The Screening Deficit

I stood by my closed bedroom door, listening in a tense silence to my dad and sister

outside. She had just come forward about experiencing symptoms of depression and suicidal

thoughts. “You don’t know how good you have it. How could you be so ungrateful to not want

the life you have? This is pathetic!” As he spewed out curse after curse in brutal hostility, my

sister started having a panic attack. Being wrapped up in the midst of what would be a dramatic

turning point in every member of my family’s lives, I began to cry. A whirlwind of emotions

surged through me. An ease in my breath for not being the one yelled at. A pit in my stomach for

it being my sister. A growing root of contempt in my heart towards my father. A total loss of

control. I found myself under the freeze response, too afraid for my own sake to stand up for my

sister. My selfish agenda manifested bad karma, in the form of my own self-loathing.

But it was in these moments of debilitating guilt and sorrow, that something clicked. No

one with a mental illness should be treated in such a degrading manner and should be validated

for their needs. Raising the bar for mental health care is a cause I have always had passion for

and is something I hope to do as part of my future career. Mental illness is embedded in

humanity, as well as the perpetual stigma surrounding it. Due to the immeasurable and intangible

characteristics of mental disorders, throughout history it has remained masked by the masses,

covered up under a blanket of social repression. Although screening has been proven to help

continually, there is still an overwhelming lack of accessibility and policy for it in a variety of

areas. As a result of the unaffordable costs for medical insurance and the rising shortage of

mental health professionals, the mental health industry is slipping through the cracks. Youth are

even more prone to developing a disorder, but are not even receiving half the attention that
pediatricians typically allocate for physical illnesses. On account of these factors, research has

been made on the basis of employing a universal screening program for mental disorders in the

school system. Talking about mental health is imperative for the growth and development of

teenagers, and employing an outlet for that in schools would only normalize discussion even

more.

As an accumulation of my perplexity towards the problems, I wanted to delve further into

investigating the lack of resources in the mental health industry and how that translates into

screening tools serving as a solution in school settings. My main focus will be directed towards

the reasons why younger generations are not receiving the help they need, as employing the

universal screening system in schools would be targeting this age group. Through my research, I

will also be determining the effectiveness of current methods of mental health screening and

what can be done to improve the industry as a whole. This leads me to ask the question: How

does the absence of mental health screening in schools affect the rates of mental illness in

children and young adults?

There are an infinite number of reasons as to why the mental health of teenagers is not

being properly prioritized, which can all be linked to family influences. First and foremost, it is

extremely common for kids to not seek professional help because they do not have the capacity

to understand the seriousness of their mental state themselves. This willful ignorance often

creates a tendency to bottle up feelings, which only adds to the severity of the problem. While it

is useful in retrospect for teenagers to gain insight into their feelings through introspection and

profuse ranting to friends, it is crucial that they can rely on their family for help too. When it

comes to the subject of mental health, there frequently lies an unspoken barrier between parents

and their children that can stem from the way in which they treat them early on. Mollycoddling
and overprotection are standard themes in parenting techniques, which can run rampant when

children are subjected to distressing situations. Although overprotection during childhood is not

a cause of mental illness, studies have shown a correlation, as depriving kids of unpleasant

experiences and stresses can affect their growth (Haidt). On the opposite side of the spectrum,

“Low levels of sensitive parenting and greater use of harsh discipline have been causally linked

to the development of behavioural problems” (Ryan). In order to prevent the lack of diagnosis in

children and young adults, parents should be aware of the pivotal role they play in the shaping of

their child’s mental development in how they serve as a risk to psychopathology.

Due to the unprecedented rates of mental illness in today’s world, the mental health

industry is suffering a total loss of resources and availability. There are many gaps to be bridged,

that being the gap between the supply and demand of mental health care professionals as well as

medical provider outreach to patients. A study found that, “demand for psychiatry in the United

States ‘will outstrip supply by 15,600 psychiatrists, or 25 percent’ by 2025” (Holzer). Along

with following clinical practice guidelines, part of being a qualified medical provider requires

outreach among patients. Qualification of psychiatrists, therapists, and all occupations involved

in the medical field means establishing effective communication and without it, patients are

subject to become even less mentally stable (Dixon). However, this factor can sometimes be

overlooked with providers, and is part of the overarching issue of failure to diagnose people with

mental illnesses. Another aspect that needs improvement in mental health services is how they

can be accessible to different cultures. When asked the question: How can the mental health

industry combat the shortage of providers and resources? Mr. Chang-Yeh, a clinical psychology

professor at Alliant International University, shared with me a project he was a part of, in which

he developed a screening method that was able to be translated into different languages for
communities from Southeast Asia in San Francisco. “Once we did the screenings we found really

high rates of depression, anxiety, and PTSD, but there was no one to send them to because there

was no one who could do therapy in their primary languages.” Even with their progressive

efforts, the communities were not able to get help simply because mental services have not

trained providers to cater to underprivileged people and non-native English speakers.

