| Screen
test
President
George Bush personally backs a drive to screen the entire US population,
including preschool children, for undiagnosed mental illness. Thousands
of schools are already participating in screening their pupils.
But is screening effective, who really benefits and would such a
policy ever be accepted in the UK? Adam
James investigates
May
10, 2006
.....
It’s
now just over two years ago that 15-year-old Chelsea Rhoades arrived
at school, was ushered into a classroom
and – according to legal documents - told she needed to
take a “test”.
Chelsea duely signed an assent form, and, with other pupils at Penn
High School in the US state of Indiana, completed the test. Chelsea
was required to answer questions such as whether she felt suicidal
or had tried to kill herself. All she had to do was answer ‘yes’
or ‘no’. Simple. The test took just 10 minutes.
The legal documents state Chelsea was then taken aside by one of
the people who had administered the test and told – quite
up front – that she had obsessive compulsive disorder and
social anxiety disorder. The documents state these diagnoses were
made because Chelsea, when filling out the form, had indicated,
for example, that she like to help clean the house and did not much
like to “party”. Chelsea was told that if her “condition”
worsened she should be taken to the local mental health centre for
treatment.
The test that Chelsea had completed was, in fact, called Teenscreen,
one of dozens of mental disorder screening programmes being implemented
across the United States. Since 2001, the makers of Teenscreen say
its programme - used to screen for depression, anxiety, and substance
abuse - has been used in almost 500 schools, doctors surgeries and
youth centre in 43 states. Last year, 122,000 youngsters completed
Teenscreen.
The mental health screening policy was introduced by the Bush administration,
and its ambitious aim is to screen the entire US population, including
preschool children, for mental illness. This policy – effectively
President Bush’s War On Mental Illness - was spawned in April
2002 when Bush established a “New Freedom Commission on Mental
Health”. Its remit was to investigate the US mental health
service and to resolve the problems “that allow Americans
to fall through the [mental health] system's cracks.”
The commission reported back to Bush stating that “despite
their prevalence, mental disorders often go undiagnosed”.
The commission’s subsequent goals included building mental
health care that is “consumer and family-driven”, to
speed up research and to ensure that “early mental health
screening, assessment, and referral to services are common practice.”
These goals were greeted by an all-round thumbs up by all main US
mental health professional and user groups, from the American Psychiatric
Association to the National Alliance for the Mentally Ill. US government
reports spoke of “recovery” and the importance of community-based
mental health services. All the right buttons were hit.
Community mental health service cash has since flowed. Last year
US government grants included: $92.5m for “mental health transformation”
over five years to seven states; $184.5 million over six years for
25 children community mental health services; $17.5 million over
five years for a national training center for child and adolescent
mental health; $13.2 million over three years for mental health
services for older adults; and $7.2 million over three years for
projects aiming to divert people with mental health problems away
from the criminal justice system and into community services.
While this cash has been welcomed, it is, however, the screening
policy that continues to face vehement criticism on a number of
fronts.
One fear voiced by critics is that the scientific “evidence”
on screening effectivenesss is being bull-dozen by pharmaceutical
firms whose commercial clout and influence pervades the entire US
psychitric system. Critics say it is these drug firms who will gain
most from screening. This is because, they argue, screened people
identified as having a mental health problem will be subsequently
treated, above all, with medication. For example, one Teenscreen
leaflet states that of a sample of 255 high school students, 24%
of students subsequently referred to mental health professionals
were prescribed medication. “Screening is a drugging dragnet,”
is how Jim Gottstein, president of the Alaska-based Law Project
for Psychiatric Rights, puts it.
Teenscreen, run by Columbia University and which says its receives
no funding from pharmacuetical firms, stresses that its screening
makes no medication recommendations. “Our goal is to provide
parents…with information about a possible problem and to link
youth in need to qualified professionals who can perform a complete
diagnostic assessment,” Teenscreen’s website reads.
