Academic journal article Ethical Human Psychology and Psychiatry

Mental Health Screening in Schools: Essentials of Informed Consent

Academic journal article Ethical Human Psychology and Psychiatry

Mental Health Screening in Schools: Essentials of Informed Consent

Article excerpt

Increasing numbers of public schools are adopting the use of mental health screening programs for the purpose of identifying suicidality or psychiatric conditions in children and teens. Concerned observers maintain that these programs commonly violate the requirements of federal law, because they fail to provide properly informed consent for evaluation and special services. This article presents a critical analysis of the requirements of informed consent in education, discusses the problems of consensus, and offers basic facts that might be communicated by pertinent authorities in order to facilitate state compliance with the Individuals with Disabilities Education Act (IDEA).

Keywords: mental health screening; Teen Screen; informed consent; Individuals with Disabilities Education Act; evidence-based medicine; research bias

Mental health screening programs, such as Columbia University's Teen Screen, are being implemented in an increasing number of American schools (Columbia University Teen Screen Program, 2006). The goal of these programs is to identify and treat children and adolescents who are considered to be at risk for suicide and mental health problems. Recognizing the potential harmfulness of these developments, a growing number of informed citizens and politicians have responded to the fact that the screening projects are illegal in their present form, because they violate the requirements of federal law (Individuals With Disabilities Education Improvement Act, commonly referred to as IDEA). In some states, elected officials have attempted to introduce corrective legislation.

The purpose of this article is to offer support for these efforts. Three main themes will be discussed. First, the essential features of informed consent will be introduced. Second, existing obstacles to informed consent will be reviewed. Third, suggestions will be made about the basic information that might be communicated by pertinent authorities, in order to bring state agencies into compliance with the requirements of federal law.


Within American medicine, the principle of informed consent has evolved from a combination of historical principles and court precedents (Lowe & Kerridge, 1997; Vollman, 2000). The ideals of the Renaissance and the Enlightenment gave rise to the notion of natural rights, including privacy. Such a right to privacy was eventually construed as conferring protections against unwanted or uninvited bodily assault by the practitioners of medicine. It was in the context of these predominantly 19th-century conceptualizations of physical autonomy that the 1957 landmark case of Salgo v. LeLand Stanford Jr., established the responsibility of physicians to disclose important information about medical care, including the nature, benefits, and risks of proposed treatments, and alternatives to the same.

Currently, the American courts and medical profession recognize five essential tenets of informed consent:

* The patient must be competent (in the case of minors, the competency of parents or legal guardians would apply).

* Consent must be voluntary and not coerced.

* Sufficient information must be disclosed.

* The information must be understood and evaluated in terms of the patient's (or guardian's) own values.

* Consent should entail conscious or explicit permission.

An understanding of these elements is a pre-requisite for the proper implementation of the Individuals with Disabilities Education Act, 20 U.S.C. § 1414 (a) (1) (D) (i), according to which parents must give proper informed consent for both the evaluation and the delivery of special services (Wrightslaw, 2004):

(I) CONSENT FOR INITIAL EVALUATION-The agency proposing to conduct an initial evaluation to determine if the child qualifies as a child with a disability . . . shall obtain informed consent from the parent of such child before conducting the evaluation. …

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