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September 9, 2006

National Physician Center Concerns Regarding Federal Child Mental Health and Mental Health Screening Programs

Mr. George W. Bush

President of the United States


August 22, 2006

Dear Mr. President,


It is a great honor to be able to hear you speak today in Minnetonka, Minnesota.  As a wife, mother of three children and a pediatrician, I want to thank you for your great concern for the health of the American people, including their mental health.  The undersigned groups and I are also appreciative of efforts on the part of your administration to evaluate the effectiveness of programs and eliminate or decrease the funding of those that are ineffective and not wisely using the people’s hard earned funds as was reflected in the budget requests for the Departments of Health and Human Services (HHS) and Education.  We want to support and promote those stewardship efforts, especially in relation to programs having to do with mental health screening and intervention, and particularly in relation to programs involving children.


Goal 4 of the New Freedom Commission (NFC) Report which says, “Early Mental Health Screening, Assessment, and Referral to Services Are Common Practice,” its model programs, such as TeenScreen and the Texas Medication Algorithm Project (TMAP) and the follow-up Federal Mental Health Action Agenda (FMHAA) has resulted in the promotion of a whole series of federal grants and programs to the states for the mental health screening and intervention of children beginning in infancy when there are documented problems with the scientific validity, safety, effectiveness, and cost of both the screening and the associated interventions. In addition, there are grave concerns regarding whether the federal government should be involved in something that has such profound implications regarding individual autonomy, parental authority, freedom of conscience, and privacy.  Here are some examples of programs of concern: 


  1. State Early Childhood Comprehensive System (ECCS):  This program is part of the Maternal Child Health Bureau within Health Resources Services Administration.  Minnesota describes the program as a “…federally-funded grant project to coordinate and integrate early childhood screening systems to assure that all children ages birth to five are screened early and continuously for the presence of health, socioemotional or developmental needs. Children and their families should then be linked to mental health services, early care and education, …so that all eligible children … enter school ready to learn.”[1] (Emphasis added.) Problems with this approach include -

·        Lack of diagnostic accuracy, especially in young children, as admitted by the World Health Organization[2], the Surgeon General[3], the National Institute of Mental Health[4], the National Center for Infant and Early Childhood Health Policy[5], and major psychiatric texts.[6]

·        Overuse of psychiatric drugs in the early childhood age group as indicated by research[7], ongoing research to test potent antipsychotic drugs in 3-5 year old children when they do not have an actual diagnosis of psychosis[8], and statements by psychiatric opinion leaders indicating a need for medication for young children who show “genetic susceptibility” to mental illness.[9]

·        Lack of scientific validity of the screening instruments and no documented safety or effectiveness of pharmacological or psychosocial treatments in this age group[10].


  1. Foundations for Learning Grants – This mental health program for children ages birth through seven is funded through No Child Left Behind and raises all of the same concerns as the ECCS program just described.  We heartily concur with your administration’s suggestion to eliminate this program.


  1. Development of Early Childhood Programs:  The FMHAA states, “HHS and ED have launched a 5-year research effort to find the best ways to prepare preschool children for later success in school. In the initiative's first year, eight institutions across the country will receive $7.4 million in research grants to test preschool curricula, Internet-based teacher training, and the importance of parental involvement for improving children's readiness to enter school.”[11]  Concerns related to this approach include

·        Lack of need.  According to the large and well controlled National Center for Education Statistics study America’s Kindergartners, 94% are proficient at recognizing numbers, shapes, and counting to ten; 92% are eager to learn; and 82% have basic pre-literacy skills, such as knowing that print is read from left to right;[12]

·        Socioemotional harm of early childhood programs as documented by the 2002 National Institute of Child Health and Human Development study[13] and by researchers at the University of California at Berkley and Stanford University in late 2005[14]

·        Federal promotion of extremely controversial and non-academic outcomes that involve mental health, gender, family structure, multiculturalism, and environmental issues through Head Start and in concert with national groups, such as the National Association for the Education of Young Children (NAEYC)[15]


  1. Suicide Prevention ($26,730,000), via the Garrett Lee Smith Act enacted in 2004:  Among the activities funded are mental health screening programs, particularly TeenScreen. Specific problems associated with TeenScreen include -

·        The use of passive consent in violation of Congressional intent[16]

·        TeenScreen’s history for teaching program operators how to avoid the Protection of Pupil Rights Amendment (PPRA), despite specific mention of PPRA in this law[17]

·        An 84% false positive rate as admitted by the author of TeenScreen[18]

