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12/01/2004

Increased Mental Health Screening? Are You Crazy!?!

Summary: Increased mental health screening for children and adults is being encouraged by the federal government in response to strong marketing and lobbying by the pharmaceutical industry. This concerns everyone, and homeschoolers have extra reasons for concern. This article discusses how and why screening programs have been developed, serious problems these programs cause, and what we can do.

In April 2002, President Bush launched the New Freedom Commission on Mental Health. The Commission conducted a "comprehensive study of the United States mental health service delivery system" and developed six goals "as the foundation for transforming mental health care in America." This article will focus on Goal 4, "Early mental health screening, assessment, and referral to services are common practice." (The Commission's executive summary is at http://www.mentalhealthcommission.gov/reports/FinalReport/FullReport.htm.) One of the next steps is for Congress to provide funding to pursue the goals. Mental health screening is not yet mandated by the federal government. However, the Commission's report is clearly a big step in the direction of increased screening. People concerned about it should act now and not wait until it is mandatory.

Two points are important in understanding the Commission. First, much of its work was based on the Texas Medication Algorithm Project (TMAP), begun in 1995 to treat mentally ill people in state mental health institutions and prisons. When a similar program was introduced in Pennsylvania in 2003, a whistleblower in Pennsylvania's Office of Inspector General revealed TMAP's highly questionable ways of operating. TMAP included the Texas state university, mental health, and corrections systems and was financed in part by drug companies, which had a strong influence on its decisions. TMAP instructed state doctors to treat people labeled as mentally ill with drugs that are still protected by patents and therefore are much more expensive than generic drugs and increase drug company profits. When clinical trials indicated that these drugs were not significantly more effective than generic drugs, TMAP made its decisions based on "expert consensus guidelines" developed by simply asking scientists and physicians (many of whom had received money and other favors from drug companies) to recommend drugs.

 In 1997-98, TMAP began working on the Texas Children's Medication Algorithm Project (TCMAP) which also receives funds from drug companies. An expert consensus panel decided to use on children drugs used on adults. According to the whistleblower, no studies or clinical trials were done to support this decision. In fact, the use of two of the drugs (Paxil and Effexor) on children had already been banned in Britain. Since then, Paxil has been linked to violent behavior, suicide, and cerebral and cardiac problems in teens. In June, 2003, the FDA warned that Paxil should not be used for people under 18 because of the alarming number of suicides by children taking it.

For more details, see http://psychrights.org/Drugs/AllenJonesTMAPJanuary20.pdf.

Second, it's important to understand what's happening in the pharmaceutical industry, where drugs for mental illness play a very large role. It's well known that drug companies are making huge profits. (In 2002, "the combined profits for the ten drug companies in the Fortune 500 [$35.9 billion] were more than the profits for all other 490 businesses put together [$33.7 billion]." "The Truth About the Drug Companies" by Marcia Angell, The New York Review of Books, July 15, 2004, pp. 52-58. The drug industry spends enormous amounts of money on lobbying, campaign contributions, promotion, and to get the FDA and other government agencies to make decisions that benefit them. Less well known is the fact that despite a public relations campaign that gives the impression that drug companies need to charge high prices to cover the costs of research, development, and testing of new drugs, during the 1990s they spent a staggering 36% of sales revenues on "marketing and administration," which was two and a half times what they spend on R & D.

However, since 2000, drug company profits have been declining, partly because patents have expired or are about to expire on some popular drugs such as Prozac, Prilosec, Glucophage, and Claritin. Obviously, a program like increased mental health screening offers them great opportunities: identify lots of people who can be labeled as "mentally ill" and maneuver so the treatment of choice is expensive patented drugs (as has been done in TMAP) rather than less expensive generic drugs, therapy, or other approaches. (For more information about drug companies, see Angell's article cited above and her book The Truth About the Drug Companies: How They Deceive Us and What to Do About It.)

Problems Raised by Mental Health Screening

Even if mental health screening were increased for the best of reasons (assuming good reasons could be found), it would raise serious problems. The fact that increased screening has been recommended by a commission with strong ties to drug companies and TMAP give us even more reason to examine it closely. Among the problems raised by mental health screening:

• Those who define mental illness and decide who is mentally ill have enormous power. Unlike physical illness where symptoms are often clear and uncontroversial, the definition of mental illness depends on one's approach to life, self-interest, history, and belief system. In other words, essentially anyone could be labeled "mentally ill" depending on the definitions chosen. The groundwork for labeling many people mentally ill has been laid in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), an 886-page book published in 1994 by the American Psychiatric Association.

