Guide to Mental Health Screening in Schools
Statistics show that mental health disorders ranging from depression and anxiety to attention deficit hyperactivity disorder, or ADHD, are common among school-age children and adolescents. The Centers for Disease Control and Prevention reports that among children ages 3 through 17, about 3.2% have diagnosable depression, while 7.1% have anxiety.
Treatments and therapeutic interventions are available for these conditions, but the first step is simply diagnosing the problem. One way for parents and educators to become more aware of mental health disorders in the classroom is through screening. Nurses can play a critical role here, providing mental health screenings in schools to ensure that children who need help receive it.
What Is Mental Health Screening?
A mental health screening is a kind of emotional examination, designed to reveal underlying mental health concerns or abnormalities.
Reasons to Undergo a Mental Health Screening
Mental health screenings are recommended for anyone who displays one of the hallmarks of a mental health disorder. Schoolchildren may be encouraged to receive a mental health screening if they exhibit any of the following symptoms:
- Excessive fear or worrying
- Extreme sadness
- Significant changes in behavior, including eating or sleeping habits
- Extreme anger or irritability
- Fatigue or general lack of vigor
- Avoidance of social gatherings or group activities
Some of these symptoms may simply reflect the normal travails of adolescence; a mental health screening can help determine the presence of deeper issues that require treatment.
Benefits of Mental Health Screenings
Mental health screenings are beneficial for several reasons:
- They can differentiate between expected “growing up” issues and clinical concerns.
- They can provide early detection for mental health disorders, which makes treatment more likely to prove effective.
- Mental health screenings in schools can provide parents, teachers, and educators with clarity about the issues their students are facing, and about the best ways to address those issues.
Components of a Mental Health Screening
A mental health screening may be administered by a pediatrician or a psychiatric professional; in a school setting, the mental health screening is most likely to be guided by the school nurse. The following components are included in mental health screenings:
- A brief physical examination
- Blood tests, which check for issues such as thyroid disease
- Questions about the patient’s mood, emotional state, interests, etc.
- Written questionnaires that focus on habits, common behaviors, etc.
Why Administer Mental Health Screenings in Schools?
Mental health screenings can be especially impactful when they identify problems in childhood or adolescence, as opposed to allowing those issues to go undiagnosed until adulthood. One reason for this is that mental health disorders can influence behaviors that impair academic outcomes. Diagnosis and treatment provide students with the opportunity to develop strategies to overcome these challenges. Additionally, mental health treatments tend to be most effective when they start early in life while the brain is still developing, meaning early detection has clinical advantages as well.
Learn More About Mental Health Screenings
For further information about the mental health screening process, check out these resources:
- MedLine Plus, Mental Health Screening — An overview of the mental health screening process
- Mental Health America, Position Statement 41: Early Identification of Mental Health Issues in Young People — MHA’s policy regarding the importance of treating mental health disorders as early as possible
Common Mental Health Issues for Students
Mental health screenings can test for a range of issues, but a few are especially common among school-age children and teens.
Some of the most common mental health disorders for children in the 3 through 17 age range include:
- Learning disabilities
- Eating disorders
- Dual Disorders
Many mental health disorders occur simultaneously with other conditions. This can complicate diagnosis, making accurate mental health screenings all the more important. For example, statistics from the Centers for Disease Control and Prevention show that about 3 out of 4 children who have depression also have anxiety. Of those, about half exhibit significant behavioral problems. Additionally, mental health disorders often go hand in hand with addiction or substance abuse issues. Dual diagnosis is important, because it allows health care providers to ensure that they are treating the entire problem, not just one facet.
Causes of Mental Health Disorders
Mental health disorders have a number of potential causes. Sometimes, it’s a simple matter of genetic predisposition. In other cases, exposure to social and economic disruption can contribute to anxiety, depression, and trauma. For example, being exposed to a school shooting or to abuse in the household can make a child more likely to develop a serious mental health condition.
