Stop Asking Kids if They're Depressed

Mandatory Mental Health Screening for Kids is a Disaster

Dear Truth Fairy Reader,

I am hard at work on a new book — The Plot Against Love — about how Gen Z’s dating and mating life went so desperately off track. I have talked to many of you; I’d be thrilled to talk to more. If you’re a member of Gen Z, open to talking about your dating life without attribution, please get in touch: abigail.shrier@gmail.com.

I’ll be posting more about The Plot Against Love in the coming months.

I also wanted to bring to your attention the new Illinois law that makes mental health screening mandatory in public school. Mental health screening is more insidious than it seems. I lay out some of the harms in this new piece.

If you have a child in public school, consider arming them with these words: “I am not allowed to take this survey. Please call my mother.”

Warmly,

Abigail

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Illinois intends to crop-dust its public schools with mental-health diagnoses.

Last week, Illinois governor JB Pritzker signed into law mandatory annual mental-health screenings for all public school children in third through twelfth grades. “Illinois is now the first state in the nation to require mental health screenings in its public schools,” the governor trumpeted on X. “Our schools should be inclusive places where students are not just comfortable asking for help—they’re empowered to do it.”

Empowered to “ask” for help by submitting to mandatory and invasive mental-health surveys, that is. If basic literacy hadn’t already collapsed in Illinois, kids might pose spirited objections to Pritzker’s sales pitch.

In fact, far too many American children and adolescents without debilitating mental disorders have already been funneled into the slippery mental-health pipeline.

I know: I’ve spoken to hundreds of parents of such kids.

In 2024, I published Bad Therapy, an investigation into the surge in adolescent mental-health diagnoses and psychiatric prescription drug use. Many young people without serious mental illness nonetheless spend years languishing with a diagnosis, alternately cursing it and embracing it, believing they have a broken brain, convincing themselves that their struggles are insurmountable because of the disorder’s constraints. They meet regularly with a therapist or school counselor on whom they become increasingly reliant, losing a sense of efficacy, unable to navigate on their own even minor setbacks and interpersonal conflicts. They begin courses of antidepressants that carry all kinds of side effects—suppressed libido, fatigue, the muffling of all emotion, and even an increase in depression. Antianxiety drugs and the stimulants given to kids diagnosed with ADHD are both addictive and ubiquitously abused.

Often that tragic descent begins with a simple mental health survey.

By chance, while I was writing the book, my middle school–age son returned home from sleepaway camp with a persistent stomachache. I took him to urgent care, where a nurse asked me to leave the room so he could administer a mental health screening tool put out by our National Institute of Mental Health. That turned out to be NIMH explicit protocol: ask parents to leave so that you can administer the following questions to kids who have not shown any signs of mental distress, aged eight and up.

I requested a copy of the survey and photographed it. Here, verbatim, are the five questions the nurse intended to put to my son in private:

1. In the past few weeks, have you wished you were dead?

2. In the past few weeks, have you felt that you or your family would be better off if you were dead?

3. In the past week, have you been having thoughts about killing yourself?

4. Have you ever tried to kill yourself? If yes, how? When?

5. Are you thinking of killing yourself right now? If yes, please describe.

Kids are wildly suggestible, especially where psychiatric symptoms are concerned. Ask a kid repeatedly if he might be depressed—how about now? Are you sure?—and he just might decide that he is.

Introduce “gender dysphoria” into a peer group, and a swath of seventh grade girls are likely to decide they were born in the wrong body. Introduce “testing anxiety” or “social phobia,” or “suicidality” to them, and many teens are likely to decide: I have that, too. There is a reason clinicians keep anorexia patients from socializing unsupervised in a hospital ward; anorexia is profoundly socially contagious.

“Mandatory school screenings of kids for mental illness is great in theory and terrible in practice,” Dr. Allen Frances, Duke University professor of psychiatry and author of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, widely known as the “psychiatric bible,” wrote to me over email. “Most kids who screen positive will have transient problems, not mental disorder. Mislabeling stigmatizes and subjects them to unnecessary treatments, while misdirecting very scarce resources away from kids who desperately need them.”

