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Universal Mental Health Screening

July 14, 2004

Proposed Universal Mental Health Screening
Karen R. Effrem, M.D.
EdWatch Board of Directors
ICSPP Advisory Board

A June 19, 2004 report in the British Medical Journal (http://bmj.bmjjournals.com/cgi/content/full/328/7454/1458) reports that a major U.S. mental health initiative will be announced in July. This coming proposal, according the British Medical Journal, will be based on a 2003 report of New Freedom in Mental Health Commission (http://www.mentalhealthcommission.gov/reports/FinalReport/downloads/FinalReport.pdf).

One of the recommendations coming from the New Freedom in Mental Health Commission will involve mental health screening for adults and children as young as preschool age in primary care health settings, schools, and correctional facilities -- basically anywhere people interact with government or medicine. Other recommendations of the New Freedom Commission will include expanding school based mental health programs and requiring specific treatments for specific conditions, including the use of specific medications. 

The recommendations of the New Freedom in Mental Health Commission raise a number of serious concerns. First, medications that would be required are newer, more expensive, less proven, and have a higher incidence of severe side effects. Second, the credibility of the recommendations for the use of these medications is severely compromised by credible charges of undue influence by the pharmaceutical industry. (See the British Medical Journal article linked above).

The Commission’s over-aggressiveness toward our children is revealed in their report, which states:

"…nearly 120,000 preschoolers under the age of six ­ or 1 out of 200 ­ received mental health services [in the year 1997]. Each year, young children are expelled from preschools and childcare facilities for severely disruptive behaviors and emotional disorders,” and “Since children develop rapidly, delivering mental health services and supports early and swiftly is necessary to avoid permanent consequences and to ensure that children are ready for school."

We see this same type of aggressiveness in other recent publications, such as the January, 2004 edition of Pediatric News. Dr. David Willis, Medical Director of the Northwest Early Childhood Institute in Portland, Oregon, writes:

"General pediatricians don’t have to be behavioral health specialists, but they can still intervene.  Psychopharmacology is on the horizon as preventive therapy for children with genetic susceptibility to mental health problems. " (Emphasis added.)

It appears that this expert would drug babies with powerful and dangerous medications simply for having a history of mental health problems in their family.

The federal education law, No Child Left Behind (NCLB), also incorporates some disturbing mental health initiatives for school age children. “The Foundations for Learning Act,” sponsored by Senator Edward Kennedy (D-MA) and Representative Patrick Kennedy (D-RI), was passed as part that law. Its goal has been “To provide mental health services to eligible children [0-7] and, when necessary to promote the child's healthy development, their families, provided that such services cannot be paid for by other sources.” An eligible child is one who has “been removed from child care, Head Start, or preschool for behavioral reasons or is at risk of being so removed” or “been exposed to parental depression or other mental illness.”  (Emphasis added.)

The questions all of us should be asking are these: who decides when a child is “at risk” of behavior problems or “exposed” to mental illness?  What are the criteria?  Who really wants government through the schools to evaluate the mental health of our very youngest children or their families?  What are the parents’ rights to refuse evaluation and treatment for their children or themselves?  While this program in NCLB has not been funded yet, will the New Freedom Commission report give its funding new impetus?

Regarding school aged children, the New Freedom report says:

"Schools are where children spend most of each day. While schools are primarily concerned with education, mental health is essential to learning as well as to social and emotional development. Because of this important interplay between emotional health and school success, schools must be partners in the mental health care of our children. Schools are in a key position to identify mental health problems early and to provide a link to appropriate services. Every day more than 52 million students attend over 114,000 schools in the U.S. When combined with the six million adults working at those schools, almost one-fifth of the population passes through the Nation’s schools on any given weekday." (Emphasis added.) 

The Commission seems quite happy to have a large, captive audience on which to work its schemes.

The No Child Left Behind Act is already carrying forward the ideas of expanding mental health in the schools and early identification. Title IV, the Safe and Drug Free Schools section of the legislation, is working towards:

"…expanding and improving school-based mental health services, including early identification of violence and illegal drug use, assessment, and direct individual or group counseling services provided to students, parents, and school personnel by qualified school based mental health services personnel."

Why should we be concerned?

