Why Are We Afraid of Mental Health Screening?

Should all school children be screened for mental health?

The evidence suggests that if we do not screen them, then we will be continuing a persistent and historical pattern of neglecting the mental health needs of our children.  But why let evidence get in the way of fear?

Over the past several months, legislators in a number of states have considering mandating – or at least offering – mental health screening for all children, either in the schools or in pediatricians’ offices. 

But when the Connecticut Legislature had a public hearing on a mental health screening bill recently, opponents came out in force. 

One parent called mandatory screening an “unnecessary invasion.”  The Connecticut Civil Liberties Union argued that mental health screenings should be optional.  A treatment provider asserted that the problem wasn’t with a lack of assessment, but the lack of treatment options.

And in recent days, a Palm Beach Post writer in Florida joined the chorus when he claimed that mental health screening is less “straightforward” than vision and hearing screening in an editorial entitled “Florida Should Not Require Mental Health Screenings in Schools.”

The truth is that if we don’t at least screen, then we don’t know what it is we’re supposed to treat.  And this “head in the sand” approach is what has gotten us into trouble in the first place.

The extent of our neglect of our children’s mental health needs is staggering.  

In 1999, the U.S. Surgeon General estimated that 10 percent of children had mental illnesses serious enough to disrupt their home life or schooling.  That percentage is still cited today, but we have more recent data, too.

For example, the Substance Abuse and Mental Health Services Administration noted that in 2009 two million children between the ages of 12 and 17, or 8.1 percent of the population, had a major depressive episode.

In the same report, SAMHSA also disclosed that 2.9 million children that year, or 12.1 percent of the population, received at least some mental health services in a school setting.

But here’s where the neglect comes in.  Only 407,000 children in 2009 received special education services because of their mental illness – just a fraction of those who needed them.

And this neglect is getting worse.  According to the most recent data from the U.S. Department of Education, only 389,000 children were offered special education services in 2011 as a result of their mental illness.  To put this number in context, this was:

• The smallest number in 20 years;
• A drop of over 20 percent in just six years; and
• Only 8 tenths of one percent of the entire school-age population.

In other words, less than one in every ten children with a serious mental illness is even identified as emotionally disturbed by our special education system.

As for the other nine in ten, their time bombs just tick silently.

Perhaps this could be justified if the stakes were low.  But they are not.  We all know the results of neglect.  We see them every day in our homes and neighborhoods, and, most tragically, on the news.

And what is most frustrating is that the “controversial” screening that could save lives is both simple and non-invasive – and straightforward. 

More often than not, mental health screening consists of a few questions that can be answered and scored in minutes. 

Here is a link to a commonly-used tool, called the PHQ-9.

It asks nine questions about how a person has felt in the last two weeks, with one follow-up question at the end.  Has the person been having trouble falling asleep or staying asleep, or sleeping too much? Been feeling tired? Experienced a poor appetite or overeating? Had trouble concentrating?

These are hardly the kinds of questions that probe so deeply into the psyche of the individual as to scar or stigmatize them for life. 

But, ironically, when we refuse to ask these questions we do end up stigmatizing people for life – if not costing them their lives.

It may seem hard to believe that there could be any fuss about using such screening tools universally when you consider the alternative.  Or that the tools can reasonably accurately identify an emerging mental illness.  But they can, and do.  And the more we use them, the better off we will be.

So what are our schools afraid of?  And, more importantly, what are we all afraid of? 

To reach Paul Gionfriddo via email: gionfriddopaul@gmail.com.  Twitter: @pgionfriddo.  Facebook: www.facebook.com/paul.gionfriddo.  LinkedIn:  www.linkedin.com/in/paulgionfriddo/