Once upon a time in an address to the South East Region, which includes Kent, Al Aynsley-Green (now the Children's Commissioner) warned against persistent attempts by the popular media to ‘demonise’ teenagers. The BJGP has performed a useful service in summarising our limited understanding of the long-term consequences of screening school children randomly for traces of illicit drugs.1 The economic and workforce costs are high and there is no evidence of health gain. I was consulted (pro bono) about some aspects of the unilateral initiative in Kent. That felt to me much more relevant to symbolism about discipline and public relations (especially for the private sector participants) than related to the health of young people. This high-profile exercise took place at a time when many in the NHS were coming together, unsung, in a major effort to improve the care of young people at risk of harm from substance use (including alcohol) and to develop better treatment and rehabilitation services for dependent users.2
At the time when the tabloid papers were enthused, my main concern was the lack of public health perspective about this drug screening. We have failed to provide the target of ‘one school nurse per secondary school’, we have failed to recruit enough doctors ‘with a special interest’ in child protection, and in the poorest neighbourhoods we have failed to stem the spread of TB among young people. Rolling out indiscriminate drug screening of high cost and no benefit seemed like a white elephant that could trample more needed work in school health. However, on reflection it became clear that the worst outcome of screening might be a major increase in school exclusions and truancy (both associated with harmful substance use and other health hazards). Such young people are likely to get no primary health care at all (as our ‘Right Fit’ project with Barnardo's demonstrated). The context of substance use is critical. For example, there was no insight in the screening exercise that the population of 11–12 year olds who regularly misuse substances, and who may be at the greatest risk of self-harm, overlaps considerably with the population who have experienced abuse or exploitation by adults.3
It is many years since I taught adolescents (rather poorly). However, I recall that good education thrives in an environment of respect and trust. Any process that causes humiliation and alienation to teenagers is risking their long-term wellbeing. Too many teenagers now feel demonised. Thankfully, the Royal College of General Practitioners has launched an initiative on adolescent health. At Primary Care 2005 in Birmingham, there was a packed house for the College session, eager to learn how better to help young people at school.
- © British Journal of General Practice, 2005.