U.S. Health Secretary Robert F Kennedy Jr and Education Secretary Linda McMahon want schools to do away with mental health screenings and therapy. Instead, they argue in a Washington Post opinion piece that schools "must return to the natural sources of mental well-being: strong families, nutrition and fitness, and hope for the future."
In the op-ed, the two secretaries mention a recent bill signed by Illinois Governor JB Pritzker, which requires all schools in the state to offer mental health screening tests, starting with third graders. The screenings are standardized questionnaires that ask children about their feelings and well-being.
Kennedy and McMahon posit that such screens "medicalize the unique and sometimes unpredictable behavior of young children," creating "new stigmas that students might carry with them for life. We must make American children healthy again without treating them all like patients."
NPR spoke to mental health experts who say the op-ed is misleading about school-based mental health screenings and therapy. Here are three points they say are important to know about the issue.
1. Mental health screenings reduce stigma, rather than create it.
Mental health screenings open up a conversation about mental health.
"They are awareness and conversation-starters," says psychologist Mary Alvord, founder of Alvord Baker and Associates, who also works with schools in the Washington, D.C. metro area to improve student well-being and resilience.
"Stigma is when you don't talk about it and you hide it," Alvord says. "And then you make it so people don't want to talk about it and they don't want to then deal with it."
As research has shown, stigma prevents people with mental health conditions from seeking help.
Also, these school-based screenings are meant to be universal, says Alvord, and they normalize conversations around mental health, raise awareness and encourage help seeking.
School-based mental health screenings also provide important insight into the kinds of things that kids are struggling with, things that can be addressed by schools, not by sending individual kids to therapy, but by addressing bigger issues schools might be facing. Most schools doing school-wide mental health screens usually aren't screening for a specific mental health condition.
Instead, they're aiming for a wider lens into students' well-being and struggles, says Dr. Vera Feuer, director of child psychiatry at Northwell Health. She also works with several school districts in Long Island, NY, to improve student mental health.
"They might be called a wellness survey or a school climate survey or, you know, something along those lines," says Feuer.
It gives schools a window into how children are faring and coping, Feuer says. These screenings help schools bring in programs that can boost student mental health.
For example, many schools work with mental health care clinicians to provide evidence-based strategies to improve emotional resilience in kids, or to improve connectedness among students.
2. Screeners screen, they don't diagnose.
"One of the things that I felt was really misguided in the [op-ed] article [is] it said things like, we're treating everybody as patients," says Feuer.
As she and other mental health experts noted, mental health screenings don't end in a clinical diagnosis.
"Screeners are brief assessments that identify this population at risk," says psychologist Benjamin Miller. "They're not diagnostic, and they require us to take an additional step to know, to find out more information and the most appropriate course of action."
The next step might be for a student whose mental health symptoms are identified in the screening test to see a school counselor, or a school nurse, who can do a further assessment to understand what is going on in the student's life and evaluate them for a referral to a mental health care provider.
Most students taking a screening will not need that referral, but for those who do, it's a way to catch their symptoms early so they can get connected to care before things escalate into a crisis.
"The prevalence of mental health disorders is high," says Feuer. "A lot of the disorders do start before age 15. We know that the rates have increased [in recent years]."
School-based mental health screenings help in early detection of symptoms, Feuer says.
And if schools have a plan in place to connect students to care, she notes, schools can also help in bridging the gap for access. They are no different than screenings for physical health problems, notes Miller, who is on the board of advisers for Inseparable, a mental health advocacy group.
"We screen all the time in schools for things like vision and hearing," he says. "So it makes a lot of sense that we would just continue to screen for things that are equally as important, like our mental health."
3. A positive screen doesn't always lead to a therapy appointment.
Access to mental health care remains a huge challenge for all Americans, especially children, primarily because there just aren't enough providers to meet the demand.
And even when a child sees a therapist, or a psychiatrist, it doesn't necessarily result in a mental health diagnosis.
When Feuer evaluates a kid, she also assesses their physical health to make sure it isn't what is causing the mental health symptoms.
"We often do diagnose other medical conditions, including diabetes or other things that may be present," says Feuer. "Somebody looking like they're distracted in the classroom, falling asleep, not being engaged, can look like they're depressed."
But further examination by a physician might reveal, for example, that the child had diabetes causing those symptoms, she says. However, even in cases when a child is diagnosed with a mental health condition, it might take a long time for that child to connect to a therapist, adds Feuer.
"The biggest barrier continues to be even when things are diagnosed, the actual access to care is still very, very difficult in most places in this country."
Kennedy and McMahon also argued in favor of "natural sources of mental well-being," which are well accepted by the mental health community.
Factors like good nutrition, social interactions, sleep, and family support are key to better mental health for kids, says Feuer. "They're actually part of a really important mental health promotion plan."
"But it's not everything," says Alvord. "You can be eating and sleeping well and still have mental health challenges."
And that's why regular school-based mental health screens are so important, say Alvord and others. They help catch symptoms early and connect vulnerable kids to care before there is a crisis.
NPR reached out to the U.S. Department of Health and Human Services with a request to interview Kennedy or another official to elaborate on plans for addressing kids' mental health, but we did not receive a response by deadline.
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