Kathlyn Stone -- World News Trust
Oct. 6, 2006 -- Just how comfortable are parents having their children, from pre-schoolers through high school, screened for mental illness? How will they respond when, if their child is diagnosed with a mental disorder, he or she is prescribed psychotherapeutic drugs?
In Indiana, parents of a 15-year-old are suing the school for screening their daughter without their consent.
High school mental health screening has already taken root in many Minnesota schools. Forest Lake , Cloquet, Lakeville and some St. Paul schools have adopted “Teen Screen,” a suicide prevention screening program supported by grants from the Substance Abuse and Mental Health Services Administration (Sample questions at the end of the article). Under passive consent, parents must opt-out of the screening. But first they need to be aware of the programs. Opponents of the screening say the screening surveys are invasive and unscientific.
Minnesota schools have been screening pre-schoolers as “a requirement” for entering kindergarten since 2005-2006, but parents are not legally bound to complete the screening. Federal programs aim to extend the screening to include children at birth to age five.
Mandatory mental health screening, inching ever forward to full national implementation, is one of those rare issues that is finding vociferous opposition among civil libertarians, conservative and liberal groups alike.
In Illinois, school screening has been aligned with the academic standards required by No Child Left Behind. For those not familiar with NCLB, states must comply with requirements for testing, along with other requirements, or lose federal funding.
Universal mental health screening comes under the umbrella of the New Freedom Commission on Mental Health. I can’t help wondering if the deftly named New Freedom Commission is to pharmaceutical companies what the Blue Skies Act is to industry polluters, the Healthy Forests Initiative is to the corporate timber industry and No Child Left Behind is to the education test market and military recruiters. Oh yes, and Medicare Part D and pharmaceutical companies again.
In other words, it is eerily similar to other Bush Administration legislation based purely on profit-making instead of sound public policy.
That’s a pretty strong claim. However, if you look at how the national universal health screening plan evolved out of a Texas alliance created in 1995 under then-governor George Bush, the idea isn’t far-fetched at all. The Texas Medication Algorithm Project (TMAP) was an alliance of representatives from the University of Texas, the pharmaceutical industry, and the mental health and corrections system of the state of Texas. Critics of the screening claim that industry members of TMAP have influenced policy makers in order to ply their wares and gain access to more citizens. Under the Texas program, all who access state programs, voluntarily or involuntarily (for example, prisoners and patients at state psychiatric hospitals) are required to follow the treatment algorythms (see algorythm for depression).
Allen Jones, a former investigator in the Pennsylvania Office of Inspector General (OIG), Bureau of Special Investigations, was fired after he brought forth his concerns about what he called the TMAP "political/pharmaceutical alliance" when it was introduced in Pennsylvania. He nonetheless wrote a report where he asserts that the alliance strategy was to promote the use of newer, more expensive antipsychotics and antidepressants. “TMAP is a Trojan horse embedded with the pharmaceutical industry’s newest and most expensive mental health drugs,” wrote Jones. “Through TMAP, the drug industry methodically compromised the decision making of elected and appointed public officials to gain access to captive populations of mentally ill individuals in prisons and state mental health hospitals. The pharmaceutical industry bypassed governmental safeguards and medical review by creating and marketing TMAP as a “treatment model” that was instituted in various states as an administrative decision by a select few politically appointed officials.”
Jones said many of the big drug marketers of mental health drugs (Janssen Pharmaceutica, Johnson & Johnson, Eli Lilly, Astrazeneca, Pfizer, Novartis, Janssen-Ortho-McNeil, GlaxoSmithKline, Abbott, Bristol Myers Squibb, Wyeth-Ayerst Forrest Laboratories and U.S. Pharmacopeia) were intimately involved with crafting the model and influencing public officials. “Drug industry money guided TMAP from conception through development and expansion to other states.” Bush’s initiative, the New Freedom Commission, embodies TMAP on a national scale.
EdWatch, a Chaska, Minn.-based non-profit with national reach, considers the New Freedom Commission another handout to pharmaceutical companies.
Julie Quist, an EdWatch spokesperson, said that universal mental health screening is “100 percent going forward. In Minnesota we’ve held off some of it but the whole system is being systematically put into place. It’s not fully put in place legally, “ she added.
Still, we will assume legislators meant well when they appropriated $20 million in 2004 to help states coordinate mental health initiatives in the fiscal year 2005 Omnibus Appropriation. Rep. Ron Paul (R-Texas) offered an amendment to the Labor-HHS-Education appropriations bill that would have prohibited funds from being used to implement universal mental health screening programs without the express, written, voluntary, informed consent of parents.
