When children are about to start school, most parents don’t think twice about making sure they have the required immunizations. School physicals have long been a part of American culture.
But why aren’t children screened for mental health problems the same way they are screened for hernias, head lice, and other conditions?
We asked six experts whether routine mental health screenings in schools are a good idea.
Kristin Carothers, Ph.D., a clinical psychologist in the ADHD and Disruptive Behavior Disorders Center at the Child Mind Institute, New York City
According to the National Institute of Mental Health, one in five children meet criteria for a mental health diagnosis during their lifetime.
For many children, lack of access to mental health care is an extraordinary burden due to barriers, including low socioeconomic status and membership in traditionally underrepresented groups.
As the primary contexts in which children live and learn, schools are prime settings for increasing access to mental health care through screening and intervention.
Numerous studies of school-based mental health initiatives have demonstrated the benefit of access to mental health care through schools. In studies of school-based mental health screenings, researchers found that mental health screening played an important role in reducing barriers to learning, provided youth with access to services for mental health care, and resulted in positive educational and behavioral outcomes.
Conducting mental health screenings in schools also has the potential to provide researchers and clinicians with important information about the prevalence of mental health symptoms, and has great implications for improving clinical practice, research, and policy.
At the Child Mind Institute, with the generous support of the Robin Hood Foundation, psychologists and social workers have provided mental health screenings for 50 youth in charter schools where mental health evaluations were not previously available. With additional support from government agencies and private foundations, resources for providing screenings could be greatly increased and enhanced, allowing more children to be served.
Engaging in efforts to provide mental health screenings in schools is an extremely important initial step in the fight against mental illness, and will result in the ability to improve the mental health care of children and families everywhere.
Darcy Gruttadaro, J.D., director of the Child and Adolescent Action Center at the National Alliance for the Mentally Ill, Arlington, Virginia
Excerpted from “Out of the Darkness: Making Student Mental Health a Priority,” published early this year in Principal Leadership:
Stigma continues to be a major barrier for youth seeking the help they need, and this often leads to students struggling in silence. But schools can help students feel more comfortable talking about mental health and seeking help. Many students have a close relationship with one or more adults in school, such as teachers, counselors, coaches, or administrators.
If mental health was discussed more frequently in schools, students would feel safer talking about it with adults.
Paul Gionfriddo, president and CEO of Mental Health America, Alexandria, Virginia
Excerpted from an article he wrote in the September 2012 issue of Health Affairs in reference to personal experience with his mentally ill son:
More than one educator has argued with me that I shouldn’t blame the schools; their purpose is to educate children like Tim, not to treat them.
I understand. But I also learned from personal experience that ignoring a child’s special needs makes the special education concepts of “appropriate” and “least restrictive” education meaningless. These terminologies — and the realities they represent — were things that policy makers thought about too narrowly.
The word "disability," for instance, should have covered Tim and children like him. But as a friend who worked a generation ago on drafting the regulations for the federal government’s Individuals with Disabilities Education Act told me, “Paul, we were thinking of kids in wheelchairs.” Not much has changed.
In 2012 Tim’s former Middletown school district made national news for using “scream rooms” — little more than unpadded cells — to control children with mental illnesses.
Official Policy Statement from Mental Health America
Early identification, accurate diagnosis, and effective treatment of mental health or substance use conditions in school-aged young people can alleviate enormous suffering and heartbreak and help young people to benefit from their education and to lead productive lives.
No one contests that state and federal systems that serve young people like juvenile justice and child welfare need to engage in comprehensive screening, but several states have sought to ban mental health screening in schools.
Mental Health America opposes such legislation because it compromises the responsibilities of the schools under federal law to provide an education to all young people, regardless of disability, compromises the schools' obligation to identify and address significant impediments to learning of all kinds, discriminates against young people with emotional or behavioral difficulties, and risks constraining free communication by teachers and counselors to parents, which is essential to early identification and effective treatment of mental health and substance use conditions.
Whenever warning signs are observed, parents should be counseled to see their primary care physician or a mental health professional concerning their child's need for mental or other health care.
Kita Curry, Ph.D., president and CEO, Didi Hirsch Mental Health Services, Los Angeles
About one in four Americans lives with mental illness in a given year, and about half of them began experiencing symptoms by age 14.
We know that people who receive early treatment have the best chance of leading happy and productive lives, yet a decade typically passes between the onset of symptoms and when people seek and receive help.
Mental health screenings — whether in school or out — should be as routine as any other health screenings, such as those for eyesight or hearing. They would not only ensure kids don’t fall behind because of a delay in treatment, but also would help erase the stigma of mental illness that stops people in need from reaching out.
If schools had mental health screenings, we could get children and families help earlier and prevent many of the complications that arise from untreated mental illness.
Dr. Edward Fruitman, medical director of Trifecta Health Medical Center and Trifecta Med Spa, New York City
Schools have the unique opportunity to observe behavior that a child may not exhibit at home. Specifically, behavior in group settings with peers, which one-on-one attention often does not expose. This includes self-destructive behavior; risk-taking behavior; substance use; social difficulties, including Asperger’s Syndrome and social anxiety; and bullying.
It is, however, important when conducting such screenings to not over-pathologize children’s behavior and to flush out only the true statistical outliers.
Any normal child at one point or another, if observed by a mental health professional, may demonstrate a symptom related to a particular diagnosis.
For this reason, it is important that there be a second confirmed opinion by a senior observer before further clinical evaluation is conducted and/or brought to the parents’ attention,.
Barry McCurdy, Ph.D., director of the Devereux Center for Effective Schools, King of Prussia, Pennsylvania
We know that a large percentage of young people (perhaps up to 20 percent) meet the criteria for a mental health disorder at some point in their early lives. Unfortunately, research tells us that less than one-third of children who may be in need of mental health services actually receive treatment.
Today, more and more schools are collaborating with mental health service providers to offer school-based mental health services. The advantage is increased access for students and their families — that is, students referred for mental health services are more likely to receive them.
As part of the referral process, it is important that we are able to identify all students in need of help.
Although students with overt behavior problems are easily identified, often by teachers and administrators who need to manage their behaviors, students with emotional distress (e.g., anxiety and depression) are not as readily apparent within the context of the school and classroom.
Brief mental health screening measures administered at defined time points across the school year can be helpful in identifying students in need. One caveat, of course, is that if schools commit to screening for mental health concerns they should be able to ensure access to services for students and families.