Why do psychological assessments – the context of the times and society
On September 11 this year, the official website of the National Health and Health Commission released the "Work Plan for Exploring Special Services for the Prevention and Treatment of Depression", which proposes that all high schools and colleges and universities will include depression screening into the content of student health examinations, establish student mental health files, assess students' mental health status, and pay close attention to students with abnormal assessment results. I am very supportive of this program overall, and it does prevent extreme events and reduce suicide rates. This decision has a background, that is, the global COVID-19 epidemic has continued to the present, and the mental health of children and adolescents in many countries and regions has shown a deteriorating trend, and the United Nations Child Development Foundation has also published a report on this. This is also the case in China, where the number of suicides among children and adolescents is 2-3 times higher than in previous years, and we see reports in the media from time to time. I think these things will really go to the bottom line of our hearts, so many good lives are ruined, not only the children lose their future, but the family will also suffer greatly.
In view of the current situation of more serious mental health problems in children and adolescents, I can understand that schools and education authorities are eager to solve these problems, but the pace seems to be a little faster. For example, in the first half of this year, a middle school principal came to me for help because of a number of student suicides in the school, and I told him that he would give a psychological assessment to all the students. It was done for all students because suicide was contagious. Failure to build a sound suicide prevention system could lead to a collapse. In my experience over the years, suicidal behavior does not spread to people who are mentally healthy, but only to those who are already suicidal.
But suicide is a particularly important thing, and people who want to commit suicide often also consider the meaning of their own life, or consider the things that love their parents and their own thoughts; but once someone similar to him commits suicide, then he will imitate. So one of the basic ways to prevent suicide is to go to the crowd and find people who are already suicidal. For example, if there is a student suicide in a school, then we must evaluate the students who originally have suicidal tendencies to see the impact and impact of this matter on them, so that they can directly intervene in various ways to save lives. To do this, all students must be screened and assessed.
China leads the world - the mental health service system for college students
At present, almost all colleges and universities will do psychological assessments for students when they enter the school. The main purpose of doing this work is to screen out students for depression or extreme conditions, which refer to situations of self-harm or harm to others. There is a very important time node in this, that is, the Magaju incident in 2005. Since 2005, the Ministry of Education has required every university to establish psychological counseling centres to provide students with mental health services. One of the main purposes of doing these things is to actively identify and help students in need and save their lives.
Is this effective? The suicide rate of American college students is 6.5 per 100,000, that is, 6.5 people in the United States commit suicide every year for every 100,000 college students; and data released by the Chinese Ministry of Education show that the suicide rate of Chinese college students is 1.26 per 100,000, which is almost only 1/5 of that in the United States.
As a developed country, the United States has developed its psychology for more than 100 years, while China, as a developing country, has developed psychology for 40 years, so our professional team is still far from the United States. However, our suicide rate is much lower than theirs, and one of the important reasons is that we have scientific psychological assessment and a sound suicide prevention system, which can detect crises in advance and help them. The hardest part of crisis intervention and suicide prevention is often not the intervention and treatment itself, but that you don't know who this small probability event will happen to when and where. Although the figure of 1.26 per 100,000 does not seem large, it is not small in terms of the absolute number of college students in the country. It is precisely because life is priceless, and because we have such a set of assessments and interventions, that we can effectively save the lives of many people.
How to do a good job in psychological assessment - science and ethics are equally important
Assessment is a professional and scientific matter that requires the subject's informed consent. Because primary and secondary school students are minors, informed consent from parents is required. In this regard, we can't be afraid of trouble, this is what must be done, but some students and parents may have concerns about this, so whether they want to do it or not is the subject's freedom, and we can't force him to do it. I personally really encourage everyone to do this, because it can really save lives and solve problems, which requires us to do a good job of science popularization for parents and students: first, we must explain the reasons for doing the assessment, and second, we must emphasize that the results of the assessment will be strictly confidential, and this personal privacy is protected by national laws. If the evaluation results are not required by laws and psychological counseling ethics to break through confidentiality, then the results cannot be known by a third party.
There are only three most common scenarios for breaking through the principle of confidentiality. The first is that the subject has a clear tendency to self-harm or hurt others, such as the subject has obvious suicidal tendencies, at this time we want to do our best to save his life, rather than to comply with the principle of confidentiality to let him commit suicide, because the right to life is the first in ethics; if he has a clear intention to hurt others, it is even more necessary to break through the principle of confidentiality. The right to life is the first, the right to privacy is second to the right to life, in order to save lives can break through the principle of confidentiality, which is the consensus of the whole world.
The second is that primary and secondary school students, as minors, if they are shown to have been sexually assaulted, abused or injured in assessment or counseling, then for reasons of protecting minors, national law stipulates that teachers, doctors and counselors must adopt a mandatory reporting system.
The third situation is other situations provided for by law, such as appearing in court to testify, and the court has the right to break through the principle of confidentiality to understand some situations.
In these three cases, the first and second situations are the ones that are most closely related to primary and secondary school students, and if these two situations occur, the principle of confidentiality should be broken; as for the situations other than the above three, they should be strictly confidential.
These are still legal and ethical issues, in addition to the problem of accuracy, which is the more difficult part. The methods we use now are basically self-aged scales, answering the questions on the scale according to their actual situation. However, this assessment presupposes that the subject reports the real situation. If the subject is obviously bad, but he says he is good, the scale will not detect his problem. Subjects may not provide real information because of various considerations, such as whether you will tell my parents, whether you will think that I am neurotic and abnormal, and then isolate, discriminate, hurt, and so on. Therefore, before the assessment, we must carefully and patiently do the work for parents and students, and strictly follow the law and ethics.
The scales we currently use are all foreign scales, but Chinese culture and Western culture are different, and there are differences in the times between different scales. For example, many of the scales we use now were translated into China in the 1980s and 1990s, and now that thirty or forty years have passed, these scales may not be able to accurately assess the psychological conditions of contemporary people, or the accuracy rate is relatively low, so we must design a localization and adapt to the times of the evaluation system.
In addition, when we interviewed primary and secondary school students after the assessment in the past two years, we found that some children did not actually understand what some of the test questions meant, which would lead to inaccurate assessment results. So how do you make your child understand? First of all, you have to use the language of the child, not the language of the adult. But if his cognitive level does not develop to the desired level, such as children in the lower and middle grades of primary school, then we have to change to other ways outside the scale, such as projection and play.
Assessment is just the first step in the long march – our goal is to help our children
If the child is found to be dangerous after the assessment, it must be taken seriously, because the purpose of the assessment is to help him. If at-risk students are identified, we will contact these students for interviews and confirm the validity and accuracy of the assessment based on the results of the interviews. After we find a problem, we will solve it and develop a series of courses that we will help the child before the accident occurs. This kind of help can be mental health courses, lectures for parents, training for teachers, especially for front-line teachers, to help them improve their psychological professionalism, increase their professional ability to help children, so that they can find children with problems in time. We will design a complete set of mental health system programs for primary and secondary schools in this way.
I think the Ministry of Education should provide guidelines for the work, because we're going to do it nationwide. In the face of such a large country, we should give full play to our collectivist advantages, concentrate the strength of our experts, draw on our experience in universities, and develop a work guide. This work guide should not be too complicated, and should be easy for schools to implement and implement. Schools should have mental health teachers, and these mental health teachers should learn some of these guidelines and norms, and we also need to train mental health teachers.
Only when parents, teachers, schools and professionals integrate and design a mental health work plan for primary and secondary school students, can we truly and effectively care for children's mental health and promote their overall growth and development