·        Lack of effectiveness of screening programs at preventing suicide and reducing suicide mortality[19]

·        The promotion of further overuse of dangerous and ineffective psychiatric medication[20]

·        The financial burden that paying for these medications cause already overburdened public programs like Medicaid and foster care[21] 


  1. State Incentive Grants for Transformation:  Despite public statements to the contrary from the Substance Abuse and Mental Health Services Administration (SAMHSA) and Members of Congress, according to documentation from SAMHSA, the purpose of these grants is to “enable States to begin implementing the Commission’s findings,”[22] which include mental health screening and psychotropic drug treatment when study after study is proving these drugs dangerous and ineffective, especially for children.  In addition, part of the transformation process is to fund technical assistance grants to the National Association of State Mental Health Program Directors and six non-governmental organizations as subcontractors to assist Statesin the development of activities and plans to implement the New Freedom Commission recommendations.[23]  All of these organizations have a vested financial and or professional interest in expansion of mental health screening and intervention programs and have been uncritical supporters of these programs without acknowledging any of the problems mentioned in this letter. We appreciate that the budget request held funding level, but believe that given the dangers and ineffectiveness of the model programs, such as TeenScreen and TMAP, that these grants should be cut altogether.


  1. Violence Prevention Programs: The majority of funding goes for the Safe Schools, Healthy Students (SSHS) grants under SAMHSA.  These involve infant mental health and TeenScreen suicide screening with all of their already mentioned problems.  In addition, another program funded under these grants is the Early Warning, Timely response program developed jointly via the Departments of Education, Justice and HHS.  This program lists several supposed warning signs for potential mental health and violence problems that include “intolerance for differences and prejudicial attitudes.”  The description of this warning sign says, “All children have likes and dislikes. However, an intense prejudice toward others based on racial, ethnic, religious, language, gender, sexual orientation, ability, and physical appearance when coupled with other factors may lead to violent assaults against those who are perceived to be different.”[24]  All of us are very concerned about federal government involvement in labeling children as potentially mentally ill or violent based on these kinds of subjective and politically motivated criteria. We strongly agreed with the budget request to not fund any new SSHS grants and would hope that even more would be cut. We also strongly commend and support the budget request to eliminate the Safe and Drug Free Schools state activities that fund many similar programs.


  1. Mental Health Integration in the Schools: This program, funded through No Child Left Behind, is yet another vehicle for mental health screening, with all of its attendant problems to be implemented in the schools.  We heartily agree with your administration’s budget request to eliminate this program.


In direct contradistinction to many other groups, I and the undersigned groups are not asking for more funding and more federal involvement in child mental health issues and programs, but much less or none.  Given the many problems with these programs as outlined above in these times of many competing budgetary priorities, we are asking you to urge Congress in the strongest possible terms to support your budget requests regarding these programs and to go even farther to reduce or eliminate these programs that are of questionable medical, as well as constitutional, safety and effectiveness.


Thank you again for the opportunity to hear you speak and for your attention to these important issues.  Please do not hesitate to contact me or any of the groups listed for further detail on the issues and programs.


Best Regards,

Karen R. Effrem, MD


105 Peavey Road, Suite 116
Chaska, MN 55318


 Groups in Support:

Alliance for Human Research Protection

National Physicians Center

International Center for the Study of Psychiatry and Psychology

Concerned Women for America

Eagle Forum

Association of American Physicians and Surgeons

The Liberty Coalition

Law Project for Psychiatric Rights

MindFreedom International

Republican Liberty Caucus

Citizens Health Alliance for Truth

US Bill of Rights Foundation


[1] Minnesota Roadmap for Mental Health System Reform, p. 165, http://www.citizensleague.net/what/projects/mmhag/library/Roadmap.doc


[2] The 2001 World Health Report said, “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.” - World Health Organization (2001) World Health Report Mental Health: New Understanding, New Hope, p.50 of pdf, http://www.who.int/entity/whr/2001/en/whr01_en.pdf


[3] “The science is challenging because of the ongoing process of development. The normally developing child hardly stays the same long enough to make stable measurements.  Adult criteria for illness can be difficult to apply to children and adolescents, when the signs and symptoms of mental disorders are often also the characteristics of normal development.”  - (1999) Surgeon General’s Report on Mental Health, p. 7 of pdf, http://www.surgeongeneral.gov/library/mentalhealth/pdfs/c3.pdf

[4] Dr. Benedetto Vitiello, chief of child and adolescent psychiatry at NIMH, admitted “the diagnostic uncertainty surrounding most manifestations of psychopathology in early childhood.”  Vitiello, B. (2001) Psychopharmacology for young children: clinical needs and research opportunities. Pediatrics. 108: 983-990.