Speaking of neglecting the needs of lower socioeconomic classes, an overwhelming

number of people with serious mental disorders are not able to receive the care they need

because mental health care insurance is unaffordable. “The Substance Abuse and Mental Health

Services Administration (SAMHSA) estimates that mental and substance use disorder treatment

spending from all public and private sources for direct costs alone will rise to a total of $280.5

billion in 2020, an increase from $171.7 billion in 2009” (Lieberman). This study demonstrates

that the costs are only increasing and thus access to mental health care is only depleting over the

course of time. Additionally, it is more probable that a person with a mental illness can develop

other chronic medical conditions, meaning they will have a much shorter lifespan. (Liberman). If

people’s lives are on the line, should there even be a cost for providing service? The mental

health care industry should take the reduction of these costs into account, as this issue affects the

vast majority of people today. Even families in stable financial conditions struggle to access

effective and appropriate services. “Moreover, families with fewer financial resources and

families of ethnic minority heritage face even greater impediments” (Tolan). Reinstating the

point made earlier, the struggle is even more pronounced for racial minorities with mental

illnesses, as they are the least attended to in terms of accessible outlets to services. Insurance

companies must take steps to prevent instances like this from occurring by establishing increased
funds for family holders. Due to the accumulation of costs as well as the lack of medical

providers, people do not have access to efficacious mental health care services.

While mainstream media has become more cognizant of mental illness, the quality of

care has yet to be raised to the same standards for physical illnesses. In many instances, mental

illnesses can cause physical ones and increased rates of morbidity. “Severe mental illness (e.g.,

schizophrenia and bipolar disorder) is emerging as a prominent health disparity category, given

estimates that persons in this group die 8‐25 years younger than the general population”

(Kilbourne). There are enough statistics to go around to prove that mental illness has posed an

ongoing fatal threat to humanity, but still remains cast aside from the spotlight that physical

health inhibits. Only up until recently, structural progress has been made to optimize mental

health care standards to be at a primary care level. “The US Centers for Medicare & Medicaid

Services is also deploying initiatives that seek to improve provider use/engagement in evidence‐

based practices as well as delivery system changes to sustain them. The main focus has been to

integrate mental health treatment into primary care, where most patients with mental health

symptoms initially present” (Kilbourne). Adding on to that, I spoke with Dr. Pelen Wu, a

pediatrician from John Muir Medical Center, about the imbalance of access to physical health

service in comparison to mental health. She responded, “ I would say the truth of the matter is

people come in to see us when they’re sick with some sort of physical illness. That’s a majority

of the visits. That being said, it is definitely top of mind for pediatricians when someone comes

in for a physical ailment, whether or not there is an underlying mental health component” As she

reported, families most usually ask for appointments concerning the identification and treatment

of physical illnesses. Therefore, it is not that mental health is not necessarily a priority, but rather

that pediatricians don’t deal with cases of mental health problems as much.
 Following the concerns of the lack of mental providers, the proposal to implement mental

health screening programs in schools universally is becoming more popularized. For most kids,

school serves as a kind of safe haven, a place where they can be who they want to be and can

find comfort in making connections. The idea of employing a program geared towards the

mental health of kids would not only be extremely beneficial in heeding to stress caused by

academics, but also because it is a place where expressing their feelings would typically feel

most natural and safe. Especially in today’s generation, consulting with peers on issues of mental

health is much more common in day to day discussion. Consequently, school is an appropriate

place to further open that doorway to discussion by providing an outlet to effective counseling.

“Despite the prevalence of mental health concerns, only 45% of youths with a diagnosis receive

treatment. And less than 25% of those youths receive any form of treatment in the schools,

despite the overwhelming evidence supporting early prevention and intervention” (Goodman-

Scott). As the evidence indicates, there is little to no diagnosis and treatment being provided for

younger generations, so it is only more imperative that there is an accessible form of screening

geared towards them. “In studies of school-based mental health screenings, researchers found

that mental health screening played an important role in reducing barriers to learning, provided

youth with access to services for mental health care, and resulted in positive educational and

behavioral outcomes” (Heitz). Besides the positive effects screening can have on a child’s

growth, it is actually proven that mental health screening can improve learning abilities in

children.

The idea itself of screening is one thing, the steps to achieving it is another. The common

counterargument for this proposal is that schools do not have the infrastructure to pay and

support a program like this. While this is to some extent true, believers in this system are
continuing to develop a constructive and comprehensive plan in order to establish success. More

and more school districts are considering universal mental health screening (UMHS), but it

requires a certain level of operationalization and expenses to be facilitated effectively

(Goodman-Scott). The general plan outlines as follows: creating a multidisciplinary team and

securing buy-in from key stakeholders, discussing resources and logistics, and choosing

screening tools and methods. Each school is different in terms of what would be needed to instill

this program, such as the number of trained counselors and the needed support garnered from

government agencies and private foundations. Additionally, “Conducting mental health

screenings in schools also has the potential to provide researchers and clinicians with important

information about the prevalence of mental health symptoms, and has great implications for

improving clinical practice, research, and policy.” Employing UMHS would be a service to

students, parents, and mental health professionals everywhere. With wide range support from

both my interviewees and mental health advocates alike, this plan could become a powerful tool

to combat the rates of mental illness in young adults.

The future of better mental health services is possible through the application of the

universal mental health screening in schools. To answer the central question: How does the

absence of mental health screening in schools affect the rates of mental illness in children and

young adults? It has been concluded that implementing a universal mental health screening

system could serve as a solution to combat the many challenges that the mental health industry

still faces today. As Dr. Pelen Wu asserted, “We have to normalize talking about mental health

at the school level, the family level, the teenager level, and the media level.” As mental illness is

such a prevalent problem, it is one that requires the attention of everyone. With the stigma of
mental illness continuing to plague society, spreading awareness and instilling validity among

peers for means of professional help is vital for the wellbeing of us all.