President Bush created the New Freedom Commission on Mental health to address three issues in every state:
· The stigma surrounding mental health
· Treatment and financial limitations placed on mental health and private health insurance.
· The fragmented mental health delivery system.

This commission suggests a national focus on the mental health needs of young children and their families and includes screening, detection, assessment, early intervention, treatment, training, and financing services. In fact, the framework of the New Freedom Commission will build upon those who qualify for services under part B of the IDEA, for increased capacity and improved services within communities through the schools.

The New freedom Commission’s publication, Achieving the Promise: Transforming Mental Health Care in America, explains how the existing NCLB and IDEA federal laws will enable the expansion of mental health care into the public schools. The framework exists and needs only new legislation, regulations, or mandates.

President Bush established the new Freedom Commission in April of 2002 as a part of his commitment to eliminate inequality for American’s with disabilities. It should be clear to anyone who has read the Commission’s report that schools will clearly be expected to provide mental health services and programs that will be regulated by each state and initially federally funded.

Let me explain how:
“The No Child Left Behind Act of 2001” is designed to help all children, including those with serious emotional disturbances reach their optimal potential and achievement. To fulfill the purpose of this Act, schools must work to remove the emotional, behavioral, and academic barriers that interfere with student success in school. Consequently, it is critical to strengthen mental health programs in schools….” (Emphasis added) (Quoted from New Freedom Commission on Mental Health report, page 8)

This effort may involve:
· Ensuring that mental health services are part of school health centers.
· Ensuring that these services are federally funded as health, mental health, and educational programs.
· Creating a State-level structure for school based health services to provide consistent state-level leadership and collaboration between education, general health, and mental health systems.
· Working at the local level amongst parents, local providers, and local agencies to support screening, assessment, and early detection of mental health issues of ALL CHILDREN.

The New Freedom Commission indicates because schools are where children spend most of their day, schools are in the best position to be utilized as the vehicle in facilitating this process. The Comission believes that education is intertwined with mental health and school success. Because of this belief, they feel schools shall be the hubs of mental health screening of all children and be directly involved. The commission goes on to recommend that schools are in the best position to identify mental health problems early on and are in the best position to link children and families to appropriate services and outside providers throughout communities.

“Since the IDEA requires that a variety of professionals collaborate in the school and in the community, the Commission urges that coordinating services be regarded as a “related service” in the student’s Individual Education Plan. In developing the IEP, there should be a stronger family focus and youth involvement and support. The training and research funds designated in this Act should be considered for use to train teachers, related services for professionals, and parents to recognize signs of emotional and behavioral problems in children, make appropriate referrals for assessment and services and classroom accommodations, and implement and evaluate evidence-based school mental health interventions.” (Quoted from New Freedom Commission on Mental Health Report, Page 9 of 12 page report)

Challenges within the Commission’s many recommendations are numerous and quite complex as services would be integrated amongst various levels.
As related specifically to the IDEA, is the challenge of the transition requirements for students age 14 addressing conversion from adolescence to adulthood and the current requirements unable to address students after that point in time. Policymakers should therefore anticipate new federal legislation, regulations, or mandates to conquer that barrier enabling this process to move forward in the next two years.

Since teachers will be the first line screeners to this process, this not only adds an academic responsibility to their current job description, but, imposes
An incredible requirement to screen their students for mental illness. One can only imagine the contentiousness of the language added into the collective bargaining agreements statewide to address this issue amongst schools and unions. Because screening at this level will be largely subjective, some important questions need to be asked:

· What screening instruments will be used?
· Will normal behavior be labeled for treatment?
· How will the mental health information be secured and meet privacy?
· Who will have access to the information since the system will be integrated at various levels and by various entities?
· What will happen to parents or students who do not want to participate?
· When and how will teachers be expected to screen the children?
· How much academic time will be lost?
· How much teacher training will be diverted from the content areas to psychological training?
·· With schools receiving extra money for children identified with special needs, what will stop schools from utilizing screening and diagnosing from becoming an incentive for labeling the child?
· Was a cost-benefit analysis been done to insure efficiency?
· How much will this cost taxpayers?
· Do primary care physicians receive adequate training in mental health?
· Are there enough fully trained psychiatrists, psychologists, and specialists necessary to manage increased numbers of patients that massive screening by schools may possibly identify?
· What about the use of drugs?
· Will more and more identified students be placed on drugs that can be overused, misused, and even deadly?
· Who is liable for providing services and drugs in the event there is a misdiagnosis?
· Is there and should there be a concern of stigmatizing a student with a mental health illness who has been misidentified?
·Schools will likely increase their student populations of sub groupings under NCLB, yet these same students will be expected to meet proficiency on the PSSA for AYP purposes….will more schools be more inclined not to meet AYP because of these increased students with IEP’s?
· Can the primary care center or the schools be expected to provide the vigilance needed for students taking psychotherapeutic drugs?
· Should the creation of a more intrusive federally mandated state mental health system be a part of our state? Our schools?
· Do more government programs ever provide the best solution to the problem?

One cannot ignore the costs, both personal and financial, of mental health illness. However, one is hard pressed to find statistics that require and mandate a vast expansion of mental health screenings. More importantly, should schools necessarily be the vehicle used to facilitate this process?

Kim Geyer
Mars Research & Retrieval Services
November 14, 2004

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