Cato Institute
August 15, 2004
Schools Shouldn't Play Doctor
by Michael F. Cannon and Marie Gryphon

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Michael F. Cannon is director of health policy studies and Marie Gryphon is an education policy analyst at the Cato Institute.

The Department of Health and Human Services will announce this fall a plan to improve access to mental health services. The initiative follows the release last year of a report commissioned by President George W. Bush recommending that "schools should . . . play a larger role in mental health care for children," screening public schoolchildren for mental illness (with parental consent) and providing counseling and referral services.

The HHS should reject these recommendations. Until parents can choose their children's schools, expanding public schools' role in treating mental illness could be harmful to both students and parents.

At first glance, public schools seem like a great place to address childhood mental illness. The 2003 report notes that "more than 52 million students . . . [pass] through the Nation's schools on any given weekday," and early diagnosis improves the odds that medical treatments will succeed.

But consider Daniel Taylor. Like more than one million American children, Daniel was prescribed methylphenidate (a.k.a. Ritalin) to control his attention deficit hyperactivity disorder (ADHD). Ritalin is at the center of an emotional debate. Though apparently a safe and effective treatment, many believe the drug has become a convenient means of quieting unruly children. Even with a correct diagnosis, some experts worry that doctors, parents, and teachers have become too quick to medicate.

Thus, when Chad Taylor noticed that his son was losing sleep and his appetite -- two of Ritalin's known side effects -- he took Daniel off the drug. When Daniel's school found out, it reported the Taylors to child welfare authorities.

Soon the New Mexico Department of Children, Youth and Families dispatched a detective and social worker to visit the Taylors. Chad Taylor told a reporter: "The detective told me if I did not medicate my son, I would be arrested for child abuse and neglect." Though the police dispute that charge, they did claim, as an ABC News story put it, "parents could be charged in situations like his."

Or consider Patricia Weathers. According to the Christian Science Monitor, "When Patricia Weathers' son Michael had problems in his first-grade class, a school psychologist told the New York mother he had attention deficit hyperactivity disorder, or ADHD, and needed to be medicated with stimulants. If not, he would be sent to a special education facility near his Millbrook, N.Y., school." Weathers complied, but soon noticed "the medicines were making Michael psychotic" -- another of Ritalin's reported side effects. When she stopped Michael's drug regimen, "the school reported her to state child protective services for child abuse." Charges were later dropped.

By law, public schools must serve all children in their neighborhood using limited resources. When their obligation to a special needs child conflicts with their obligation to the majority of students, public schools will attempt to minimize that conflict. The Christian Science Monitor reports even educators worry that "teachers in crowded, cash-strapped classrooms are more likely to steer a disruptive child toward medication." At the same time, public schools do not bear the costs that are sometimes associated with medication -- as the Taylors and Weatherses did.

Given these incentives, empowering public schools to "play a larger role in mental health care for children" could do special needs students and their parents more harm than good.

While special needs children in private schools can avoid such conflicts by choosing another school, public school students typically do not have that choice. A better way to help public school children with behavioral problems would be to let their parents choose the school that best fits their needs.

In Florida, children with disabilities, including ADHD, can request a voucher to attend an alternative school that their parents choose. School choice encourages collaboration -- rather than conflict -- between parents and teachers over how a child's mental health and educational needs might best be met. If the two cannot agree, the parents are free to seek educational services from another willing provider, often a mainstream private or parochial school.

The McKay Scholarship Program serves over 12,000 Florida students. It transforms children from hostages into customers, and families love it.

Empowering public schools with more power over children's mental health treatment invites conflict. Instead, states should empower parents to choose the school that meets their children's needs. That would improve the mental health of all involved.