School-Based Mental Health Programs are Ineffective
Public health-style interventions fail once again
Carolyn Gorman and Scott Dziengelski of the Manhattan Institute just released an article on school mental health programs in City Journal. This is one of those “pieces I wish I had written” for me, as it sums up so much of what has been on my mind in recent months as my own work has turned more towards k-12 education.
Mental health issues among kids and teens have been rising for the past few years. Schools have attempted to deal with this surge by integrating mental health interventions into the school day. This can be overt, as in mental health awareness programs, or covert, as in Social Emotional Learning (SEL) which sneaks emotional education into normal subjects like math and P.E.
Whether or not one agrees with such an approach in principle, Gorman and Dziengelski are correct in pointing out that there is no solid evidence for its efficacy:
Decades of research have found little rigorous evidence that universal school-based mental-health programs prevent youth mental illness or suicide. These programs do not direct clinical resources based on the severity of a child’s condition. Instead, students least in need of mental-health services get outsized attention, while those who most need psychiatric care fall through the cracks.
“All sorts of so-called universal interventions, in which a big group of teens are subjected to ‘healthy’ messaging from adults, have failed,” writes Olga Khazan in The Atlantic. In fact, she highlights, some studies find that such interventions result in worse outcomes, even when the programs were developed from evidence-based approaches like dialectical behavior therapy and cognitive behavioral therapy.
Why aren’t these programs working? One reason may be the difficulty of adapting new versions of evidence-based programs outside of a research context. Another reason, as Abigail Shrier has documented, may be the iatrogenic effects of such anticipatory therapeutic interventions—that is, the treatment itself can make things worse. “Awareness” programs, for instance, can make kids glamorize or ruminate on mental states they previously hadn’t been inclined to indulge, to sometimes harmful ends. Just as D.A.R.E. didn’t succeed in reducing drug use and WebMD has not made people healthier, educating kids on a wide-range of disorders won’t prevent them from developing psychiatric issues.
The authors cover a growing number of worrying trends: Teachers being forced to act as pseudotherapists to their students; a growing class of “mental health promotion” workers whose careers are based on them delivering these ineffective public health-style programs, and the lack of resources and attention available for the severely mentally ill children who need them most.
Read the full piece here (highly recommended).
I am even starting to doubt the actual effect sizes of therapies. Whilst I do think they are somewhat effective. But when you pair that with dubious disease mongering syndromic diagnostic criteria from the DSM5, I. E. Most diagnostic criteria only became broader and more inclusive over the years, which means they also become vague and ambiguous, I am not talking about all diagnoses, as I think there are more than enough valid ones in the DSM, but the concept creep is quite severe, and the amount of syndrome only increases, and does not become clearer, more accurate or more sensitive over time. Pretty much all that the DSM has done over the years is include more diagnoses, make it more possible that more people get diagnosed, but no actual move towards sensitivity, accuracy and reliability like you see with many medical diagnosis. Even those that are very controversial among the scientific community or even those that no longer are seen as valid still are in the DSM5. So the scientific usefulness of the DSM5 has been criticized a lot over the years. So I think that the problems with the DSM5 also play a role in why therapies show dubious effectiveness in many cases outside the strictly therapeutical environments.