Mental Health Screenings in Schools: What's at Stake for Patients

U.S. Health Secretary Robert F Kennedy Jr and Education Secretary Linda McMahon want schools to do away with mental health screenings and therapy. Instead, they argue in a Washington Post opinion piece that schools "must return to the natural sources of mental well-being: strong families, nutrition and fitness, and hope for the future."

In the op-ed, the two secretaries mention a recent bill signed by Illinois Governor JB Pritzker, which requires all schools in the state to offer mental health screening tests, starting with third graders. The screenings are standardized questionnaires that ask children about their feelings and well-being.

Kennedy and McMahon posit that such screens "medicalize the unique and sometimes unpredictable behavior of young children," creating "new stigmas that students might carry with them for life. We must make American children healthy again without treating them all like patients."

NPR spoke to mental health experts who say the op-ed is misleading about school-based mental health screenings and therapy. Here are three points they say are important to know about the issue.

1. Mental health screenings reduce stigma, rather than create it.

Mental health screenings open up a conversation about mental health.

"They are awareness and conversation-starters," says psychologist Mary Alvord, founder of Alvord Baker and Associates, who also works with schools in the Washington, D.C. metro area to improve student well-being and resilience.

"Stigma is when you don't talk about it and you hide it," Alvord says. "And then you make it so people don't want to talk about it and they don't want to then deal with it."

As research has shown, stigma prevents people with mental health conditions from seeking help.

Also, these school-based screenings are meant to be universal, says Alvord, and they normalize conversations around mental health, raise awareness and encourage help seeking.

School-based mental health screenings also provide important insight into the kinds of things that kids are struggling with, things that can be addressed by schools, not by sending individual kids to therapy, but by addressing bigger issues schools might be facing. Most schools doing school-wide mental health screens usually aren't screening for a specific mental health condition.

Instead, they're aiming for a wider lens into students' well-being and struggles, says Dr. Vera Feuer, director of child psychiatry at Northwell Health. She also works with several school districts in Long Island, NY, to improve student mental health.

"They might be called a wellness survey or a school climate survey or, you know, something along those lines," says Feuer.

It gives schools a window into how children are faring and coping, Feuer says. These screenings help schools bring in programs that can boost student mental health.

For example, many schools work with mental health care clinicians to provide evidence-based strategies to improve emotional resilience in kids, or to improve connectedness among students.

2. Screeners screen, they don't diagnose.

"One of the things that I felt was really misguided in the [op-ed] article [is] it said things like, we're treating everybody as patients," says Feuer.

As she and other mental health experts noted, mental health screenings don't end in a clinical diagnosis.

"Screeners are brief assessments that identify this population at risk," says psychologist Benjamin Miller. "They're not diagnostic, and they require us to take an additional step to know, to find out more information and the most appropriate course of action."

The next step might be for a student whose mental health symptoms are identified in the screening test to see a school counselor, or a school nurse, who can do a further assessment to understand what is going on in the student's life and evaluate them for a referral to a mental health care provider.