WASHINGTON - Two years ago, a federal commission created by President George W. Bush recommended that U.S. officials "improve and expand'' mental health programs in schools to help promote the emotional well-being of the nation's children.
With 52 million students, the nation's schools are in a "key position to identify mental health problems early and to provide a link to appropriate services,'' which, in turn, can help improve students' academic achievement, the commission said in its report.
The commission also highlighted one possible means of early diagnosis, the Columbia University "TeenScreen'' program. With that program, all students in a school - with parental permission - are given a mental health "checkup'' via a computer-based questionnaire before graduating from high school.
Those suggestions and more than a dozen others on improving all aspects of the U.S. mental health system for children and adults were included in the commission's 86-page report, which generated little attention in Washington when it was released.
But the commission's recommendation to expand school mental health programs has sparked outrage among some parents and become a popular rallying cry for conservatives pushing parental rights against what they see as unwarranted government intervention.
Opponents of school-based mental health programs point to parents who say their children have been misdiagnosed with mental health problems, such as attention deficit hyperactivity disorder (ADHD), and forced to take medication to attend classes after school officials pressured them to get psychological care.
To these parents, the commission's suggestion to "improve and expand'' school mental health programs is the first, inexorable step towards mandatory school mental health screening of all students, despite repeated assurances by commission members and congressional experts that that isn't the case.
Led by groups like Ablechild.org and EdAction, these opponents want to prohibit schools from having anything to do with students' mental health, saying it is the job of parents to ensure their children's well-being.
As a first step, the groups are pushing Congress to pass legislation, sponsored by Rep. Ron Paul, R-Tex., to formally prohibit any federal funding for mental health screening of students without the written consent of their parents.
"If (this legislation) is passed, it will prevent wasteful and potentially devastating federal funding while safeguarding the informed consent rights of all parents in what is a most serious matter - their children's health and safety,'' said Patricia Weathers, president and co-founder of Ablechild.org.
The educators and medical professionals on the other side of the debate readily agree that parental consent should be required for any school mental health screenings. But they also believe that it's worth studying the idea of voluntary mental health screenings in schools - with parental consent - as a way of trying to help children as early as possible.
"There is this curious coalition of people who are concerned about stuff that we didn't recommend, and are making a big noise about it,'' said Michael Hogan, who served as the chairman of the now-disbanded New Freedom Commission, and now is director of the Ohio Department of Mental Health.
"The core thing that the commission was concerned about is the fact that a lot of these mental health problems are pretty clearly problems of childhood and adolescent onset. Added to this is the fact that most children never get to see a mental health specialist.
"The fundamental logic of what the commission said is that we should take steps to facilitate access to care where children are.''
Mr. Hogan also stressed that the commission formally recommended mental health screenings "only in settings where there is known to be a very high prevalence of children with serious mental health conditions,'' such as those in foster care or the juvenile justice system.
"Beyond that, we sort of encouraged people to look at screening in schools as one alternative, although we recognized that we might not be ready yet for it,'' Mr. Hogan added.
The debate over school screenings is just part of a larger discussion over the role schools should play in ensuring children's mental heath. Many educators point to a clear connection to good mental health and academic achievement.
"There are a whole slew of intra-personal variables that contribute to a kid's ability to learn and are heavily related to their academic success,'' said Stacy Skalski, public policy director for the National Association of School Psychologists.
"There are also inter-personal variables. Kids don't come into the world knowing how to relate to others. They need to learn that.''
Bruce Hunter, a veteran policy official with the American Association of School Administrators, said it's clear "the education business is tough enough without getting into the mental health business.
"But if a kid is going to beat the hell out of other kids regularly, and is disrupting the classroom, that's a child that needs some mental health assistance. One of the things that our members have expressed is a rising concern about students' mental health, and the ability to get them help when they have a problem,'' Mr. Hunter said.
A complicating factor in the debate over school mental health problems is that it has become enmeshed in the vehement opposition of some people to medicating children for depression, hyperactivity and other problems.
These opponents point to problematic side effects of some of the commonly-prescribed drugs, including suicide, and argue they aren't safe for children.
Mr. Hogan and others who support school mental health programs agree that more long-term testing should be done on anti-depressants and other emotion-altering drugs prescribed for children and teens.
"We (commission members) recommended that the scientists and regulatory officials get on top of the safety issue,'' Mr. Hogan said, stressing that the commission's recommendation was made even before recent studies showed a possible connection between teen suicides and certain anti-depressants.
Ms. Weathers is among those who believe that more attention should be given to children's nutrition and behavior management, instead of "being so quick to prescribe a drug.'' Her group supports legislation, sponsored by Rep. John Kline, which would prohibit schools from requiring parents to have their children medicated to attend school.
Mr. Kline's bill would expand protections in the Individuals with Disabilities Act, which prohibited schools from requiring special education students to take certain medications, to all students. The bill also would cover more types of medication than in the disability law.
Ms. Weathers said she was pressured into medicating her then first-grade son after a school psychologist diagnosed him with attention deficit disorder.
But Ms. Weathers' son became psychotic on the medications. When Ms. Weathers stopped giving him the medications, however, she said that the school reported her to state children protective officials for child abuse. A lawsuit brought by Ms. Weathers against school officials is pending; her son, meanwhile, is now 15 and "doing fine.''
"We have 1,000 stories like this,'' Ms. Weathers added. "Our group is not saying that children don't have attention or behavior problems. Some kids do,'' Weathers added. "But why should we force parents to drug their children so they can attend school?''
Ms. Skalsi, however, said "it is a myth'' that teachers will refuse to have a student in their classroom because they aren't taking medication for behavior problems.
"But teachers will say (to a school psychologist or counselor): 'I have a kid with behavior issues. I need help,''' Ms. Skalski said. In those cases, school psychologists or counselors will work with the teacher and with the family to develop strategies to help curb the behavior problem and allow the student to get back on his or her academic track.
Ms. Skalski also notes that many parents initiate contact with a school psychologist about such issues as helping their children deal with divorce. These parents see the school psychologist as a resource for their children's emotional health, just as the school nurse is a resource for their children's physical health, she added.
In most school systems, school psychologists and counselors don't have the time to see most students one-on-one, Ms. Skalski noted. While her group recommends that there be one psychologist for every 1,000 students, most school psychologists are responsible for many more children than that, she said.
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