Mental Health and Suicide
Another reason detecting mental health disorders as early as possible is critical: Doing so can minimize the risk of suicide. According to research from the American Academy of Child & Adolescent Psychiatry, a majority of children who attempt suicide have a serious underlying mental health disorder. Most often, it’s depression.
Mental Health Disorders Among Children and Teens
For additional insight into mental health disorders among children and teens, these resources may help:
- Mayo Clinic, Mental Illness in Children: Know the Signs — Information about what mental health disorders look like in the lives of school-age children and teens
- Centers for Disease Control and Prevention, What Are Childhood Mental Disorders? — An overview of mental health disorders among school-age children
School Nurses and Mental Health Support
School nurses can play a significant role in promoting mental health awareness among students and teachers alike, and often that begins with administering mental health screenings in schools.
Involvement in the Screening Process
School nurses are uniquely suited to administer mental health screenings. While counselors or even teachers may assist with emotional health questionnaires, only nurses have the clinical experience necessary to perform a physical examination or to recognize situations where lab work or further clinical intervention may be needed.
Mental Health Metrics
A nurse’s mental health screening may yield information in several different categories, including:
- Potential “triggers”
- Medications that the student takes
- Family or personal medical history
- Proposed treatments or interventions
- Recommendations for further assessment from mental health providers
- Working with Administrators
School nurses must work closely with school administrators to ensure that an infrastructure is in place to optimize the efficiency of mental health screenings. For example, clear policies that dictate when teachers should recommend their students for evaluation and what responsibilities administrators have to follow up with students and their families are critical. Also needed are clear regulations that define how the results of a screening should be conveyed to parents in accord with patient confidentiality guidelines.
Learn More About the Role of Nurses
Get more information about the role of school nurses in the mental health screening process, beginning with these resources:
- National Association of School Nurses, The School Nurse’s Role in Behavioral/Mental Health of Students — An NASN position paper defining the role school nurses play in mental health advocacy and awareness
- National Association of School Nurses, Mental Health — An overview of resources for school nurses supporting their students’ mental well-being
Mental Health Screening in Schools Challenges
While mental health screenings in schools provide clear benefits, nurses may also face some obstacles to offering these screenings effectively.
One potential problem is socioeconomic disparity. Students in low-income families may not have access to the mental health resources they need, while schools in disadvantaged areas may not have the resources to provide mental health screenings in the first place. School nurses may have limited influence they can wield over budgetary decisions, but they can still advocate for their students and be attentive to signs of mental distress. By gathering data points about mental health conditions within the school, nurses may be able to convince administrators to invest in additional mental health screening resources.
Another potential issue is student privacy, in particular, the communication of mental health diagnoses or treatments to teachers and administrators. As students miss classes to seek treatment from the school nurse, teachers require notice; however, students may not always want the specifics of their condition revealed. Additionally, school nurses will need to work to protect the confidentiality of their students, ensuring they are not subject to bullying or scorn from their peers. To accomplish this, nurses must work with administrators and with teachers to ensure a clear, consistent policy regarding student privacy.
Mental health screenings in schools may reveal major trends regarding bullying or other abusive behavior, which can sometimes be a catalyst for depression or anxiety. Nurses can play an active role in developing bullying prevention programs. One specific way in which nurses can help is by collecting data points from their mental health screenings, interviewing students about their experiences with bullying, and providing clear metrics to school administrators. This data can help to underscore the need for anti-bullying programs.
Mental health screenings that uncover a serious diagnosis may demand that the school nurse be involved in ongoing treatment, support, or care, all of which can be highly effective, but also resource intensive. Being able to connect students to local providers, including telehealth providers, can be essential. Nurses can help facilitate these relationships between local medical officers or community health programs, in conjunction with school administrators.
Promoting Mental Well-Being in K-12 Schools
Mental health disorders can affect people of all ages, including school-age children and teens. One of the best ways to raise awareness and promote all-around mental well-being is to institute school mental health screenings. School nurses are well-equipped to provide clinical leadership and guidance in this key diagnostic process.