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NMHA Responds to Hurricane Ravaged Gulf Coast

Medicaid Cuts Still in Doubt As Advocates Say "No!"

First Person: Teen's Cutting Experience Leads to Opportunities to Educate

Kid's Corner: Legislators' Opposition To Screening Misplaced

New York Mental Health Associations Help Pass Geriatric Mental Health Act

NMHA Medicare Enrollment Campaign Gets Off to a Strong Start

Research Notes

Children are once again caught in the cross-hairs of a political firefight. This time, the issue is the President’s New Freedom Commission’s (NFC) final report on mental health. In its 2003 report, Achieving the Promise: Transforming Mental Health Care in America, the NFC calls for providing mental health screenings to children in a variety of settings—including primary health clinics and schools—to ensure early detection and intervention.

Yet, since the report was released, several state legislators and U.S. Rep. Ron Paul, R-Texas, have proposed legislation to prohibit mental health screening of children in schools. In Alaska, for example, the proposed legislation would not only block screening but would forbid school personnel from discussing mental health issues or recommending that parents consult a mental health professional.

Rep. Paul’s bill, which received 90 votes in the last congressional session, cites concerns expressed by anti-mental health groups that the call for “universal screening” is a plot “spawned by the pharmaceutical industry” to medicate America’s children. However, the report doesn’t call for the “universal screening” of all children and stresses that the main goal of screening is the early intervention of mental health problems, which can halt the progression of disorders and prevent recurrences later.

So what exactly is mental health screening?

Screening commonly refers to the use of one or more brief, structured questionnaires that can help assess the possibility that a person has a mental health problem. Mental health screening tools are not diagnostic tools. They are designed to answer two basic questions: Does the person have signs or symptoms of a mental health problem? If so, should this person be referred to a mental health professional for an assessment?

Although mental health professionals usually administer these screens, they may be administered by trained nonmental health staff from other agencies. Most screens are designed to be fairly brief processes, usually 15 to 30 minutes. Clearly, any efforts to formally screen a child should be done by a welltrained and qualified person.

To be sure, mental health screenings present several challenges. First, there are many screening tools available, but they have not all been equally wellresearched. In addition, their validity on diverse cultural groups has not been well-established. These two facts mean that the tools may result in over- or under-referrals for mental health assessment. The degree of subjectivity in the tools may also increase the vulnerability of some cultural groups through bias in administration and scoring.

A separate issue lies in the use of screening tools in school settings. While the NFC does not take a position on who should administer screens in schools, it does note that: “Every day more than 52 million students attend over 114,000 schools in the U.S. When combined with the 6 million adults working at those schools, almost onefifth of the population passes through the nation’s schools on any given weekday.” This means that mental health problems are most likely to be noted in schools. And, left untreated, they will hamper a child’s ability to learn.

There is also considerable concern regarding the potential for screenings to violate a child’s privacy and stigmatize him or her. Especially in school settings, care must be taken to ensure that privacy is maintained. And we’ve all heard concerns regarding potential coercion by schools. Stories abound of parents being told that their child must be medicated to remain in school or that because he or she has a mental illness, they must be transferred. In the end, there remains the perennial question of what to do once you have identified a potential mental health problem. Where are the resources to help the child?

Any effort at early identification and treatment of mental health problems in school settings must take these concerns seriously and work to address them. Because the word “screening” evokes such strong emotional reactions, NMHA prefers the phrase “early identification.” Although this is partly semantics, early identification is a broader frame, allowing for a variety of approaches, including alternatives to screening.

While there is considerable debate about the use of screening, the consequences of failing to identify and treat emotional disturbances in children are clear. Left unidentified and untreated, children are at risk for academic failure, suspension or expulsion for behavior problems, and involvement in the juvenile justice or corrections systems. As we all know, children from diverse backgrounds who have mental health problems are particularly at risk, because they are the least likely to receive appropriate care and are disproportionately overrepresented in our nation’s juvenile justice facilities. Failure to identify and address problems early also increases the risk of a variety of negative outcomes for all children, including suicide.