Identifying the Unidentifiable: How Washington's Public Education System Can Aid in the Prevention and Detection of Childhood Mental Illness

• Publication year: 2009

UNIVERSITY OF PUGET SOUND LAW REVIEWVolume 33, No. 1FALL 2009

Identifying the Unidentifiable: How Washington's Public Education System Can Aid in the Prevention and Detection of Childhood Mental Illness

Alexis L. Toma (fn*)

I. Introduction

In the wake of the tragedies at Columbine, Virginia Tech, and Northern Illinois University,(fn1) FDA black box warnings on antidepressants for young adults,(fn2) and the Church of Scientology's public stance against psychotropic medications,(fn3) children's mental health is of great and growing concern to parents, schools, and society at large.(fn4) Although research is improving, relatively little is known about the most effective strategies for the prevention, detection, diagnosis, and treatment of childhood mental disorders.(fn5)

Because factors such as lack of medical knowledge, cultural beliefs, privacy concerns, and stigmatization shape attitudes toward children's mental health, this social issue lacks consensus on not only basic definitions but also effective strategies.(fn6) As a result, states have begun to take radically different approaches to children's mental health legislation.(fn7) In addition to the factors that influence peoples' attitudes toward children's mental health, several core issues complicate the debate on children's mental health, including the role of parenting and family values,(fn8) the decision to treat children with pharmaceuticals,(fn9) and the ethics of pediatric clinical research.(fn10) While these factors and issues guide parents, schools, and legislators in acknowledging childhood mental illness,(fn11) they should not take precedence over the best interests of the mentally ill child. If the intention of all those involved is to protect the best interests of the mentally ill child, the issues that most need to be addressed in this dialogue are how to prevent and detect children's mental illness.(fn12)

To improve the prevention and detection of childhood mental illness, it is first necessary to consider the systems at work. That is, who is in the best position to prevent the onset of a child's mental disorder?(fn13) Who is in the best position to detect if a child suffers from mental illness?(fn14) Few would argue that the two social groups most intimately involved in a child's life, and therefore in the best positions to prevent and recognize a child's mental health issue, are parents and family members and teachers and schools.(fn15) But if both the family unit and the education system are gatekeepers of a child's mental health, which system should be responsible for standing guard? And what is the best way for that system to implement comprehensive prevention and detection measures? These are the central issues of this Comment. Consensus is polarized on the issue of the proper respective roles of parents and the public education system in not only offering preventative measures but also detecting childhood mental illness.(fn16)

This Comment explores three states' approaches to mental health screenings for earlier identification of impaired mental health functioning in educational settings. The State of Washington has yet to pass any legislation aimed at instituting a mental health schema within its public schools. This Comment argues that the Washington legislature should enact children's mental health legislation that reflects an integration of the three state positions.(fn17) Specifically, Washington should adopt a cooperative and transparent mental health scheme for public schools that includes in-school screening, informed and active parental consent, educator training, and emotional health curriculum because it preserves parental rights while also protecting the well-being of mentally ill children.

Part II of this Comment discusses both the current state of children's mental health and the concepts of prevention and detection. It emphasizes the significance of educating teachers, implementing emotional health curricula in public schools, and utilizing mental health screenings as early detection devices. It also provides a summary of the current state of children's mental health law as it relates to Washington's public education system. Part III describes the federal government's attitude toward children's mental health and reviews federal statutes pertaining to the distribution of school surveys in public schools. Part IV explains the development of the constitutional right to parent and its application to children's mental health. It also discusses the tension between parents and schools on privacy issues such as distributing screenings to students. Part V presents children's mental health legislation from three states: Illinois, Utah, and Connecticut. This Part introduces not only the substance of the various legislative measures but also the radically different positions taken. Part VI recommends that Washington adopt a cooperative and transparent system that includes in-school screening, informed and active parental consent, educator training, and emotional health curricula.

II. Background

Before describing the mental health legislation Washington ought to adopt, it is first necessary to define mental health and mental disorder and discuss how children are affected when they are labeled by such terms. This Part also introduces the concepts of prevention and detection to emphasize the need for holistic legislation and mental health screenings. Finally, this Part concludes with a summary of Washington's current children's mental health legislation.

A. The Mentally III Child

According to the Surgeon General's Report on Mental Health, mental health is "a state of successful performance of mental functioning, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and cope with adversity."(fn18) Mental illness, on the other hand, "refers collectively to all of the diagnosable mental disorders"(fn19) included in the Diagnostic and Statistics Manual of Mental Disorders IV.(fn20) Mental disorders are "health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress or impaired functioning."(fn21)

Mental health is perceived along a spectrum stretching from "successful mental functioning" to "impaired functioning."(fn22) The mental health spectrum exists for both children and adults.(fn23) In the relatively recent past, professionals believed that mental disorders such as anxiety disorders, depression, and bipolar disorder began in adulthood.(fn24) Now, however, it is well-known that these disorders can begin in childhood.(fn25) It is estimated that ten percent of children and adolescents in the United States suffer from mental illness severe enough to cause some level of impairment.(fn26) The National Institute of Mental Health estimates that fewer than one in five of those children receive treatment.(fn27)

This startling statistic can be explained by problems with detection. Because children develop and grow at a rapid pace, it is often difficult for professionals such as pediatricians, child and adolescent psychiatrists, therapists, and school personnel to diagnose childhood mental illness.(fn28) For example, some mental health problems are short-lived-such as situational anxiety or depression-and therefore require no treatment.(fn29) Others are persistent and serious-such as autism, bipolar disorder, and schizophrenia-and necessitate substantial professional treatment.(fn30)

Because mental illness affects ten percent of children and adolescents, it is important for states to take positive steps toward enacting legislation addressing this issue. Children's mental health legislation should target holistic prevention by means of educator training and introducing emotional health curricula and early detection by implementing mental health screenings.

B. Prevention

To effectively address the concerns about children's mental health, the Washington legislature must integrate a preventative-education component into the legislation. This prevention component should include training educators on children's mental health issues and introducing emotional health curriculum to students. Public schools stand in a particularly good position to educate children on managing their emotions and employ preventative measures to help thwart the development of mental disorders.(fn31) This section focuses on the development of prevention interventions and the factors associated with creating and implementing prevention programs.

Progress in the development of prevention interventions in the field of mental health has faced several challenges.(fn32) Prevention advancement has been slow for two reasons: insufficient knowledge of the cause of mental disorders and inability to alter the known causes of a particular disorder.(fn33) To improve prevention interventions, researchers have developed prevention programs aimed at reducing risk factors and enhancing protective factors.(fn34)

There are various risk factors associated with prevention programs. Risk factors are characteristics or hazards that, if present, make it more likely that a particular child, rather than another child will develop a disorder.(fn35) Examples of risk factors include lack of social support, inability to read, difficult temperament, and exposure to bullying.(fn36) To reduce a child's chances of developing mental illness...