Last week, U.S. Surgeon General Vivek Murthy labeled youth mental health needs “the defining public health crisis of our time.”
But school mental health screenings—which can alert schools if students are showing signs of depression, anxiety, or other mental health problems, and need help—have been slow to catch on in many districts despite being a strategy recommended by the National Association of School Psychologists, the National Center for School Mental Health, and a host of psychologists and youth mental health researchers.
Only 20 percent of schools screen students for their mental health, according to a 2020 study published in the National Library of Medicine. And, so far, New Jersey and Illinois are the only states with laws that provide funding and logistical resources for school mental health screenings. New Jersey requires the screenings in schools while they’re optional for districts in Illinois. The funding from the laws gives schools the ability to offer screening to more students, connect schools with local public health agencies to make sure screenings are research-based, and provide more robust communication to parents.
A handful of states are taking steps to follow suit. But some efforts to broaden screenings have run into resistance from some parents who claim that the screenings infringe on their rights and children’s privacy. Their opposition echoes the themes of a national debate on parents’ rights through which parents have argued for the ability to opt their children out of curriculum materials they object to and ban selected books from school libraries.
In Colorado, lawmakers passed a bill this week that would create a mental health screening program for 6th- through 12th-grade students. It just needs a signature from Colorado Gov. Jared Polis to become law. And last week in Delaware, lawmakers introduced a comprehensive mental health package that includes a line item to develop a process to screen and identify school-aged youth in need of mental health services.
“We now hear school principals, superintendents, talk about mental health as being a significant challenge for the students that they’re entrusted with,” said Angela Kimball, senior vice president of advocacy and public policy at Inseparable, a nonprofit that advocates for greater access to school-based mental health services. “We all want our kids to be safe, healthy, and happy, but we’re starting to realize, ‘Oh, we need to be paying attention to their mental health.’”
But even with the widespread acknowledgment of the problem, some efforts to establish screening programs have faced political barriers.
A bill in Montana failed to pass the state legislature in February. Lawmakers who voted against it argued that the state already had screenings for youth through the state’s Department of Health and Human Services, such as its Youth Behavioral Risk Survey, which is administered every two years and gives the state an anonymous snapshot of student mental health needs.
The bill in Colorado has faced opposition from parents’ rights advocates, who argue that it gives schools the ability to overstep their bounds by using a passive model of parental consent for the screenings, in which parents have to opt out of having their children participate rather than affirmatively opt in. Parental consent has been a key part of the push for parents’ rights policies at the local, state, and national levels.
“Quite frankly, it’s not the school’s role to subordinate the parent when it comes to their children,” said John Graham, president of the Colorado Springs School District 49 board, which adopted a resolution earlier this month to oppose the state’s bill.
Not a diagnostic tool
It’s not uncommon for students to have their vision and hearing screened at school. Mental health experts say it’s only natural to add mental health screenings.
“The bottom line is schools are where most young people spend the vast majority of their time outside of their home or family,” said Sharon Hoover, co-director of the National Center for School Mental Health and a professor at the University of Maryland. “So from a public health perspective, if we want to try to understand the health status in a variety of areas at a population level, then schools are the natural place to do it.”
As with vision and hearing screenings, early identification is critical to prevent serious cases of mental illness, Hoover said.
But the screenings aren’t meant to diagnose clinical conditions. Instead, they serve as a way to flag when students might need additional help or attention because they’re showing symptoms of anxiety and depression.
“Typically, screeners are not diagnostic,” said Katie Eklund, a school psychologist and professor at the University of Wisconsin-Madison. “Just because a child receives a screening measure, it isn’t going to say, ‘this student has clinical rates of depression’ or ‘this student has ADHD.’ It’s more designed to be a red flag indicator to say, ‘Hey something is going on with this student. We need to gather more information to find out how we can best help support them.’”
Around 80 percent of students the screenings flag for concern already show signs of struggling with their mental health, Eklund said. But the screeners are especially helpful in alerting parents and school officials about students who are not outwardly displaying symptoms of mental illness but are still struggling.
The question of parental consent
Graham isn’t opposed to schools playing a roll in supporting student mental health. The school board president said he’s well aware of the struggles students have faced since the onset of the pandemic and wants to see the school play a role in supporting that.
But he doesn’t think the state’s proposed bill goes far enough to ensure parents have enough agency in the process. As it’s written, the Colorado bill would require participating schools to provide written notice to parents about the mental health screenings at least two weeks prior to conducting them, giving parents the chance to opt out of participation.
Experts refer to the opt-out model as passive participation, because students whose parents don’t do anything will still be screened. Graham said he’d rather see active participation, in which parents have to opt in before their children are screened.
“Mental health is huge,” he said. “We are finding that the behavior and mental health challenges of students just this past year have increased. So there do need to be mental health solutions, but that has to involve the parent or guardian … and there also has to be treatment.”
District 49 isn’t the only Colorado district to oppose the bill. Woodland Park School District, also near Colorado Springs, adopted a similar resolution to oppose the bill, arguing that it “seeks to usurp parental/guardian authority of their minor child(ren) by interposing the state as a surrogate decisionmaker,” according to the Pikes Peak Courier.
An issue with an opt-in model is that it leads to lower rates of participation, Eklund and Hoover said. That’s especially a challenge when it comes to reaching students whose parents aren’t as connected to the school system and might not see the notice from their children’s school alerting them of the screening opportunity.
“There’s no doubt that when you have passive and opt-out consent processes you will reach more children,” Hoover said. “You’ll reach more in terms of the number that gets screened and more in terms of the number that get identified and receive mental health supports and services. This is especially true in our more marginalized or minoritized communities, where rates of consent response are lower.”
But that doesn’t mean models should be opt-out or nothing, Hoover said. If it makes a community more comfortable to have an opt-in process, then schools and states should consider pursuing that route rather than not having any screening at all, she said.
Screenings are a first step
Mental health screenings alone are not going to solve the student mental health crisis. They should only serve as a first step to help schools determine who needs help, how many school psychologists they need to hire, and what kind of services they need to provide, Eklund said.
First and foremost, states and the federal government should focus on expanding the pipeline of school psychologists and other mental health professionals, Eklund said. Nationwide, there were on average more than a thousand students for every school psychologist in the 2021-22 school year, according to the school psychologist association. That falls far from the association’s recommended ratio of 500 students to every school psychologist.
Eklund, who is also a member of NASP, said the association supports state policies that set ratio goals for schools, such as the 500 to 1 ratio.
“Those types of policies ensure that school psychologists are available to consider the mental health and well-being of all students in their school, and then are also there to provide individual and small group support to kids who need something more,” she said.
