Reports, analysis and opinions about recent incidents of on campus mass murder by distrubed or mentally unstable young men have fueled many private and public debates. Improving mental health care with an emphasis on mandatory mental health screenings for all children and youth is one proposed approach in the search for ways to predict and prevent suicidal and homicidal behavior by so-called 'crazy people'.
In an article that apeared in USA Today (January 31, 2013), Rahill Briggs, assistant professor of pediatrics at the Albert Einstein College of Medicine in New York tries to build a case for such screening practices based in part of the argument that since physical exams are required for school admissions, then why not psychiatric assessments as well? Mr. Briggs wrote, "Early social and emotional development is a robust predictor of future mental health and stability. Today we not only have the skills, but reliable tools to help identify children at a very early age who might be at risk for mental health problems long before they erupt into debilitating illness and though rarely, a dangerous crisis."
Mental distress that becomes disabling is very difficult to understand, let alone predict. Throughout the article Mr. Briggs uses medical terminology to explain the need for screening, e.g., a "mental health check-up". To quote the author again, "We must rethink what's required to attend school. A child must be physically, mentally and behaviorally ready to participate."
What about the many ethical, practical and civil rights questions that such screenings raise? Will there be a "one size fits all" set of testing instruments and protocols mandated by the same people (i.e. the Federal government) who brought us the complicated and largely unsuccessful 'No Child Left Behind' initiative? Or will there be a patchwork quilt of regulations and procedures created by each state or school board that will consider certain behaviors as just a normal part of growing up in one jurisdiction, but considered a serious diagnosis outlined in the DSM-V in another?
Snapshot behavioral observations and psychological questionaires by pediatricians and family practice doctors (the clinicians who provide most front-line medical care for children) who often have limited training or experience in mental health, are highly unlikely to be valid predictors of future behavior disorders. Furtheremore, what is the standard for normal behavior that will determine whether or not a child has passed their check-up? Who will set those standards? And if the parent tells the provider that the child has a history of rage, frequent bouts of sadness and nonstop crying and even sucidal behavior..who will provide the appropriate services and will those services be based primarily on the recovery or the medical model?
I am all for expanded mental health and suicide prevention education and dialogue in the public schools. Mental health screening can be helpful in many ways, but it should never be mandatory for school participation. It must always be voluntary and based on informed choice exercised by a child's parents or legal guardians. Human behavior is varied and unpredictable. There are many reasons a child or adult may experience thoughts and feelings that are so intense and troublesome that they could lead to a temporary or long-term psychiatric disability.
To create what amounts to threat assessments and law enforcement data bases via mandatory mental health screening that begins with school-age children is wrong. Here is another perspective on the relationship between gun violence and mental health: "Tragedies such as Newtown's grow from a U.S. culture of violence in which guns are accessed with ease," says Dan Fisher, psychiatrist and leader of the National Coalition for Mental Health Recovery (press release, November 21, 2012). "Other developed countries have an incidence of mental health issues similar to the U.S., yet they have much lower rates of gun-violence."
Public safety is vital to a stable society. Mental health for all people is just as important; and the same goes for civil rights and common sense.