Illinois’ Disastrous School Mental-Health Program

Last week, Governor J. B. Pritzker made Illinois the first state to require mental-health screenings for all public school students. The governor boasted that such assessments, which screen every student in grades 3–12 for potential mental-health challenges, will enable “those who are struggling [to] get the help that they need as soon as possible” and “improve academic and social outcomes.”

He’s wrong. By requiring schools to screen all students, the law will make it tougher for young people who need mental-health services to get them, while exposing students who don’t need treatment to potential harm.

In recent decades, American schools have become increasingly entangled with the mental-health system. Today, many schools believe that they’re obligated to screen for, diagnose, treat, and prevent mental illness—tasks for which they lack a mandate and the relevant expertise. What began as a legal obligation to serve disabled students under the Individuals with Disabilities Education Act has expanded into an all-consuming quest for student “wellness.”

The premise behind Illinois’ law is that by universally screening students for mental-health conditions, schools will catch problems early. That’s a noble goal, but decades of research have shown that it is not feasible.

Experts caution against universal mental-health assessments even when they are administered by licensed physicians in primary-care settings. One reason is that such screenings—whether for depression, behavioral or emotional risk, or suicide—lack any empirical support to show that they prevent mental-health challenges from developing or help those in need of services to get them sooner.

Another is that universal assessments can yield more than 50 percent false positives, resulting in inappropriate diagnoses and unnecessary treatments. That’s why experts believe that screening is “unethical” unless schools have the resources to ensure accurate diagnosis, treatment, and follow-up. Illinois schools are not clinical settings, so they cannot deliver on any of these prerequisites.

Giving children an inaccurate diagnosis can harm their wellbeing. Even a “correct” diagnosis has potential downsides; it does not explain the cause of a mental-health problem, can lock a child into a label, and does not guarantee access to the right treatments. For some young people, medical diagnoses, including mental-health diagnoses, can shape their identity and expectations, lead to long-term medication use, affect job prospects, and diminish their sense of control over their future. These are not theoretical risks; they are documented realities.

Moreover, youth mental-health treatments generally are less effective than many assume. For example, in a two-year follow-up assessment of a randomized control trial, psychotherapy was found to offer little benefit for children’s mental health. Randomized control trials for youth use of antidepressants have found similarly weak effects—meaning these treatments should be used when cases are serious, not as a universal first-order solution.

Several forms of school-based mental-health services—mental-health centers, mindfulness trainings, universal cognitive-behavioral-therapy programs, and efforts to prevent depression and anxiety—have been shown not to work. Practices that researchers describe as “evidence-based” are typically demonstrated in clinical settings and often are incorrectly implemented in schools.

Children with serious emotional disturbances and behavioral challenges may benefit from targeted mental-health interventions. And mental-health professionals can, in some cases, help kids facing major distress. But such treatments don’t prevent children from developing mental disorders, and they don’t cure already existing mental illnesses. In fact, common mental-health symptoms like depression and anxiety often go away on their own without treatment.

Governor Pritzker, in support of universal screening, claimed that it lowers the “stigma” associated with seeking mental-health treatment. But that coin has two sides. Normalizing behaviors, such as seeking a mental-health diagnosis, can make them spread. Some researchers find that reducing stigma around suicide, for example, can inadvertently normalize it. And stigma argument is thin, given that teachers report that kids are regularly diagnosing themselves with mental-health conditions.

Other advocates for school-based mental health services claim that they improve academic outcomes. But evaluations have found no consistent impact on attendance, test scores, or other academic measures.

Mental-health services in schools—including universal screenings—have almost no upsides but real downsides. Such services lead schools to misallocate time and money that could be spent teaching necessary skills, like learning to read. Illinois is a case in point. The state will now focus on dubious mental-health interventions while its schoolchildren continue to fall behind academically.

There is a better way for schools to improve student well-being, and it’s cheaper than the nearly $3 billion Illinois already spends on mental health–oriented student-support services: academic leaders should implement policies to ensure that children consistently attend class in-person. Research consistently links attendance to academic and social outcomes. That type of structural reform, unlike universal screening, has demonstrated effectiveness in supporting both academic success and healthy development.

Governor Pritzker may be eager to tout Illinois as a pioneer, but he’s blazing a trail in the wrong direction. Other states should keep their schools focused on academics and leave clinical treatment to the health-care system.

Photo:  Maskot / Maskot via Getty Images