The Liberty Committee, a group of libertarian Congressmen, wrote in defense of Paul’s amendment:
“The American tradition of parents deciding what is best for their children is, yet again, under attack. The pharmaceutical industry has convinced President Bush to support mandatory mental-health screening for every child in America, including preschool children, and the industry is now working to convince Congress as well. But mandatory screening alone is not what the pharmaceutical industry wants. The real payoff for the drug companies is the forced drugging of children that will result -- as we learned tragically with Ritalin -- even when parents refuse.”
Paul’s amendment failed 97-304.
My representative in the U.S. House, Betty McCollum (D-MN), voted against the amendment. In a letter explaining the vote to a constituent, she wrote, “While I believe strongly in the rights of parents, it is also critical that we have tools available to detect physical or mental difficulties facing our children.”
Many supporters of universal mental health screening argue that it is a needed tool to help children. The leadership of the American Psychological Association, which states that an alarming “20 percent of our nation’s children display the signs or symptoms of a diagnosable mental disorder within the course of a year,” testified at New Freedom Commission hearings in support of universal screening.
But other physicians, policy leaders, and health care activists -- from all political ideologies -- believe the screening may actually be detrimental to a broad population of children. Many children may be misdiagnosed, stigmatized by a diagnosis, or develop neurological damage from psychotropic medications.
Dr. Karen Effren, MD, a Plymouth, Minn., pediatrician and board member of EdWatch, wonders how children identified as needing mental health intervention will be treated if not by psychotherapeutic drugs. She’s especially concerned about the screening of young children. “Data clearly demonstrates that mental health screening is highly unreliable,” sayd Effren. “Mental health screening in children is very subjective and falsely labels young children for life. “It is also very dangerous to the health of our children because treatment almost always results in prescriptions for powerful, expensive prescription drugs with dangerous, even fatal, potential side effects, including suicide.”
Dr. Michael Greelis, PhD., a youth psychologist in private practice in northern Virginia and an allied staff member of the Dominion Psychiatric Hospital in Falls Church, asks, “What’s the point of having universal screening if you lack sufficient treatment services for follow up? One wonders how sufficient “screening” could be found -- if that were truly possible -- given the shortage of mental health professionals actually providing child and adolescent mental health services.” Greelis treats adolescents with mood disorders, anxiety disorders (including PTSD), serious social inhibitions, and concurrent problems with substance abuse.
“Make no mistake about it, the follow up treatment for children and adolescents ‘identified’ would necessarily be psychotherapeutic, with the exceptions of serious mental illness like pediatric bipolar and psychotic disorders,” Greelis says. Nine out of 10 children who received treatment by recently trained child psychiatrists received prescription drugs, according to a survey published in the Journal of the American Academy of Child Adolescent Psychiatry in 2002.
“You are hard pressed to find pediatricians willing to administer SSRI’s after the suicide scare, which is really not that discouraging given the disappointing performance of these medicines for mood disorders among children,” Greelis said. Greelis believes preventative screenings offer, “the worst of all possible worlds: screenings based on a pool of personnel who will either be depleted due to demands, or deplete treatment programs; referrals for providers who are already overburdened as we speak; and as a result of diagnosis, through short term screening rather than longer term observation, the inevitable failure to differentiate developmental or trauma-based issues from actual mental disorders, resulting in counterproductive labeling and treatment. What could be worse than this?”
Dr. Patch Adams is the celebrity physician-spokesperson (who often dresses up as a clown) for MindFreedom International, a coalition of more than 100 advocacy organizations united in their opposition to the New Freedom Commission. In 2004, Adams kicked off MindFreedom’s campaign against universal mental health screening by volunteering to screen President Bush. "He needs a lot of help. I'll see him for free," Adams said.
Resources for further reading:
EdWatch: www.edwatch.org
Lenzer, Jeanne, “Bush plans to screen whole US population for mental illness,” British Medical Journal, June 19, 2004.
Lenzer, Jeanne, “Secret US report surfaces on antidepressants in children, British Medical Journal, August 7, 2004.
Ismail , MA , “Drug Lobby Second to None: How the pharmaceutical industry gets its way in Washington,” The Center For Public Integrity, July 7, 2005.
New Freedom Commission on Mental Health www.mentalhealthcommission.gov
Paul, Rep. Ron, “No Mental Health Screening for Kids,“ Speech before the U.S. House of Representatives, October 6, 2004.
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Examples of TeenScreen questions provided by EdWatch: Have you tried to kill yourself in the last year? Are you still thinking of killing yourself? Have you thought seriously about killing yourself? Have you often thought about killing yourself? Have you ever tried to kill yourself?"
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