Enhancing Quality in
School Mental Health

A School Mental Health Perspective

Politicians and parents alike debate the value of screening for mental health problems in schools. As front-line service providers, school mental health clinicians and their programs need to make decisions about whether and how to best use screening for mental health problems as part of their work in the schools.
This article summarizes some of the pertinent issues related to screening for depression in schools. The first part describes different approaches to screening for depression; the second covers current controversies about screening for depression in schools.
Screening process
While no uniform standard exists for screening for depression in schools, effective methods share certain things in common:
Standardized assessment tools
Multiple informants
Collaboration amongst teachers, clinicians, and specialists (e.g., speech-language pathologists, resource center staff
Culture of awareness within school community (i.e., knowing signs of depression)
Schools with these characteristics exhibit openness to identifying depression and sensitivity for normal student development.
Screening tools
Some of the most commonly used instruments for screening for depression include:
Center for Epidemiological Studies – Depression Scale for Children (CES-DC)
Child’s Depression Inventory (CDI)
Strength and Difficulties Questionnaire (SDQ)
Responses on no one measure definitively classify a student as depressed. In addition to these measures, students must also receive further evaluation and observation before receiving a formal diagnosis.
Screening tools such as those listed above allow mental health professionals to respond more appropriately to the presenting needs of students.
Current debate about screening in general
As mentioned earlier, politicians and parents voice varying concerns about the utility of screening for depression.
Advocates claim that screening prevents a host of related problems (e.g., suicide, substance abuse, criminal activity, etc.) by enhancing responsiveness to student needs.
On the other hand, critics argue that screening violates privacy rights and lacks proven effectiveness, forcing schools to incur heightened costs due to over-identification and insufficient resources to meet the needs reported by the students.
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Working with Students

This article briefly describes how school clinicians can teach students how to “catch” and correct negative thoughts.
A student begins by saying, “I’m stupid.”
You can counter this statement by presenting a realistic and truthful statement such as, “You’re not stupid. You’re very good at writing stories.”
Remember not to counter the student’s statement with an unrealistic statement. (e.g., “You are the smartest person I’ve ever met.”)
Help the student create a list of all the things they do well. Ask them to write down only things they truly believe, since they need to use this list to counter negative thoughts.
If a student has difficulty creating a list, explain for them the different types of abilities people possess.
Demonstrate for the student how to use this list to replace negative thoughts.
Ask the student to practice this “catching” technique.
Once the student knows what negative thoughts to “catch,” have the student practice replacing the negative thoughts by referring to the list of things they do well.
Encourage the student to carry their “positive thoughts” with them on a note card they can refer to during the day.

Common Cognitive Distortions
Feelings are Facts: Jim did not have plans with his friends this weekend. He felt lonely and inferior. He thought, "No one likes me. I have a terrible personality."
Catastrophizing: Sierra did not make the cheer leading team after working hard in tryouts. She thought, "My life is over. I'll never have any friends or any fun."
Discounting: Jose was complimented by his teacher for his artistic drawing. He thought, "Anybody could have drawn that. She doesn't know anything. I don't have a special ability. “
Walker, P.H. & Martinez, R. (Eds.) (2001) Excellence in Mental Health: A school Health Curriculum - A Training Manual for Practicing School Nurses and Educators.

Screening for Depression

Current debate about screening in school
Screening for depression in schools elicits opinions about public resources and family privacy.
Advocates see the positive long-term benefits of screening for depression in school: reduced mental health costs and easier access to services (when compared to other private and/or community-based providers). Advocates also believe that proper screening improves academic success and emotional-wellbeing outside of school.
On the other hand, critics argue that screening for depression in schools detracts from the original intent of the education system (i.e. teachers teach, students learn) and further stretches the limited resources available in most schools.
School mental health clinicians stand at the forefront of this debate. Although no clear consensus exists about the utility of screening for depression in schools, school mental health clinicians must decide if an how they will utilize screening measures.
Adelman, T. & Taylor, L. (2005). Screening mental health problems in schools. Retrieved January 12, 2006, from University of California, Los Angeles, Center for Mental Health in Schools website: http://smhp.psych.ucla.edu/pdfdocs/policyissues/mhscreeningissues.pdf