However, the drug firm behind one computerised medication plan specifically
recommended by Bush’s Freedom Commission has handed over large
amounts of money to the Bush administration. The Texas Medication
Algorithm Project (TMAP) advises on medication for psychotic patients.
One first line antipsychotic drug TMAP recommends is Zyprexa, a
drug made by Eli Lilly which helped fund TMAP’s development.
George Bush Senior was a member of Eli Lilly’s board of directors
and in 2000 the company donated 82 per cent of its $1.6m political
contributions to George Bush Junior and the Republican Party. According
to the US-based Center for Responsive Politics, manufacturers of
drugs and health products contributed $764,274 to the 2004 Bush
campaign.
Critics
argue that it is these heavy-weight political and econonic forces
that drive forward the US screening programme, rather than the programmes’
proven effectiveness. In May, 2004, the American national treatment
advisory body, the US Preventive Services Task Force, stated there
is “no evidence” that screening for suicide risk reduces
suicide attempts or mortality. Before this, in 2002, it had concluded
that evidence is “insufficient” to recommend for or
against routine screening of children or adolescents for depression.
Nevertheless, Teenscreen, for example, keenly promotes its effectiveness.
Its website points to two published research papers by Teenscreen’s
own developer, psychiatrist David Shaffer. His research says Teenscreen
identifies young people both at risk of suicide and those with depression,
anxiety, and drug or alcohol abuse.
Another criticism levelled at Teenscreen
and other screening programmes is that they are compulsory in all
but name. Teencreen does stress that its tests are not compulsory.
However, schools and other bodies have been criticised for implementing
screening on a “passive consent” basis. This means that
schools, having informed parents of the screening plans, will not
screen a pupil only if the parent writes to forbid it. Lawyers acting
for the parents of Chelsea Rhoades plan to sue her school for invasion
of privacy. In a trial due later this year, they are to argue that
the parents did not even receive notice of the planned screening
to take place at the school. Previous similar legal actions have,
however, failed. In November last year, San Francisco appeal judges
ruled that parents have no rights to override school policy.
Nevertheless, on the ground screening
is fast becoming part of the fabric of US mental health policy.
Activists such as service user Abigail Adams, of the Freedom Center
“survivor” organisation in Massachusetts, say they are
not against screening per se. But it is how screening fits into
the bigger picture that concerns her. She fears that screening programmes
are gateways for youngsters to a mental health service underpinned
by an “abusive” biomedical approach to mental ill health
and where drugs, such as anti-depressants and Ritalin, are prescribed
in unprecedented levels to children. “I am well aware of the
abusive type of care these kids can receive - and they do not have
access to alternative care and support,” she says. In addition,
Gottstein is concerned with the mounting pressure to medicate troubled
young people. “I know poor parents and single mothers who
are told their child will be kicked out of school if their kid does
not take prescribed psychiatric drugs, or their kids will be taken
into care,” he says. “I do not think a month goes by
when I do not hear of someone in the situation.”
Adams is now working with her local Massachusets high school to
discuss how it implements a screening programme called the SOS Signs
of Suicide, sponsored by a range of professional mental health bodies,
and which has been used in more than 1,500 schools since 2000. Adams
says: “We want to see the screening implemented as humanely
as possible, that anonymity for the student is protected and that
it is more voluntary.”
As yet little there has been no genuine indication of plans to introduce
such a screening policy into the UK. However, one psychiatrist,
Prem Kunjukrishnan, of Dewsbury & District Hospital, once commented
at the website of the British Medical Journal: “On this side
of the Atlantic, the powers that be in the Department of Health
will, undoubtedly, watch with interest what unfolds as this [screening]
gets underway.” If so, prepare for a fiery controversy.
teenscreen.org
President Bush's
New Freedom Commission on Mental Health
Psychsearch.net
- Critic of Teenscreen
* A shortened version of this article first appeared in
Openmind
magazine.
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