Outline of the state of Guam

Early Identification and Referral

Early Identification and Referral

State law authorizes districts to conduct mental health screening in schools or to disseminate information on mental health resources.

17 Guam Code Annotated 6700 Legislative Findings and Intent.

[Guam Legislature] finds that:

  • (a) The use of educational settings to screen children and adolescents for "mental disorders" has led to parents not being given sufficient information about the purpose of such screenings and the ramifications if they consent, such as psychological or psychiatric treatment for their child and family, thereby violating the recognized requirements and Standard regarding "full informed consent".

  • (b) Frequently, a system of "passive consent" is used whereby "consent" is considered provided when the parent does not return the consent form. The onus is, therefore, on the child/adolescent to transmit the consent form to the parent, and on the parent ensuring that if consent is not given, the form is signed and returned. However, the onus should rest on both the school and the mental health professional or agency seeking to conduct the screening, with criminal penalties if consent is not obtained in writing and the child is subjected to non-consensual screening.

  • (c) "Passive consent" or other consent forms often:

  • (1) mislead parents into thinking that what is taking place at the school is just a health evaluation for their child, not a psychiatric evaluation;

  • (2) do not include information about the personal and invasive questions their child will be asked;

  • (3) do not contain information on the difference between "emotional health concerns", mental disorders, or physical diseases, the latter of which can be physically tested for and the former cannot; and

  • (4) leave the parent with so little information that he or she cannot make a proper informed decision to give valid informed consent.

  • (d) Parents also are not informed that mental health screenings for "mental disorders" are based on those defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). However, in the introduction of the DSM-IV it states, "Moreover, although this manual provides a classification of mental disorders, it must be admitted that no definition adequately specifies precise boundaries for the concept of 'mental disorder'". Further, "...the term 'mental' disorders...persists in the title of DSM-IV because we have not found an appropriate substitute".

  • (e) Unlike scientific methods to determine physical diseases like cancer, diabetes or tuberculosis, a diagnosis of "mental disorder" or "syndrome" is not based on any medical test, such as a brain scan, a 'chemical imbalance' test, x-ray or blood test. The former U.S. Surgeon General, in his 1999 Report on Mental Health, which became a reference for many countries, stated, "The diagnosis of mental disorders is often believed to be more difficult than diagnosis of medical disorders since there is no definitive lesion, laboratory test or abnormality in brain tissue that can identify the illness."

  • (f) Harvard Medical School's Dr. Joseph Glenmullen warns that the checklist rating scales used to screen people for conditions, such as "depression", are "designed to fit hand-inglove with the effects of drugs, emphasizing the physical symptoms of depression that most respond to antidepressant medication ...While assigning a number to a patient's depression may look scientific, when one examines the questions asked and the scales used, they are utterly subjective measures". He says, "The symptoms are subjective emotional states, making the diagnosis extremely vague".

  • (g) Based on the subjective nature of the mental health diagnostic system and mental health screenings, millions of children are prescribed antidepressants or stimulants recognized by leading drug regulatory agencies as causing suicidal behavior, suicide, violence, hostility and, in the case of stimulants, the potential for strokes and heart attacks. In October 2004, the U.S. Food and Drug Administration (FDA) required a "black box" warning of suicide risks for all antidepressants prescribed to those under eighteen (18) years old. In August 2005, The Commission of the European Communities that represents twenty-five (25) countries issued the strongest warning yet against child antidepressant use, warning of the drug's potential to cause suicide attempts and suicidal ideation, aggression, hostility (predominantly aggression, oppositional behavior and anger), and/or related behavior. According to the U.S. Drug Enforcement Administration, the stimulant drugs being prescribed to children are scheduled as abusive as opium, morphine and cocaine. In February 2006, an FDA Advisory Committee recommended a "black box" warning for stimulants, stating that they can cause heart attacks, strokes, and even death.

  • (h) As such, Guam's parents, without explicit protection, will be unable to give informed consent about whether they want their child to participate in such screening. It is the intent of I Liheslatura to prohibit the Guam Department of Education from conducting any mental health screening on school children without the informed consent of parents.

Policy Type

17 Guam Code Annotated 6701 Informed Consent Required for Mental Health Screening of Students.

The Guam Department of Education shall:

  • (a) prohibit the use of schools for any mental health or psychological screening or testing of any student, whether a non- emancipated minor or emancipated minor, without the express written consent of the parent or guardian;

  • (b) the consent form must be in a clear and legible form and in compliance with any local or federal regulation, in the primary language of the parent, not less than forty-five (45) days in advance of any such screening; and

  • (c) the consent form must be signed by the parent or legally appointed guardian of each minor.

Policy Type

The Student Conduct Procedural Manual

Manual provides procedures for addressing student conduct, including tiers of support, referrals, and roles and responsibilities of school counselors, psychologists, and social workers.

Policy Type