the third highest cause of death among teens.
÷een Screen is free for agencies that qualify. Agencies interested in having a Teen Screen program must submit a signed letter from mental health providers ensuring that any student who needs assistance will be seen by a professional immediately.
The program is voluntary, and participants must have parental consent. The screening can be done either on a computer or with a paper-and-pencil instrument.
When a screening shows a student might be depressed, the professional giving the screening decides whether a full evaluation is needed, notifies a parent, and makes an appointment with a therapist.
Teen Screen is a “very effective” program, and “we’ve never had any complaints or controversies,” says Marian Sheridan, coordinator of health and safety for the Fond du Lac, Wis., school district and coordinator of the Fond du Lac County School Health Initiative.
The district began using Teen Screen in 2002 for ninth- graders at Fond du Lac High School, and now uses it at a second district high school, two alternative schools, and a private school.
The program is incorporated into the ninth-grade health curriculum and is carried out as a “community-school commitment,” Sheridan says. Students and their parents must sign a consent form before they can be screened.
At Fond du Lac High School, 358 of the school’s 632 freshmen participated in the screening the last time it was given, she says. Sixty-four students had “screened positive,” which means they are given clinical interviews the same day, and 55 of that group were referred for additional services. About half were referred to mental health services in the community, the rest to the school psychologist or guidance counselor.
School nurses who serve as case managers work with parents to identify mental health professionals covered by parents’ insurance. They also make three follow-up contacts with students and parents to ensure that they’ve gotten the help they needed.
“Research shows we’re most effective in finding and identifying kids you wouldn’t know have a problem,” Caruano says. Teens often have a way of “internalizing their disorders,” he says. “Usually you can’t look at someone and tell if they’re depressed.”
After a teenager commits suicide, Caruano says, people often say things like: “We had no idea he had any problems. He was on the honor roll. He seemed happy.” According to Caruano, when a therapist asks a teen, “Why didn’t you tell anyone how you felt?” the answer often is “nobody ever asked us.” He says Teen Screen opens a door for troubled youths: “A lot of kids are looking for a way to open the door to their parents. They don’t know how to bring it up.”
The only other major screening initiative is the SOS High School Suicide Prevention Program, developed by a nonprofit organization called Screening for Mental Health Inc., which includes an instrument that teaches students how to recognize the signs of suicide in themselves and others and take appropriate action.
Approximately 1,700 public schools have participated in the program, says a spokesperson for the organization. It differs from Teen Screen in that students take and review the screens themselves.
Illinois plan
The Illinois Mental Health Act of 2003, and a series of recommendations mandated by the act, have become a lightning rod for opponents of screening. A conservative Christian group called the Illinois Family Institute says, “Illinois schools are on the fast track to become the nation’s testing ground for mental health.”
Yet the law doesn’t call for mandatory screening, and the report doesn’t say schools should carry out screening, says Barbara Shaw, chair of the Illinois Children’s Partnership.
The partnership, mandated by the 2003 law, was charged with developing a series of recommendations on improving mental health services throughout the state.
The group’s draft report, to be submitted to the governor June 30, includes a recommendation that the state “promote and support initiatives that strengthen and develop best practices, quality standards, and professional training associated with voluntary mental health screening conducted with parental consent and parental involvement in accordance with existing Illinois and federal confidentiality, consent, reporting, and privacy laws and policies.”
The commission never intended to mandate screening, Shaw says. Its intent was to ensure all children have access to mental health services.
Nevertheless, Shaw says, “From day one, the conservative groups labeled the plan as a screening plan. This misinformation persists despite our attempts to provide clarifying information.”
Mental health services
Even some school mental health experts see some weaknesses in the screening concept.
“The notion of public schools doing screening as benign is naïve,” says one school health specialist, who cites concerns about privacy and the possibility of overmedication. And although the ideal screening program should have sufficient staffing and resources so a troubled student can get immediate assistance, that might not always be the case.
“You are sending them somewhere else. You have no way of knowing whether they show up,” says Louise Johnson, director of children’s services for the South Carolina Department of Mental Health.
South Carolina leads the nation in the number of mental health professionals in public schools, Johnson says. More than half of the state’s 1,000 schools have a trained clinician, mostly with a social work background.
These professionals, known as “counselors” so students aren’t stigmatized for seeing them, meet with students individually, in groups, or with their families. They can address a wide range of problems, and can provide immediate referrals to any youths who appear suicidal, Johnson says.
Yet not all states and communities are able to make such a major commitment to mental health. Youth suicide is a serious problem, and many school health specialists believe the benefits of screening outweigh the risks.