What is it going to take?

[Guest guest]

Mass mental health screening of American children is absolutely, without a

doubt, the most serious psychiatric threat to this nation. It is in our face

right now. If this is not stopped now, give it a couple years. Where will that

leave us?

Will you just wait until your child is screened or until you hear your friend's

dear child was screened and wound up on antipsychotics?

If your question is: " But, what can I do? " The answer to that question is:

Communicate! Communicate with letters to the editor, with a picket sign in your

hand (don't forget to take photos!), by calling schools across the country

asking them if they have TeenScreen and voicing your opposition if they do,

applauding them if they don't, going on the radio, speaking to groups, writing

a story about it, telling your friends, telling your family members, sending out

e-mails to all your contacts, communicating to your legislators, making a

website, posting stuff on the net about it, etc. It's just a matter of

communication. Get the word OUT! .

What it is going to take is a shoulder to shoulder effort. And we have a lot of

shoulders!

Yeah, TeenScreen has just changed it's policy to REQUIRE written parental

consent NATIONWIDE, but that's not enough for us.

We're going to take down the whole enchilada.

Here are TWO stories in today's Washington Post.

http://www.washingtonpost.com/wp-dyn/content/article/2006/06/15/AR2006061501984.\

html

Suicide-Risk Tests for Teens Debated

By Shankar Vedantam

Washington Post Staff Writer

Friday, June 16, 2006

A growing number of U.S. schools are screening teenagers for suicidal tendencies

or signs of mental illness, triggering a debate between those who seek to reduce

the toll of youthful suicides and others who say the tests are unreliable and

intrude on family privacy.

The trend is being aggressively promoted by those who say screening can reduce

the tragedy of the more than 1,700 suicides committed by children and

adolescents each year in the United States. Many of the most passionate

supporters have lost children to suicide -- among them Sen. Gordon

(R-Ore.), whose son Garrett died in 2003.

One screening program, TeenScreen, developed by Columbia University, has been

administered to more than 150,000 children in 42 states and the District. The

state of New York plans to start screening 400,000 children a year, and the

federal government is directing tens of millions of dollars to expand screening

nationwide.

Use of the psychological evaluations is growing even though there is little hard

evidence that they prevent suicides. A panel of government experts concluded two

years ago that the evidence to justify suicide screening was weak and that such

programs, although well intentioned, had potential adverse consequences.

The growing use of screening has coincided with a rapid increase in the number

of youngsters being prescribed powerful antipsychotic medications such as

Risperdal and Zyprexa that have not been specifically approved for use by

children. There was a fivefold increase in the use of these drugs in children

between 1993 and 2002, according to one analysis published this month in the

Archives of General Psychiatry, and a 73 percent increase in such prescriptions

between 2001 and 2005, according to Medco, a firm that manages pharmacy

benefits.

Proponents of screening say that it is no different than having health checkups

or visiting a dentist, and that the potential benefits are incalculable. After

's son killed himself, the Republican bucked the objections of several

conservative groups to push into a law an $82 million effort to expand programs

such as TeenScreen.

" Without any doubt, had TeenScreen been available to us as Garrett's parents, I

am convinced we would have been empowered to save his life, " said in an

interview. " Logic tells me the more you know, the more you are able to help. "

Garrett died one day shy of his 22nd birthday. He had seen a psychiatrist

shortly before he committed suicide and was given a prescription for an

antidepressant. Sen. said the family did not know whether Garrett took the

medication. Later, said, several experts concluded that Garrett probably

had bipolar disorder, also known as manic-depression. Antidepressants are not

recommended for this condition, and said his son had probably concealed

his symptoms during his single visit with the psychiatrist. Still, he said, if

the family had known that Garrett had bipolar disorder, they could have acted

years earlier.

The controversy over screening has become emotional. Opponents say such programs

have turned into fronts for the pharmaceutical industry to boost sales.

Advocates, meanwhile, say those against screening are often driven by

anti-psychiatry ideologies such as Scientology.

" It is industrial psychology at its worst, " said D. Ostrolenk, a family

therapist with the Eagle Forum, a conservative group founded by commentator

Phyllis Schlafly. " We think it is inappropriate to turn state schools into

laboratories for psychiatry. " He added that the group is also concerned that

screening violates family privacy.

But screening has wide support among both Republicans and Democrats. In 2004,

President Bush signed into law the Garrett Lee Memorial Act to boost

funding for suicide screening, and the President's New Freedom Commission on

Mental Health has been broadly supportive.

The debate over screening also turns on the scientific paradoxes of suicide. It

is rare enough that it is difficult to study by conventional scientific trials,

but common enough to claim the lives of more than 30,000 Americans each year --

far more than those who die by homicide. There were 1,737 suicides by children

and adolescents in 2003, the last year for which national statistics are

available.

Among those younger than 20, the suicide rate is 2.14 per 100,000, a fraction of

the 14.6 per 100,000 rate for those older than 50. But national surveys suggest

that about 1 in 12 high school students tries to harm himself or herself each

year with an eye to committing suicide.

Because suicide victims often turn out to have had mental disorders such as

depression and bipolar disorder, Shaffer of Columbia University, who

developed the TeenScreen questionnaire, and other specialists say identifying

and treating youngsters with such disorders may reduce the number of suicides.

