When they returned to school after summer break, ninth-graders in Wisconsin’s Fond du Lac school district were sent home with one extra form for their parents to sign:
a consent for their children to undergo a mental-health screening.

With rising concern about adolescent depression and suicide, more schools are turning to screening tests to identify those at risk and, if necessary, help them get treatment. Voluntary screenings are being offered through school health classes, school-based health clinics and community agencies, which then can refer children for diagnosis and treatment to school psychologists or local healthcare providers.

“Parents are often thinking about school physicals and sports physicals as the school year begins, but they also need to think about the critical importance of mental-health screening,” says Laurie Flynn, executive director of the TeenScreen National Center for Mental Health Checkups at New York’s Columbia University. TeenScreen provides free 10-minute computerized questionnaires for schools. The questionnaires are designed to identify several mental-health conditions.

‘IT CLICKED’

According to the National Institute of Mental Health, half of all cases of mental illness start by age 14, and about 11% of adolescents have a depressive disorder by age 18. Left untreated, such issues can lead to high dropout rates, substance abuse, violence—and suicide, the third-leading cause of death in adolescents. In a study of 2,500 students who went through the Fond du Lac program at six high schools between 2005 and 2009, nearly 20% were identified as at risk, of whom 73.6% were not receiving treatment at the time of screening. Among that group, more than three-quarters completed at least one visit with a mental-health provider within 90 days after referral to school and community services.

Nicholas McCullough, now 23, was among the first group of students who took a screening test when Fond du Lac initiated the program in 2002. He first started experiencing symptoms of depression in eighth grade, losing a great deal of weight and becoming despondent. Although his father was a physician and his mother a nurse, neither could identify what was troubling him.

Mr. McCullough recalls agreeing to do the test because he got out of class to do it. As he was answering the screening questions at school, he says, “it clicked that I wasn’t in a good way and I hadn’t thought about how serious it was getting.” His answers identified him as needing follow-up with a professional, and he and his parents agreed that he should see a local therapist.

He credits the screening program for identifying his problem before it was too late.

“It’s not something a lot of kids like to talk about with their parents and they may not want to bring it up at school either,” says Mr. McCullough. “But if everyone is taking a screening test, it’s a nonpressured way to ask for help.”

Support for screening teens is increasing, along with recognition of the role mental-health checkups can play in improving adolescent health. The Institute of Medicine in 2009 recommended that the federal government expand prevention and early identification programs. The same year, the U.S. Preventive Services Task Force recommended that physicians perform annual depression screening for adolescents 12 to 18 years old—as long as systems are in place to ensure accurate diagnosis, psychotherapy and follow-up.

TeenScreen says requests for screening questionnaires have almost tripled over a two-year period to 426,000 in 2010.

FALSE POSITIVES

Screening programs that use TeenScreen and other questionnaires aren’t without controversy. Some groups oppose them, arguing that they interfere with issues that should be overseen by the family and lead to over-prescription of psychiatric medications.

Because there are errors and false positives on such tests—kids who aren’t really depressed but may answer questions in a way that makes them seem so—opponents also fear children will be wrongly identified as problematic and stigmatized, or that parents will be penalized if they don’t seek treatment.

Howard Adelman, co-director of the Center for Mental Health in Schools at UCLA, believes that teachers and other school officials are usually good at picking out kids at risk without screening programs.

But Marian Sheridan, coordinator for health and safety for the Fond du Lac school district, counters that it is a “false perception” that schools and parents know which kids need help. “We only know the ones who are externally exhibiting symptoms,” says Ms. Sheridan. “We don’t know the ones who are suffering in silence.”

In her district, she adds, the TeenScreen program is part of a comprehensive effort to screen children and connect them with resources. Screening can take place only with parents’ and student consent. About 60% of students who were eligible were screened last year. In all, more than 6,000 children have been screened since 2002, and 1,000 have been connected to additional services.

“The majority of kids say they are better off for having been screened, and that’s what makes us keep doing it,” says Ms. Sheridan.

‘It’s not something a lot of kids like to talk about ... But if everyone is taking a screening test, it’s a nonpressured way to ask for help.’