Here are the problems and serious implications with these recommendations and with current legislation.  (For more details and complete references on each of these concerns see congressional testimony at http://www.icspp.org/media/hearingonprotecting.htm):
 
1) Mental health will be used as the enforcement mechanism of the Federal Curriculum - As academic performance becomes tied to the attitudes, values, and beliefs of the Federal Curriculum, instead of to knowledge, and as mental health screening and treatment, including medications, are based on behaviors and academic performance, it will not be very long before children are screened and treated with powerful mind altering chemicals for attitudes, values and beliefs that do not coincide with the beliefs required by the federal government.

The SAT is being changed to include essay questions about the student’s personal beliefs and worldview that will be part of the individual’s permanent record. (See http://www.edwatch.org/updates/011404.htm.) How long will it be before this test is used not only to screen college and job applicants based on political considerations, but as a mental health screen as was done with the 2000 Minnesota Basic Skills Writing Test?

School officials in Ithaca, N.Y., are requiring that first- and second-graders be graded on their tolerance, reports the Cornell Review. The kids will get grades based on how well they ‘respect others of varying cultures, genders, experiences, and abilities.’ The grade will appear on report cards under the heading ‘Lifelong Learning Skills.’  It appears well before social studies, science, reading, or writing.”  (Fox News 1/7/02)

2) Parents are being coerced into putting their children on these medications. 

Patricia Weathers and the Carroll Family, both of New York, the Johnston Family of West Virginia, and the Salazar Family of Florida were all charged or threatened with child abuse charges for refusing to give their children or taking their children off of psychiatric medications.

Matthew Smith of Michigan died of cardiac toxicity due to Ritalin and Shaina Dunkle of Pennsylvania died of cardiac toxicity due to the antidepressant desipramine both after their parents were coerced to place their children on these medications by the schools.

3) The diagnostic criteria for the mental illnesses are vague political and social constructs as admitted by those that define the criteria and the younger the child, the more difficult it is to accurately diagnose mental illness.

The 2001 World Health Report by the World Health Organization states, “Childhood and adolescence being developmental phases, it is difficult to draw clear boundaries between phenomena that are part of normal development and others that are abnormal.”

The 1999 Surgeon General's Report on Mental Health says, “The diagnosis of mental disorders is often believed to be more difficult than diagnosis of somatic or general medical disorders since there is no definitive lesion, laboratory test or abnormality in brain tissue that can identify the illness

4) The drugs that are to be recommended in the New Freedom report have many dangerous side effects, and their effects on the developing nervous systems of children are not at all understood.

The British equivalent of the FDA banned the use of all of the newer SSRI antidepressant drugs except Prozac in children under 18 last December (http://www.icspp.org/media/drugsfor.htm) after finding that the pharmaceutical companies had withheld data showing an increased risk of suicide in children taking the medications for more than 7 years, as well as not publishing studies showing no improvement for children on the medications. 

Prozac, despite being the only drug in its class allowed by the FDA to be used in children, generated more adverse drug reaction reports than any drug in America, including 2,000 reports of suicide deaths linked to Prozac. By the agency’s own calculations this reflects but a fraction of the likely number of suicides.” (FDA Center for Drug Evaluation and Research. ADR reports for Prozac between 1987-1995.as quoted in Sharav – 2003)

Psychosis in at least 9% of patients on stimulants – This is probably an underestimate. (Cherland and Fitzpatrick – 1999) Dr. Peter Breggin states in his book Talking Back to Ritalin, “…these schizophrenic-like and manic-like reactions to stimulants can lead to violence as well as depression and suicide.”  Four of the perpetrators of the major school shootings were on stimulants, anti-depressants, or both, at the time of their crimes.

5) Neither the stimulant medications, like Ritalin, nor the SSRI antidepressants, like Prozac, have EVER been found to be effective in the long term for children.

Neither the long-term effectiveness nor the long-term safety of stimulant medications has ever been demonstrated (Gillberg et al., 1997; Jacobvitz et al. 1990; Klein, 1993; Spencer, Biederman, Wilens, et al., 1996 as quoted in Jensen and Cooper)”

"No antidepressants have demonstrated greater efficacy than placebo in alleviating depressive symptoms in children and adolescents” (Baker – 1995)

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