" If the only product of screening was to predict who is going to commit suicide,

you could argue about its utility, " he said. " But the risk factors for suicide

are other treatable psychiatric disorders. "

Laurie Flynn, national executive director for TeenScreen, the largest of several

such programs nationwide, said annual physical exams are less likely than mental

health checkups to reveal problems. Moreover, she said, suicide screening can

reveal problems that parents may never detect. Flynn's daughter attempted

suicide when she was 17. When the school phoned Flynn with the news, she said,

her initial reaction was " You have the wrong number. "

Shaffer and Flynn said the goal is not to put children on medication but to

alert parents to a problem, which they can then discuss with a pediatrician, a

psychiatrist or a clergy member. Flynn said TeenScreen is supported by private

donors and receives no money from the drug industry. (Much of the initial

funding came from the late J. Ruane, a former board member of The

Washington Post Co.) Shaffer said the screening test he developed is now in the

public domain and he does not profit from its use.

In New York state, where 70 to 80 children commit suicide each year, Sharon

Carpinello, commissioner of the Office of Mental Health, said officials plan to

spend more than $60 million to expand youth suicide prevention initiatives such

as TeenScreen.

Although the argument that treating mental disorders would reduce suicides is

intuitively appealing, the U.S. Preventive Services Task Force, a federal panel

of independent experts, concluded in 2004 that there was insufficient evidence

either for or against general physicians screening the public for suicide risk.

Ned Calonge, chairman of the task force, established to assess the evidence for

various disease-prevention strategies, said the panel would reach the same

conclusion today.

" Whether or not we like to admit it, there are no interventions that have no

harms, " said Calonge, who is also chief medical officer for the Colorado

Department of Public Health and Environment.

There is weak evidence that screening can distinguish people who will commit

suicide from those who will not, he said. And screening inevitably leads to

treating some people who do not need it.

Such interventions have consequences beyond side effects from drugs or other

treatments, he said. Unnecessary care drives up the cost of insurance, causing

some people to lose coverage altogether. For every 1 percent increase in

premiums in Colorado, Calonge calculated, 2,500 people lose their health

insurance.

The same panel had concluded that there is sufficient evidence to recommend

screening adults for depression. This is in part because a variety of

medications have proved effective in treating adults. Only one drug, Prozac, has

been proved effective in clinical trials for treating depression in children.

E. Hyman, a former director of the National Institute of Mental Health

and now provost at Harvard University, said he favors developing screening

questionnaires and treatments for children to reduce the number of suicides, but

he is skeptical that such tools currently exist.

" By and large, brief diagnostic tests -- especially doing broad screening in

children -- are not well validated, and one has to be concerned about missing

real illness or, conversely, interpreting transient life troubles as a mental

illness requiring intervention, " Hyman said.

" It doesn't mean ignorance is good, " he added. " But if your instrument is poor,

or you don't know how to intervene to prevent a condition like suicide, there is

actually a risk of harm. Besides cost and intrusiveness, there is a risk of harm

in terms of stigmatization, but also interventions that backfire. "

Comments here:

http://www.washingtonpost.com/wp-dyn/content/article/2006/06/15/AR2006061501984.\

html

Letters here: letters@...

http://www.washingtonpost.com/wp-dyn/content/article/2006/06/15/AR2006061501766.\

html

By Shankar Vedantam

Washington Post Staff Writer

Friday, June 16, 2006; Page A03

Hilda Anyanwu was 16 when her high school in the Bronx organized a screening for

suicidal behavior in 1999. It was the start of a journey that would lead her to

confront the traumatic sexual abuse in her past and, she said, help her change

from a loner to a gregarious young woman.

Anyanwu's story illustrates many of the reasons proponents say screening of

teenagers is valuable -- but also why it draws questions from critics.

TeenScreen, a program developed by Columbia University researchers, placed

Anyanwu in contact with The Washington Post.

At the time she took the survey, parents were not required to sign a consent

form, something that TeenScreen says it now requires all schools using the

program to mandate. As Anyanwu's case shows, however, asking parental consent

can produce complications.

The survey Anyanwu filled out asked whether she was suicidal, was depressed or

had experienced traumatic events. On the basis of her answers, she was selected

to take a more in-depth questionnaire. At one point, she recalled, she became

upset and wanted to stop, but she stayed because she had been taught to obey her

elders.

She was then referred to a counselor, who sent her to a psychologist in

Manhattan. For this, she did need her parents to sign a consent form -- and

Anyanwu had not told them about the abuse because she had feared they would not

believe her. In an interview, she said an older cousin in Nigeria had abused her

from the time she was 8 until her family moved to New York when she was 13.

Anyanwu said she rushed her father to sign the consent sheet without looking at

it and began therapy. At times, she was prescribed the antipsychotic drug

Risperdal, the antidepressants Zoloft and Paxil, and lithium, which is often

given for bipolar disorder. She was even hospitalized a few times, she said,

once for cutting her wrists and attempting suicide as she wrestled with painful

memories.

When her therapist eventually pressured her to tell her parents what had

happened, her mother took her side but her father refused to believe her,

Anyanwu said.

But the screening and the treatment changed her life for the better, she said,

adding that she is glad TeenScreen and her therapists persuaded her to

participate.

" I wanted to be in denial, " she said. " Without the people to dig in, I would

never have been able to verbalize my isolation and tell my story. My getting

angry was part of the healing process. "

Letters here: letters@...

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