In July, the Substance Abuse and Mental Health Services Administration (SAMHSA) released its final recommendations on how to overhaul the U.S. mental health system. SAMHSA asks for nothing less than transformation, a "profound change - not at the margins of a system, but at its very core."¹

The report details 31 steps of action that concentrate on research, desired outcomes of mental health care, "community-level models of care," and ways to increase cost-effectiveness and reduce "regulatory barriers." ."²

This process began in 2002 when President Bush launched his New Freedom Commission on Mental Health. He gave it the task of studying the mental health service system's problems and recommending improvements. In 2003 the commission released its final report, including Goal #4: "Early Mental Health Screening, Assessment, and Referral to Services Are Common Practice."

Recommendations for that goal were to "promote the mental health of young children," "improve and expand school mental health programs," "screen for co-occurring mental and substance use disorders and link with integrated treatment strategies," and "screen for mental disabilities in primary health care, across the life span, and connect treatment and supports." ³

This report became the foundation for concerns of Concerned Women for America and other conservative organizations, which feared that young children would be universally screened and that the issue of parental notification would not be addressed sufficiently.

Both reports state that they "clearly recognize that parents are the decision-makers in the care for their children. Therefore, in this document, whenever the word child or children is used, it is understood that parents or guardians are the decision-makers in the process of making choices and decisions for minor children." Yet, as result of other statements within the report, you have to wonder if that is what they really mean.

For instance, the researchers state: The "Action Agenda is a living document." How does the report prevent people in the future from distorting its recommendations and action steps? The commission believes "this transformation will necessitate a shift in the beliefs of most Americans and will require the Nation to expand its paradigm of public and personal health care. It is nothing short of revolutionary." [Emphasis added.] What kinds of beliefs are they talking about? Religious beliefs? Moral beliefs? Ethical beliefs?

Even if parents don't give permission for screening or medicating, there is always the possibility that they will be overruled, as in the cases of Aliah Gleason, Matthew Smith and Shaina Dunkle. As a result of a school mental health screening, Aliah was forced into a state mental hospital without contact from her family for five months, restrained more than 26 times, and treated with at least 12 different psychiatric medications. ⁴ Matthew and Shaina died of psychiatric-medication toxicity after their schools threatened their parents with child abuse charges if they did not medicate their children. ⁵

In addition, the 2002 report states, "[F]or the young child, treating the parents' mental health problems also benefits the child." Does that mean that they want screening to be instituted for adults, not just children?

The 2005 report says that it does not "recommend mandatory and/or universal screening of children," yet it "proposes a comprehensive approach at the Federal and State levels for the appropriate intervention for children identified to be at risk for mental disorders in early childhood settings." ⁷ [Emphasis added.] The report neglects to say what kind of approach the commission wants to see implemented. Is it not a contradiction that it does not recommend universal screening but asks for a "comprehensive approach"? The report's vague wording continually steps around these issues.

The Freedom Commission's 2002 report said, "Schools are in a key position to identify mental health problems early and to provide a link to appropriate services." ⁸ Therefore, logically, teachers are the first line of "defense" against mental illness. A page on SAMHSA's Web site instructs teachers on when to refer children to a professional and what to look for in the child's behavior, stating that "it is also important to note that early action will help the child return to normal and to avoid more severe problems later." ⁹

SAMHSA also recommends that parents ask their child's teacher for help in deciding whether the child needs counseling, by asking such questions as, "Does my child break rules over and over again? Does my child seem obsessed about how he looks? Is my child unable to sit still or focus their attention?"

Those questions seem harmless in themselves, but not when you take into account an article SAMHSA posted on its Web site, titled, "The Myth of the Bad Kid," where it explains: "[C]hildren do not misbehave or fail in school just to get attention. Behavior problems can be symptoms of emotional, behavioral or mental disorders, rather than merely attention-seeking devices. These children can succeed in school with understanding, attention and appropriate mental health services." That may be true in some circumstances, but not generally. If Johnny has trouble following instructions, does it mean he has a mental illness?

The uproar over mental screening has led one of the model programs, TeenScreen, to post on its Web site what it believes to be sufficient answers to questions about the program's methods and intentions. TeenScreen, which is based at Columbia University, aims to screen 9th and 10th graders for risk of suicide, anxiety disorders, depression, and drug and alcohol disorders. Yet there is no evidence that it works. The U.S. Preventative Services Task Force "found no evidence that screening for suicide risk reduces suicide attempts or mortality. There is limited evidence on the accuracy of screening tools to identify suicide risk in the primary care setting, including tools to identify those at high risk." ¹⁰

In addition, many of TeenScreen's programs use what is called "passive consent": The child takes home a permission slip that states, "[I]f you do not want your child to participate," then return the form. [Emphasis added.] If the child loses the slip or just forgets to give it to the parent, he or she could be screened without parental knowledge or approval. Furthermore, questions asked in the program could be answered yes by many teens who do not have a mental illness. For example, "Have you often felt very nervous when you've had things to do in front of people?" "Has there been a time when you had less energy than you usually do?"

States are beginning to implement SAMHSA's recommendations. Legislators in Minnesota wanted to pass a law that required universal mental-health screening at least once by age 3 as part of a mandatory kindergarten screening; thankfully, it was defeated. However, Illinois has passed the Children's Mental Health Act of 2003, which calls for providing "mental health services for children from birth through age 18 and their families" and for screening all pregnant women for depression.

The plan also calls for public education to incorporate social and emotional standards, which could lead to screening children for politically incorrect attitudes and nonconformity with liberal definitions of tolerance.

Concerned Women for America (CWA) of Illinois has led in bringing public attention to strategies underway in the states. As Karen Hayes, CWA's associate Illinois director, said in her 2004 statement before the Illinois Children's Mental Health Partnership Preliminary Public Forum, "This plan is 26 pages of vague and subjective rhetoric that is the groundwork for citizen indoctrination by more out-of-control government bureaucracy while creating a special-interest-group bonanza."

A great concern lies in the fact that children and teenagers, as they grow, are continually changing. Therefore, how a child acts at age 3 may differ greatly from how he acts at age 12, making it extremely difficult to diagnose mental illnesses. A 1999 report by the Surgeon General stated, "The normally developing child hardly stays the same long enough to make stable measurements. Adult criteria for illness can be difficult to apply to children and adolescents, when the signs and symptoms of mental disorders are often also the characteristics of normal development." ¹¹

CWA acknowledges that some people genuinely suffer from mental illnesses. But we do not believe that the universal screening of young children is the answer. Both of these reports are so vague in the most important areas that it leads one to wonder what exactly they are calling for. The latest report, especially, seems more like a road map that will lead people to anywhere they want to go, leaving more questions than answers.

Joanna Grey, a college student in North Carolina, wrote this article as an intern for CWA.  The author acknowledges the research assistance of Michael Ostrolenk, EdWatch Director of Government Affairs, and the research of Dr. Karen Effrem, an outspoken national critic of mental health screening on behalf of EdWatch, the Alliance for Human Research Protection (AHRP), and the International Center for the Study of Psychiatry and Psychology (ICSPP).