17 GCA § 6702: Contents of Informed Consent Form.

The consent form must include the following information:

TO: (parent or guardian)

FROM: (school or organization)

[Particulars regarding name of screening program, where and when it will take place]

FULL INFORMED CONSENT FOR MENTAL HEALTH OR

PSYCHOLOGICAL SCREENING

Mental health or psychological screening methods for children and adolescents vary from state to

state, but may involve a self-administered computer interview or survey to determine how a

student feels emotionally (anxious or worried, sad or depressed) or to judge his or her behavior

at the present time or in the past. These questions can cover thoughts or feelings your child has

had or thoughts and feelings your child thinks you may have had or currently have about him or

her.

An outcome could be you are asked to take your child for a follow-up interview or evaluation to

determine if he or she has a mental disorder or syndrome. Based on an evaluation of your child’s

answers, he or she may be diagnosed with a “mental” or “psychiatric disorder”. These diagnoses

have to be made by a psychologist, psychiatrist or medical doctor, but the subjectivity of this

diagnostic process makes it a risk.

Questionnaires or tests are frequently based on symptoms outlined in the Diagnostic and

Statistical Manual of Mental Disorders (DSM) or the mental disorders section of the International

Classification of Diseases (ICD). The psychologist, psychiatrist and medical doctor often depend

upon these diagnoses in order to bill private or government insurance.

The attitudes, beliefs, actions, inactions, or behaviors of a child or adolescent and whether or not

these constitute a mental disorder are based on the opinion only of the person making the

diagnosis. Unlike methods to determine physical diseases like cancer, diabetes or tuberculosis, a

diagnosis of “mental disorder” or “syndrome” cannot be determined by any physical, medical

test, such as a brain scan, a “chemical imbalance” test, X-ray or blood test.

Mental health screening could be presented to you as a means of preventing suicide. However,

there is no scientific evidence to substantiate this at this time. The U.S. Preventive Services Task

Force (USPSTF) studied this and recommended against screening for suicide in 2004, saying that

it “found no evidence that screening for suicide risk reduces suicide attempts or mortality”.

Commonly psychiatric drugs prescribed to treat mental disorders can have very serious effects on

some children. In 2005, the European Committee for Medicinal Products for Human Use

(CHMP), which includes members from 25 European Member States determined that

antidepressants should not be prescribed to those under 18 years old because they can produce

suicidal behavior, including suicide attempts and thinking about suicide and/or related behavior

like self-harm, hostility or mood changes.

The U.S. Food and Drug Administration ordered that a “black box”, its highest level of drug

warning, be placed on antidepressant packaging advising that the drugs can induce suicide in

children and teens. The FDA also has issued concerns that stimulant drugs prescribed to children

may cause “psychiatric events,” described as “visual hallucinations, suicidal ideation, psychotic

behavior, as well as aggression or violent behavior”.

Before consenting to any such screening or survey, the educational facility must provide a manual

and other published information which fully describes:

(a) The nature and purpose of the screening/test or questionnaire.

(b) The development of the screening/test or questionnaire, its scientific validity as

replicated in scientific studies, the rationale for the screening/test/questionnaire and reliability.

(c) Scientific journal citations demonstrating that the proposed screening/test or

questionnaire has been proven to be reliable and valid by replicated scientific studies.

(d) A guarantee that no screening/test or questionnaire is based or related to any “mental

disorder” as covered in the Diagnostic and Statistical Manual of Mental Disorders.

(e) The intended use of the results or outcomes of the child or adolescent completing such

screening/test or questionnaire.

(f) The right to rescind consent at any time before, during or after the screening/test or

questionnaire being proposed.

INFORMED CONSENT FOR MENTAL HEALTH SCREENING

I acknowledge that I have read and understood the above information to the best of my ability

and have read (NAME OF MANUAL), and based on my understanding, I am choosing one (1)

of the following:

I give my consent for my child to undergo an evaluation for emotional, behavior, mental, specific

learning disabilities, or other health impairments (mental health screening), and require that I be

provided, in writing, any findings determined.

Consent means that I do/do not (strike which is inappropriate) give permission for the information

obtained from such survey or testing to become part of my child’s school or other record or to be

transmitted to any other agency outside of the [name of school].

________________________ ____________

(Signature of Parent) Date

I do not give my consent for my child to undergo an evaluation for emotional, behavior, mental,

specific learning disabilities, or other health impairments (mental health screening).

________________________ ____________

(Signature of Parent) Date

THIS FORM MUST BE RECEIVED BY THE PARENT AT LEAST 45 DAYS BEFORE THE

PLANNED SCREENING. PLEASE ENSURE THIS FORM IS RETURNED BEFORE THE

SCREENING DATE. YOU HAVE THE RIGHT TO REVOKE YOUR CONSENT AT ANY

TIME.