The issue of routine mental health screening-especially of teens-is a controversial one within the mental health consumer community. I was reminded of this once again through my participation in the Campaign for Mental Health Reform, a coalition of the country's largest mental health organizations; this topic has been the subject of some intense e-mail discussion among participants.
The President's New Freedom Commission on Mental Health identified early mental health screening as one of the six important elements in a transformed mental health system. The Commission's report says:
"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....Quality screening and early intervention will occur in both readily accessible, low-stigma settings, such as primary health care facilities and schools, and in settings in which a high level of risk exists for mental health problems, such as criminal justice, juvenile justice and child welfare systems. Both children and adults will be screened for mental illnesses during their routine physical exams."
One of the Commission's recommendations is to "Improve and expand school mental health programs." Many mental health consumers worry that expanding school screening programs will lead to increased stigma. They fear that children will become "pigeonholed" as mentally ill and be treated differently and with reduced expectations, watched with concern and offered fewer opportunities. For example, will children who are screened and labeled mentally ill have access to college preparatory classes? Will they be able to participate in school sports, class trips, student government, etc.?
There's additional concern that children could be forced into treatment (which could be talk therapy, medication or the use of tools like WRAP, the Wellness Recovery Action Plan (TM) without consent. This concern comes from a vocal part of the mental health community that has experienced firsthand-while hospitalized for their illness-the devastation of coerced, forced treatment and the trauma of unspeakably horrifying actions like seclusion, restraint and even rape. It makes sense, then, that those who have experienced such forced treatment see routine screening in schools as very, very problematic.
But on the other hand, the research shows that early treatment can help keep an illness from becoming severe. For example, it's possible to prevent chronic depression (depression that occurs three or more times in a person's life and requires lifelong treatment). Receiving appropriate treatment the first time depression occurs could prevent future episodes. And that could mean a huge difference in the quality of life for so many consumers.
We should also note the consequences of untreated illnesses. We've received literally thousands of stories from people whose lives have been devastated by bipolar disorder or depression that goes undiagnosed and untreated. How much better could their lives be today if they had received an early diagnosis and consistent treatment and care?
If everyone knew all the signs of every mental illness and could diagnose themselves, then, of course, screening wouldn't be controversial at all-it would be a personal decision. But mental illness often "hides" for years, escaping diagnosis despite routine, early screenings. Even depression, which seems fairly easy to identify, can mask itself behind completely different symptoms in different people, making a diagnosis difficult. One person might experience anxiety, sleeplessness and irritability, while another person's symptoms could be overeating, excessive sleep and sadness. The illness is the same, but it "hides" in very different ways in each person.
The issue of screening is not a simple one. But I often feel frustrated by those who speak out strongly against screening. That viewpoint seems too simplistic to me, too black-and-white for a matter that's so very complex. Is the problem the screening itself? Or is it the way our mental health system responds to screening results?
Is the answer no screening? Or is it system reform?
There are more than 20 million people living with mood disorders in our country. If we don't conduct early screenings, are we submitting millions to a life more difficult than it could/should have been, if only their illness had been caught early? Or, by conducting early screenings, are we instead submitting millions to a more difficult life of possible forced treatment and increased stigma within the health care system and society?
Where do you stand?
Published On: November 29, 2007
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