[5] “Diagnostic classifications for infancy are still being developed and validated…” National Center for Infant and Early Childhood Health Policy (2005) Addressing Social Emotional Development and Infant Mental Health in Early Childhood Systems, http://www.healthychild.ucla.edu/Publications/Documents/IMHFinal.pdf


[6] “No consistent structural, functional, or chemical neurological marker is found in children with the ADHD diagnosis as currently formulated.” Jensen, P. and Cooper, J. (Editors) (2000) Attention Deficit Hyperactivity Disorder State of the Science - Best Practices, Civic Research Institute, Kingston, NJ, p. 3-7


[7] Beale, A and Staller, J. (2006) research proposal available on request: A Study of Risperidone in the Treatment of

Persistently and Highly Aggressive Preschoolers


[8] Zito, J., et al. (2/23/00) Trends in the prescribing of psychotropic medications to preschoolers. Journal of the American Medical Association, 283:1025-1030


[9] Willis, David (January, 2004) Medical Director of the Northwest Early Childhood Institute in Portland, Oregon, as quoted in Pediatric News, "Psychopharmacology is on the horizon as preventive therapy for children with genetic susceptibility to mental health problems."


[10] Dr. Vitiello also said in the above-mentioned paper, “Little research has been conducted to study the effectiveness of psychosocial interventions in young children, and the long-term risk-benefit ratio of psychosocial and pharmacologic treatments is basically unknown.”


[11] http://www.samhsa.gov/Federalactionagenda/NFC_FMHAA.aspx


[12] NCES 2000-070, February, 2000


[13] “Children who experience long hours of child care over the first four years of life are more at risk for showing behavior problems, particularly aggression.  Not only were these children more likely to engage in assertive, defiant, and even disobedient activities, but they were also more likely to bully, fight with, or act mean to other children.” - The NICHD Early Child Care Research Network as quoted on the Society for Research on Child Development website at http://www.srcd.org/pp1.html


[14] “Attendance in preschool centers, even for short periods of time each week, hinders the rate at which young children develop social skills and display the motivation to engage classroom tasks, as reported by their kindergarten teachers...Our findings are consistent with the negative effect of non-parental care on the single dimension of social development first detected by the NICHD research team [in 2002].”- Fuller, B. et al (11/05) How Much is Too Much? The Influence of Preschool Centers on Children’s Development Nationwide Presentation at the Association for Policy Analysis and Management http://pace.berkeley.edu/summary_23DA10_new.doc 


[15] http://edaction.org/2005/062005-HR2123.htm


[16] PL 108-355 Sec. 520E(c)(14), the Garrett Lee Smith (GLS) legislation, says that “preferred programs” will, “obtain informed written consent from a parent or legal guardian of an at-risk child before involving the child in a youth suicide early intervention and prevention program.”

[17] “If the screening will be given to all students, as opposed to some, it becomes part of the curriculum and no longer requires active parental consent (i.e., if all ninth graders will be screened as a matter of policy, it is considered part of the curriculum).” TeenScreen News (Fall 2003 ) http://www.antidepressantsfacts.com/TeenScreen-crimin.pdf


[18] David Shaffer et al. (2004). The Columbia Suicide Screen: Validity and Reliability of a Screen for Youth Suicide and Prevention. Journal of the American Academy of Child and Adolescent Psychiatry, 43(1), 71-79; p. 77.


[19] US Preventative Services Task Force http://www.ahrq.gov/clinic/3rduspstf/suicide/suiciderr.htm#clinical


[20] Please see http://content.nejm.org/cgi/content/abstract/353/12/1209 and http://www.ohsu.edu/drugeffectiveness/reports/documents/ADHD%20Final%20Report.pdf  for just two of many examples of the scientific research showing the dangers and ineffectiveness of these medications.


[21] Data from Texas shows doubling, tripling and quadrupling of Medicaid expenditures over 3-4 years and Florida data shows 35% per year increases psychotropic drug expenditures.  Graphs available at http://www.edwatch.org/pdfs/Major-MH-screen-prbs.pdf 


[22] http://www.samhsa.gov/Matrix/brochure.aspx , emphasis added


[23] http://www.nasmhpd.org/targeted_ta.cfm , emphasis added


[24] http://www.ed.gov/about/offices/list/osers/osep/gtss.html

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