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Home> About Us> What We Believe> Position Statements >Position Statement 41: Early Identification of Mental Health Issues in Young People

Position Statement 41: Early Identification of Mental Health Issues in Young People

Policy 

Early identification, accurate diagnosis and effective treatment of emotional or behavioral difficulties[i] 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. Laws proposed recently in several states have sought to ban mental health screening in schools. Mental Health America opposes such legislation because it 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 between teachers, counselors and parents. Whenever warning signs of emotional or behavioral distress are observed, parents should be counseled to see their primary care physician or a mental health professional concerning the young person's need for mental or other health care.

Mental Health America believes that primary care providers must be encouraged and compensated to identify signs of mental health issues at the earliest possible time. Research should be expanded to assure the availability of reliable, culturally and linguistically competent early identification and diagnostic tools. Primary care providers need training in their use. 

As importantly, for early identification to have any value, public and private resources must be available to assure effective treatment. Two-thirds of young people in need of treatment currently receive no treatment for their emotional or behavioral difficulties. Reliable early identification of all health problems in schools and other settings and effective, nondiscriminatory treatment of all health problems can help to address a child’s needs before they lead to greater academic or social problems, including suicide or self-mutilation, substance use, school suspension, dropping out, expulsion or involvement with the juvenile justice system. 

Public education is needed to assure that people can identify the early signs of mental health problems so that young people can receive the help that they need in a timely manner.

Background

Mental health problems affect one in five young people at any given time, and about two-thirds of all young people with mental health problems are not getting the help they need.[ii] [iii] [iv]  Research shows that early intervention can prevent significant mental health problems from developing.[v] [vi] Epidemiological research confirms the relationship between mental health issues and suicide or self-mutilation, substance abuse, suspension, dropping out, expulsion and involvement with the juvenile justice system. [vii] [viii] The research also shows that effective treatment can reduce the risk of such consequences. [ix] [x] [xi]

Primary care physicians and other health care providers are the "first line of defense" in identifying signs of mental health problems because they routinely see young people and their families and because confidentiality is assured. However, pediatricians and other primary care providers often lack the training and resources to perform this role. 

Mental Health America believes that primary care providers must be encouraged and compensated to identify signs of mental health issues at the earliest possible time. . Research should be expanded to assure the availability of reliable, culturally and linguistically competent early identification and diagnostic tools. . Primary care providers need to be trained in their use, and public and private resources then need to be made available to assure that comprehensive treatment, individualized to the needs of the child and family, is available on a nondiscriminatory basis.

Recent collaborative efforts of pediatricians and mental health professionals have led to improved early identification efforts in Massachusetts, Vermont, Minnesota and New York. These efforts have enhanced access to timely and appropriate child psychiatric evaluations, consultation and treatment. Mental Health America particularly applauds such efforts, which join forces with the health care system to promote the early identification of mental health issues in children.

No one contests that state and federal systems like juvenile justice and child welfare need to engage in comprehensive screening. President Bush's 2003 New Freedom Commission on Mental Health proposed in its goal for that:  "In a transformed mental health system, the early detection of mental health problems in children and adults - - through routine and comprehensive testing and screening - - will be an expected and typical occurrence."  The report emphasized early intervention in low-stigma settings like physicians' offices and schools, but the epidemiological data show that much work remains to be done.

Although schools are required to identify all mental and other health impediments to learning under the federal Rehabilitation Act and Individuals with Disabilities Education Improvement Act, including mental health issues, screening for emotional or behavioral difficulties in schools has proven to be highly controversial and politicized. The concerns regarding school-based screening include fears of stigma, liability and cost, issues of mis-diagnosis and coercion of parents by school personnel, and deep concerns about over-medication of children. In addition, issues of cultural and racial bias are a significant concern among people of color. Finally, the development of reliable and culturally and linguistically appropriate screening tools may be some years in the future.

Mental Health America acknowledges these challenges of mental health screening. However, with appropriate safeguards, Mental Health America supports well-designed pre-school-based and school-based screening programs. Because teachers, school psychologists, social workers and other counselors have extended contact with children on a daily basis, they are often in a position to recognize early patterns of behavior that pose a risk for a child’s academic, social, emotional or behavioral functioning. While teachers and other school administrators are not and should not be diagnosticians, their candid communication with the family is vital in promoting students' well being, including their mental health. Where any health problems are noted, their concerns must be shared with the parents in a timely manner. In this regard mental health problems should be treated no differently than other health-related concerns. School personnel should be trained to recognize the early warning signs of emotional or behavioral difficulties and to know the appropriate actions to take in notifying parents and in protecting the rights and privacy of children.

Accordingly, Mental Health America opposes interference with the proper role of teachers and counselors in communicating with parents concerning the behavior and needs of their children. Schools and other community institutions and voluntary associations should encourage teachers and counselors to communicate regularly with parents concerning their child, including counseling the parents to consult with their primary care provider or a mental health professional if any sign of significant physical illness or emotional or behavioral difficulty is apparent. In so doing, it is important that the risk of stigma be avoided by maintaining confidentiality and communicating in a clear and culturally competent manner. It is essential that parents not feel in any way coerced to seek treatment or to medicate their child. 

Legislation proposed recently in several states has sought to ban mental health screenings in schools.[xii]  The 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, 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 emotional or behavioral difficulties. Mental Health America believes that such legislation, in the guise of protecting family privacy, interferes with the private relationship between teachers, counselors and parents.

Action Steps

• Mental Health America affiliates and advocates should encourage early identification and early intervention. Mental Health Association’s (MHA)s should work to defeat and legislation that gets in the way of candid discussion of mental health issues. Primary care physicians need to be supported and compensated in identifying and getting treatment for emotional or behavioral difficulties.

• Mental Health Association’s (MHA)s should actively engage with their school districts to determine what efforts are underway to “screen”or promote early identification, and what programs are in place to provide appropriate services to young people with significant emotional or behavioral difficulties that prevent them from receiving full educational benefit from the general education program, as required by federal law.

• Mental Health Association’s (MHA)s should help their school districts address issues of stigma, mis-diagnosis, coercion of parents by school personnel, over-medication of children, and cultural and racial bias in early identification programs.

• Mental Health Association’s (MHA)s can offer information and training to pediatricians and primary care providers about mental health early identification and screening.

• Mental Health Association’s (MHA)s can offer training sessions to parents and school personnel on appropriate early identification of children at risk, alternatives for getting help, and effective communication by school personnel.

• Mental Health Association’s (MHA)s should conduct legislative briefings in states where there are current (and past) efforts to enact legislation on mental health screening.

Mental Health America affiliates and advocates should encourage early identification and early intervention. Mental Health Association’s (MHA)s should work to defeat and legislation that gets in the way of candid discussion of mental health issues. Primary care physicians need to be supported and compensated in identifying and getting treatment for emotional or behavioral difficulties.

Page last updated: 09/20/2007