A certain amount of anxiety and low mood is not only a normal part of every life, they are almost a signal feature of adolescence, reflecting dramatic periods of psychosocial and psychosexual change. What might look like depression in an adult is very often just a phase in a teenager. But informing a teen that he has shown signs of “depression” is no neutral act.

Handing a mental diagnosis to a child or teen—even if accurate—is an enormously consequential event. It can change the way a young person sees himself, create limitations for what he believes he can achieve, encourage treatment dependency on a therapist, and empty out his sense of agency—that he can, on his own, achieve his goals and improve his life. And unlike the alleged benefits of mental health screeners, there is solid evidence on the harms produced by receiving a mental diagnosis, harms that are pure tragedy in the case of misdiagnosis.

In fact, there is no proof that mental health screeners have ever been shown to improve mental health outcomes. Nor are screeners capable of identifying who the next school shooter will likely be. They are poor at identifying which kids likely have depression, since they are not sensitive enough to distinguish it from normal periods of sadness. They do not even reliably indicate which kids are at risk of suicide.

What mental health surveys reliably produce is false positives. Screening for low-probability diagnoses like suicidality or clinical depression will inevitably generate a surf of misdiagnosis. It isn’t hard, mathematically, to see why.

Whenever you screen very large numbers of people for very low-incidence conditions, even with good tests, false positives will overwhelm accurate diagnoses. Making reasonable assumptions about the suicide rate in an adolescent population, the overwhelming majority of students flagged for suicidality will be false positives. “If you do the statistical calculation, you discover that the false positive rate is about 97 percent,” said Stephen J. Morse, professor of law and psychiatry at the University of Pennsylvania. That’s a lot of kids whose lives and self-conceptions the state will have altered with false alarms.

Illinois state senator Laura Fine, chair of Pritzker’s mental health committee, indicated last week that the state may harbor broader ambitions. “The screenings will be designed to catch the early signs of anxiety, depression, or trauma. . . ” A slip of the mask, if not the tongue.

“Trauma” is not a recognized mental health diagnosis. As I encountered during my investigation, in the hands of school counselors, “trauma” can and does mean any hurt suffered in childhood. Have your parents ever spanked you? Yelled at you? Forced you to attend church? Do they offer enthusiastic affirmation of your chosen gender identity, or are they skeptical? All of these are routinely identified as sources of childhood “trauma.” And because teachers and school mental health staff are all “mandatory reporters,” anything they learn about a family’s private life that carries even a whiff of “trauma” may occasion a call to Child Services.

Fine insisted last week that screeners do not purport to diagnose. But when a school informs a family that their child has been flagged for depression, it pinballs the family across a plane of panic, setting up intervention by school counseling staff and referrals for psychiatric diagnosis and medication. Nor is the fact that the law permits parents to “opt out” of screening likely to mitigate its effects. Most parents will never learn that the “opt out” exists. And many of those who do will find out how little it often means in practice. Over the years, many parents who opted out of sexual orientation and gender identity instruction for their children have told me that the school staff either didn’t know about their opt out or simply ignored it.

Especially in the last generation, adolescent mental health has leaped off a cliff—all while we have doubled and redoubled resources spent on adolescent mental health. The nonstop diagnosis and treatment of American kids hasn’t made a dent in the prevalence of mental illness; the two have risen in parallel. You can’t give kids an unhealthy life and expect mental health resources to fix it. That much should now be obvious.

The vast majority of our kids and teens are not mentally ill. But they are lonely, worried, scared, and bummed out. Schools ought to supply them with reliable bolsters to the human spirit: high expectations. Greater independence and responsibility. Far, far less screen time. More recess. Exercise. Art. Music. Involvement in goal-oriented activities that lure them out of their own minds and force them to think about something, anything, other than themselves.

Reprinted with permission from The Free Press.