According to The DSM-IV, a very wide range of behavior can be defined as abnormal and indicative of mental illness. For example, in an article in Harpers Magazine, L. J. Davis reviewed the DSM-IV's description of several adolescent disorders (including Attention-Deficit/Hyperactivity Disorder and Oppositional Defiant Disorder) and concludes, "A close reading of the text reveals that the illnesses in question consist of failure to listen when spoken to, talking back, annoying other people, claiming that somebody else did it, and (among a lot of other stuff familiar to parents) failure to clean up one's room. According to the DSM-IV, adolescence is a mental disorder." ("The Encyclopedia of Insanity–A Psychiatric Handbook Lists a Madness for Everyone" by L. J. Davis, Harpers Magazine, February, 1997)

As two other authors put it, "As you reflect on conversations you have had during recent weeks, you recall that your cousin, a young stockbroker, complained of not sleeping well; a colleague at work, who is single, appears to always choose to be alone after work; ... your supervisor's 10-year-old is in trouble at school; ... and your sister can't stop obsessing about a former boyfriend. In addition, you are really worrying about an upcoming speech. According to DSM-IV, each of the behaviors above is listed as a criterion for one or more mental disorders." (Making Us Crazy: DSM—The Psychiatric Bible and the Creation of Mental Disorders by Herb Kutchins and Stuart Kirk, pp. 21-22, italics in original)

• Increasing mental health screenings will be easier because there is already an existing structure for screening and labeling children as part of the Individuals with Disabilities Education Act (IDEA).

• Labeling people as mentally ill is a way of blaming individuals, parents, and families rather than social service agencies, schools, the economy and financial inequalities, racism, etc.

• These mental health screening programs are set up so that drug companies, public school districts, social service agencies, prison systems, some professionals in the mental health field, etc. stand to gain financially. Such financial incentives obviously make it more likely that people will be misdiagnosed and unnecessarily labeled and treated.

• Screening preschoolers and children in elementary schools is being justified by the argument that early detection will prevent more serious problems from developing. However, sometimes "early detection" catches a person in a weak moment or makes a mountain out of a mole hill, turning a behavior that a child would have outgrown given some time, support, and love into an "emotional disturbance," undermining the confidence of the child and their family, and becoming a self-fulfilling prophecy.

• Much controversy surrounds the treatment of mental illness. The use of drugs is promoted by drug companies to increase its profits. Drugs are chosen by some patients, families of patients, and professionals because they seem easier to use and give faster results than therapy or other approaches. They are promoted by HMOs and insurance companies because they are sometimes cheaper than other approaches. However, many people question whether drugs really work and are concerned about their safety. Many of these drugs have not been tested; programs like TMAP use "expert consensus guidelines" instead. Many consumers do not like taking drugs and object to their side effects. Many people object to drugging people

Additional Reasons for Homeschoolers to Be Concerned

• People who are considered to be marginal or "different" are particularly vulnerable in a program such as mental health screening. Professionals are eager to force them into conventional institutions such as public schools. This screening provides an excellent opportunity to identify, label, and redirect them. Just think of all the people who think you have to be "a little bit crazy" to want to homeschool. Just think of all the people who think there's something wrong with kids who don't do well in conventional school settings and who learn better when they're allowed to pursue their own interests and learn in their own way at their own pace.

• Mental health screening provides a legally sanctioned way for professionals to interfere with or stop homeschooling. This is especially true because some children have, quite understandably, reacted to difficulties in school (such as problems with teachers, bullying, and labeling) by becoming anxious or developing other behaviors that are listed in the DSM-IV. Many parents have found that simply removing their children from school and homeschooling them has solved the problem and was far superior to labeling the children "mentally ill" and treating them with drugs.

• Mental health screening of both children and parents could be required when complaints are filed against homeschoolers, including allegations of child abuse and neglect. Mental health screening would make it more difficult to resolve such complaints.

• Public school districts are already trying to get homeschoolers to enroll so they can increase the tax money they receive based on enrollment. This plus the money mental health professionals and drug companies would earn provides powerful financial incentives for screening homeschoolers for mental illness and labeling some of them as ill.

Sharing Our Concerns With Others

It's worth considering several points that may be raised by people who either support increased screening or feel that they do not need to be concerned about it, including legislators and their aides.

• Some may claim that mentally ill people really do need help. It's true that there are people who need or want help, and they should certainly get it. However, they are far more likely to be harmed than helped by a program of mental health screening strongly influenced by drug companies intent on increasing their profits, supported by professionals who have received money and other favors from drug companies, and promoted by lawmakers who have received lots of money from drug companies.

