US teenager's parents sue school over depression screening test

British Medical Journal 1 October 2005

by Jeanne Lenzer

The parents of an Indiana teenager have filed a suit in a federal court in the state's Northern District, charging that school officials violated their privacy rights and parental rights by subjecting their daughter to a mental health screening examination without their permission.

The suit is seen as significant because President Bush has promoted a controversial plan to encourage widespread mental health screening for people "of all ages" in the United States (BMJ 2004;328;1458). The screening programme at the centre of the legal suit, TeenScreen, was endorsed as a "model" programme by President Bush's New Freedom Commission on Mental Health.

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

The Rhoades family charges that TeenScreen test results "are highly subjective" and that "there is a lack of evidence that the screening actually 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 Substance Abuse and Mental Health Services Administration had awarded grants of more than $9.7m (£5.5m; €8.1m) to four states to implement "mental health screenings, using the Columbia University TeenScreen programme."

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

Columbia University's TeenScreen, which urges "universal" voluntary screening for all teenagers, has come under fire for offering free cinema passes and other inducements to teenagers in the hope of encouraging them to return parental consent forms (BMJ 2005;331:592 (17 Sep)). The programme has also been criticised by the Rutherford Institute, a non-profit civil liberties organisation, for using "passive consent," in which only parents who do not want to have their children screened have to sign a form and send it in to the school. If the school does not receive a form, it is assumed that the parents do not object.

Laurie Flynn, national programme director of TeenScreen, said that only 15% to 20% of schools use passive screening and that the choice to require the active consent of parents was left up to local schools. "We name active consent a preferred best practice, we train applicants to use it and we offer templates to assist them in doing so. [But] in some school districts passive consent is the norm for all student health activities," she said.

Michael Wilkes, professor of medicine and director of adolescent medicine at the University of California, Davis, said he was worried about 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 truly depressed from a teen who is experiencing developmentally normal cyclic variations in mood. Affect in teens can vary greatly from day to day. A student who didn't get invited to the prom or who broke up with his girlfriend could look depressed one day but not the next. What is needed isn't just more money for screening but money to help teens who want help. What's the point of screening to find a problem if doctors are either unavailable or unable to help?"

President Bush's plan, Achieving the Promise: Transforming Mental Health Care in America, is at www.mentalhealthcommission.gov/reports/FinalReport/FullReport.htm

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

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