[Edit: My views on this have since changed in some regards, please see the post here for clarification.]
This is a continuation from the previous post, looking at the controversies surrounding the use of the SDQ in New Zealand’s “B4 School Check.”
In this post, I am turning my attention to the issues around the public perception of “mental health,” that have come up in response to the SDQ portion of the B4 School Check. The issues and arguments I bring up here and in the next post, are all taken from talk-back radio, public forum discussions, or views of the public shared in national news stories (for links to some of those sources, see the previous post).
I’ll begin with one of the most popular responses to why the B4 School Checks should not include a check for “mental health” issues: Stigma.
The argument goes like this: Children shouldn’t be screened for mental issues, because receiving a mental health label (such as autism, ADHD, or childhood depression) is stigmatizing for the child.
This argument is so clearly and deeply flawed that it’s rather too easy to knock down (but I’ll do it anyway). However, I will also give the arguers the benefit of the doubt – that they are using the stigma argument to make other points they’re not expressly stating (and that some others do expressly state) – and run through those deeper arguments after I’ve knocked down the main one. (Perhaps if you are someone who holds to the stigma argument, or can see the argument they’re making is different than that I’ll be addressing here, you could enlighten me via the comment section.)
First off, the pure stigma point. It is my view that issues to do with the mind – conditions that impact on “intelligence” for example – are one of the last ways in which society still thinks its OK to discriminate and treat people as less than human. I believe that this point is quite strongly reflected in the stigma argument (and in other arguments I’ll be looking at too). If someone has a broken leg, impaired eyesight, or diabetes, we don’t advise against diagnosing them with these conditions because of the stigma that will attach to the individual. Rather, we recognise the condition is a fact, that needs to be identified and addressed. Yet mental health issues are treated as something to be ashamed of, and that are better left unknown and unidentified. That the stigma that will attach to the child far outweighs the benefits that come from knowledge a child has a condition and the attending benefits of knowing specifically how best to help that child.
If stigma does exist around such conditions – and sadly, it does – shouldn’t the concern be about addressing and reducing that stigma, with better information and attitudes disseminated into the public sphere? To me, it’s like saying “hey, racism exists, even though we don’t like it, so let’s just tell all the coloured people to paint their faces white.” By using the existence of stigma as an argument against recognising the conditions (or rather, differences) that people have, all you’re doing is surely reinforcing the status quo.
There is one aspect of the stigma argument that I think holds water: Since the public doesn’t understand mental issues well at this point, it would be best to make sure the information about diagnoses etc are confined to professionals who won’t misunderstand and misapply the information to the detriment of the child.
However, even this aspect of the argument isn’t going to support the stigma argument here, since the B4 School Check isn’t a diagnostic instrument. It is used to identify whether a child should be further and professionally assessed for potential issues. Even if it was a diagnostic instrument, it’s not like the mental health condition is then tattooed to the child’s forehead. The child is the same child they’d been before, there is no reason for their peers and other non-professional or non-related adults, to have access to the fact that the child has a diagnosed condition.
Hidden deeper within the stigma argument, is the claim that the harms of a diagnosis (the stigma specifically) outweigh any benefits, because the conditions at issue – mental health issues in preschoolers – are themselves suspect, and furthermore that any therapies which follow from a confirmed diagnosis, are also either pointless or harmful. Some people expressly make these arguments, and they are very popular ones, particularly in relation to conditions like Aspergers and ADHD. In my next post, I will be specifically looking at these arguments as they have arisen in the public response to the B4 School Check: Do young children get mental health issues, what are the nature of those mental health issues, is it worth treating those issues, and what is normal anyway (the argument that these are just “normal” kids being labeled with conditions that don’t exist). Embedded in all of that too is the question of whether something like “autism” – one of the conditions that can be picked up as an issue by the SDQ – is really a “mental health issue” in the sense talked about by the public.
EDIT: Due to a huge increase in my home work-load (while my husband is away on conference), it’s looking very unlikely that I will get around to the third part of this series anytime soon. Or maybe ever. I’d done all the research for it but it’s been a few very busy days since then (and I’m still incredibly snowed under), so it’s no longer fresh in my mind enough to pull together a post, without re-reading the original sources all over again. Sorry to those who were waiting for the third installment.