Will school-based mental health screening get a passing grade?
Of Canadian youth, a staggering 10–20% are affected by a mental disorder. Yet, only 1 in 5 of those children get the mental health services they need (CMHA, 2015). Something needs to change. Enter the school administered mental health screening as a means of identifying children who may be at risk of, or currently experiencing, mental health problems. The premise is simple enough, but the associated controversies and questions are far from straightforward.
A Google search of “school mental health screenings,” will yield a series of dubious articles. ‘Invasion of privacy’, ‘violation of parental rights’ and ‘method of social control’ are just some of the accusations lobbed at these screening initiatives. Others go so far as to portray the screenings as an elaborate plot by the pharmaceutical industry to boost medication sales, drugging innocent kids in the process. Conspiracy theories aside, many express concerns regarding whether these screenings will results in mental disorder overdiagnosis, leading parents to panic at the prospect of their child being labelled for life.
Although mostly far-fetched, these concerns do highlight the many unresolved questions surrounding mental health screening in schools. In my opinion, such a screening system constitutes a noble mission, allowing for early identification and early intervention. However, considerable planning and research must be conducted before widespread implementation.
A critical component of this planning process is the development, validation and selection of a screening tool. We must strive for time and cost efficient administration. Simultaneously, the screening instrument must demonstrate validity and reliability in detecting a variety of mental health problem warning signs across children who differ on a variety of factors, such as SES, ethnicity and cognitive ability. One critical factor to consider is age, not only because it affects the type of screening a child has the ability to complete, but also because symptoms and diagnosis prevalence evolve with age. It’s nonsensical to give a kindergartener the exact same screening tool as a high school senior. Adaptation and validation with diverse populations of students is necessary.
Another issue to decide is who will complete the screening. Parents? Teachers? The children? Relying on one source alone could be problematic. For example, parents and teachers may be less likely to notice a problem that manifests itself with internalizing symptoms compared to externalizing ones. Perhaps, multiple sources are the way to go, although we must balance this against trade-offs in efficiency.
Other questions to consider include to whom screening results can be released, as well as where and for how long they can be stored. Furthermore, will parents have to consent to their child being screened? Would refusal constitute some form of emotional neglect? What happens if screening raises concerns about a student’s wellbeing, but parents refuse to seek help for their child? In such a situation, what are the school’s legal and ethical responsibilities?
Moreover, we must ensure that screenings are being administered and interpreted by those with the appropriate qualifications. Critically, we must be careful not to overestimate the power of a screening; the results it yields are not a diagnosis, but rather a sign that a child may benefit from additional assessment and support. Similarly, we cannot rely solely on screening to identify children who may be experiencing mental health problems. We must train parents, teachers and students to do so as well.
This points to what in my opinion is key to a successful screening program: mental health screening should be seen as neither a definitive solution, nor an isolated one. Rather, as Weist et al. (2007), suggest, screening should be just one component of a comprehensive mental health program within our education system. To be accepted and effective, such an initiate must be developed by professionals in conjunction with important stakeholders, including school administrators, parents, teachers, community organizations and the students themselves. A larger program must include ongoing mental health education and de-stigmatisation campaigns, as well as interventions and treatment programs.
Overall, much work remains prior to the widespread implementation of school based mental health screenings. For now, their power lies in sparking conversations on youth mental health, much like this one.
Burns, J. R., & Rapee, R. M. (2015). Screening for Mental Health Risk in High Schools: The Development of the Youth RADAR. Psychological Assessment. Advance online publication. http://dx.doi.org/10.1037/pas0000237
Canadian Mental Health Association (CMHA). (2015). Fast Facts about Mental Illness. http://www.cmha.ca/media/fast-facts-about-mental-illness/#.VqzeS1MrJ-U
von der Embse, N. P., Pendergast, L. L., Kilgus, S. P., & Eklund, K. R. (2015).Evaluating the Applied Use of a Mental Health Screener: Structural Validity of the Social, Academic, and Emotional Behavior Risk Screener. Psychological Assessment. Advance online publication. http://dx.doi.org/10.1037/pas0000253
Weist, M. D., Rubin, M., Moore, E., Adelsheim, S., & Wrobel, G. (2007). Mental Health Screening in Schools. Journal of School Health, 77, 53–58.