Home Education Magazine
January-February 2005 - Articles and Columns
Increased Mental Health Screening? Are You Crazy!?!
Taking Charge - Larry and Susan Kaseman
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 column discusses how and why screening programs have been developed, serious problems these programs cause, and what we can do.
How and Why Current Proposals for Increased Mental Health Screening Have Developed
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 column will focus on Goal 4, "Early mental health screening, assessment, and referral to services are common practice." (The Commission's executive summary is here.)
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. First, much of the Commission's 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 received funds from drug companies. An expert consensus panel decided to use on children the drugs used on adults. According to the whistleblower, no studies or clinical trials were done to support this decision. In fact, two of the drugs (Paxil and Effexor) had already been banned for children 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 psychrights.org/Drugs/AllenJonesTMAPJanuary20.pdf.)
Second, it's important to understand the pharmaceutical industry. 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.) Drug companies spend enormous amounts of money on lobbying, campaign contributions, promotion, and convincing the FDA and other agencies to favor them. Although they claim to be developing new drugs, during the 1990s they spent a staggering 36% of sales revenues on "marketing and administration," which was two and a half times as much as they spent on R & D.
However, since 2000, drug company profits have been declining, partly because patents have or will soon expire on some popular drugs such as Prozac, Prilosec, Glucophage, and Claritin. Obviously, increased screening offers great opportunities: identify lots of people who can be labeled as "mentally ill" and maneuver so they are given expensive patented drugs rather than generic drugs, therapy, or other approaches. (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
Among the problems raised by mental health screening:
Those who define mental illness and decide who is mentally ill have enormous power. Essentially anyone could be labeled "mentally ill" depending on the definitions chosen. The most common basis for identifying supposed mental illness is 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, L. J. Davis reviewed the DSM-IV's description of several adolescent disorders (including Attention-Deficit/Hyperactivity Disorder and Oppositional Defiant Disorder) and concluded, "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). Increased screening would add to that structure by including in the screenings doctors, clinics, hospitals, social service agencies, juvenile justice authorities, etc.
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.
Mental health screenings 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 is being justified by the claim 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 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 profits. Drugs are chosen by some patients, families of patients, and professionals because they seem easier and quicker than other approaches. They are promoted by HMOs and insurance companies because they are sometimes cheaper than other approaches. However, many people question their effectiveness and safety. Many drugs have not been adequately tested. Programs like TMAP use "expert consensus guidelines." Many consumers dislike drugs and 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.
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. (All states have laws against physical, mental, and emotional abuse and neglect. Some also have laws against educational abuse and neglect.) Mental health screening would make it more difficult to resolve such complaints.
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. 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 but 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 be aware of this program and the many people who could be screening us and our children, including school counselors and officials, doctors and other health care providers, social service workers, and juvenile court system personnel. We can be very alert when filling out questionnaires, providing information in a doctor's office or emergency room or other places, and other such forms. We can ask what information is mandatory and ask to see the statute that states it is mandatory.
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.
The federal government's encouragement of increased mental health screening raises serious concerns for all citizens and extra concerns for homeschoolers. It is important that we be aware of the issues involved and inform others.
© 2005 Larry and Susan Kaseman
January-February 2005 - Articles and Columns
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