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Child mental health – beyond ‘screening’

This week a Cambridge university academic has suggested that children as young as 7 should be routinely screened for mental health problems.

In a letter published in the British Medical Journal, Simon Nicholas Williams, a visiting professor at the university’s Institute of Public Health, said three-quarters of adult mental disorders were “extensions of juvenile disorders” and that catching them early could save the health service a lot of money.

Like so many academics, his argument was less compassionate and more financial; and like all one-sided arguments it ignores some important issues regarding children and the origins of mental health.

The proposed testing, says the Prof could cost as little as £27 per child; he’s a little less definite on what the cost of setting a child on a potentially life-long treadmill of mental health treatment would be and whether that would genuinely take away from, or simply add to, the £105 billion we already spend on mental health care.

Still I’m betting we could see greater benefit from the £600 million we are investing in free school lunches – as long as they are of high nutritional quality.

As a recent study showed, “junk food” during pregnancy and in early childhood is linked to a significantly increased risk for poor mental health, including anxiety and depression, in very young children.

Other evidence shows that diet quality has a significant effect on mental health outcomes and may play a role in the prevention and treatment of common psychiatric disorders such as depression and anxiety in teens.

As with all screening tests, when we go looking for problems we often find them – even if they don’t exist.  And as with all screening tests, there is the problem of misdiagnosis and misinterpretation.

Mental health issues also cannot be divorced from the context (family, school, society) in which they arise, nor can we deny that what looks like strange behaviour in one context, seems perfectly fine in another.

When, as legend has it, Microsoft founder and chief Bill Gates addressed a big conference attended by hundreds of important people dressed up as Star Trek’s Mr Spock, everyone listened with rapt attention.

The costume had no connection with what he was saying, and in any other setting one might wonder if the man had had a serious breakdown. But Gates’ behaviour was perceived as effective, not inappropriate, and the man himself dynamic, nonconformist and creative.

Children who display nonconformist traits, however, are less likely to be rewarded.

If a child is creative in ways which are unfamiliar to us, or sensitive in ways that we, as adults, have long forgotten how to be, it makes us somehow uncomfortable. If he or she doesn’t feel like joining in, or – as I experienced with my own son – refuses to play with children who are serial bullies in the name of ‘inclusiveness’, this is seen as a problem.

If a child can memorise books, or spend hours on their own writing stories, but can’t sit still for homework, or brings home school papers which are messy and full of teacher’s comments such as “didn’t follow directions”, we fret.

With a child like this it can be all too easy for a parent or teacher to diagnose a mental health problem, a learning disability or to apply that catch-all diagnosis ADD, attention deficit disorder.

Screening tests – all screening tests – set relatively arbitrary norms. Anything outside of that norm is ‘abnormal’ – even if it isn’t. Imagine the soul crushing anxiety for the parents and the child of having who and what you are defined in such a way from the age of 7?

As developmental psychologists will attest, not all children develop along a predictable curve and there are many levels of intelligence and many legitimate types of self expression – many of which are inconvenient to the institutional setting of the average school.

Before we try to ‘fix’ our kids through the dubious magic of screening tests, maybe we should try to fix the system(s) that they grow up in.

Pat Thomas, Editor