• Some people may argue that they aren't afraid to be screened because neither they nor their children are mentally ill. But as pointed out above, the symptoms listed in the DSM-IV are general, broad, and widespread. It may be difficult to get through a screening, especially one conducted by someone who has a strong financial incentive to label as many people mentally ill as possible.

• Other people may argue that the current screenings are only demonstration projects aimed at marginal groups like prisoners, young people in the juvenile justice system, and families involved with social services. But the Commission's report makes it clear that the goal is to screen many adults and children. The report states, "The early detection of mental health problems in children and adults–through routine and comprehensive testing and screening–will be an expected and typical occurrence." In addition, many programs are started with assurances that they are only for a small group in need and then spread to a much wider group. For example, IDEA, originally for children with disabilities, has resulted in the screening of nearly all preschool children, the labeling of 10% of the school age population, and the wide use of Ritalin and other drugs. These drugs are now being seriously questioned, but they continue to be used, despite their obvious costs to children, families, and taxpayers, largely because professionals and institutions are committed to the program and the drugs.

What We Can Do

• We can learn more about mental health screening from the books, articles, and web sites above and other sources.

• We can work to minimize the risks and damage that increased mental health screening does to our families. We need to be aware that screenings can be done by school counselors and officials, doctors and other health care providers, employees of clinics and hospitals, social service workers, juvenile justice authorities, etc. People may not be told that the questions they are being asked are part of a mental health screening. The questions may sound reasonable, sometimes even complimentary.

            For example, here are some questions from a widely used questionnaire designed to be answered by parents of children ages 27 through 32 months or roughly 2 1/2 years old. (For information about this questionnaire see: http://www.pbrookes.com and/or http://www.pbrookes.com/store/books/squires-asqse/index.htm.http://www.pbrookes.com/store/books/squires-asqse/index.htm )

Does your child cling to you more than you expect?

Does your child seem too friendly with strangers?

[Note that it's not easy to get these questions right. Children can't be either too clingy or too outgoing.]

Does your child seem more active than other children her age?

Can your child settle himself down after periods of exciting activity?

Does your child follow routine directions? For example, does she come to the table or help clean up her toys when asked?

Can your child move from one activity to the next with little difficulty, such as from playtime to mealtime?

Scoring on this screening makes it easy for a child to be referred for a mental health assessment. For example, there are 28 questions like the ones listed above. A score of 5 points is assigned each time a parent answers the question "sometimes." A score of 57 (in other words, a response of "sometimes" on 12 or more of the 28 questions) or higher leads to a referral.

In addition to the questions above, there are open-ended questions such as:

Has anyone expressed concerns about your child's behaviors? If you checked "sometimes" or "most of the time," please explain.

Do you have concerns about your child's eating and sleeping behaviors or about her toilet training? If so, please explain.

Is there anything that worries you about your child? If so, please explain.

A questionnaire (available at: http://www.aseba.org/index.html) to be completed by parents of children ages 6 to 18 and widely used in schools includes questions such as the following:

About how many close friends does your child have? (Do not include brothers & sisters)

Do any of the following describe your child now or within the past 6 months?

Clings to adults or too dependent

Daydreams or gets lost in his/her thoughts

Doesn't seem to feel guilty after misbehaving

Feels too guilty

Fears going to school

Feels or complains that no one loves him/her

Bites fingernails

Not liked by other kids

Overweight

Prefers being with older kids

Prefers being with younger kids

Showing off or clowning

Too shy or timid

When we are asked questions such as these or asked to complete questionnaires, we can find out what our rights are. We can ask which questions or questionnaires are mandatory, which we can refuse to answer, and how the information we provide will be used. If the person asking us the questions cannot answer our questions in this regard, or if they insist that we have to answer questions we don't feel comfortable answering, or if we are told that information is mandatory but we don't want to provide it for reasons of privacy or anything else, we can ask to see the statute that requires that we provide such information. For more information on problems with screening, see the WPA handbook, pages 199-203.

• We can inform others, including other homeschoolers, relatives, friends, neighbors, members of organizations to which we belong, including churches and civic and recreational organizations.

• We can inform our state and federal legislators about this issue and state our position on this program and on having any agency fund all or part of it. Although legislators are strongly influenced by drug companies' lobbying and money, they do need votes from citizens even more than they need campaign contributions.    

From WPA Newsletter #82 December 2004 pp 10-13  

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