British Medical Journal 1 October 2005

by Jeanne Lenzer

The parents of an Indiana teenager have filed a suit in a federal courtin the state’s Northern District, charging that school officialsviolated their privacy rights and parental rights by subjecting theirdaughter to a mental health screening examination without theirpermission.

The suit is seen as significant because President Bush has promoted acontroversial plan to encourage widespread mental health screening forpeople “of all ages” in the United States (BMJ 2004;328;1458). Thescreening programme at the centre of the legal suit, TeenScreen, wasendorsed as a “model” programme by President Bush’s New FreedomCommission on Mental Health.

The complaint, filed on 19 September, charges that in December 2004Chelsea Rhoades, then a 15 year old student at Penn High School,Mishawaka, was told she had obsessive compulsive disorder and socialanxiety disorder after she took the TeenScreen examination. Chelsea hasspoken out against the screening and, with her parents, alleges in thecomplaint that “a majority” of the students “subjected to TeenScreen”with her were also told they had “some mental or psychologicaldisorder.”

The Rhoades family charges that TeenScreen test results “are highlysubjective” and that “there is a lack of evidence that the screeningactually results in a decreased risk of suicide attempts.”

On 21 September, just a few days after the Rhoades suit was filed,Rabin Strategic Partners, the public relations firm for TeenScreen,issued a press release with TeenScreen announcing that the SubstanceAbuse and Mental Health Services Administration had awarded grants ofmore than $9.7m (£5.5m; €8.1m) to four states to implement “mentalhealth screenings, using the Columbia University TeenScreen programme.”

The programme is currently in use at 424 sites in 43 states, the pressrelease says. The money was made available under the Garrett Lee SmithMemorial Act, which President Bush signed into law in October 2004 topromote programmes to prevent suicide in young people.

Columbia University’s TeenScreen, which urges “universal” voluntaryscreening for all teenagers, has come under fire for offering freecinema passes and other inducements to teenagers in the hope ofencouraging them to return parental consent forms (BMJ 2005;331:592 (17Sep)). The programme has also been criticised by the RutherfordInstitute, a non-profit civil liberties organisation, for using”passive consent,” in which only parents who do not want to have theirchildren screened have to sign a form and send it in to the school. Ifthe school does not receive a form, it is assumed that the parents donot object.

Laurie Flynn, national programme director of TeenScreen, said that only15% to 20% of schools use passive screening and that the choice torequire the active consent of parents was left up to local schools. “Wename active consent a preferred best practice, we train applicants touse it and we offer templates to assist them in doing so. [But] in someschool districts passive consent is the norm for all student healthactivities,” she said.

Michael Wilkes, professor of medicine and director of adolescentmedicine at the University of California, Davis, said he was worriedabout the widespread use of mental health screening among adolescents.”We’re way overtreating depression with medications,” he said.

“It’s often very hard to distinguish [an adolescent] who is trulydepressed from a teen who is experiencing developmentally normal cyclicvariations in mood. Affect in teens can vary greatly from day to day. Astudent who didn’t get invited to the prom or who broke up with hisgirlfriend could look depressed one day but not the next. What isneeded isn’t just more money for screening but money to help teens whowant help. What’s the point of screening to find a problem if doctorsare either unavailable or unable to help?”

President Bush’s plan, Achieving the Promise: Transforming MentalHealth Care in America, is atwww.mentalhealthcommission.gov/reports/FinalReport/FullReport.htm

http://bmj.bmjjournals.com/cgi/content/full/331/7519/714-a/DC1

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