July 14, 2009Psychiatrist Criticizes Mother's ActPrompted by a recent article in Time that examined the question of whether all expectant mothers should be screened for depression, Emory University psychiatrist Doug Bremner offers his thoughts: "The problem with this is the attitude that being a mother is a risk factor for a psychiatric disorder. First of all, there is no evidence that women without a prior history of anxiety and depression have any increased risk of getting post partum depression. So to screen all moms as if giving birth is a risk factor for depression is ridiculous. And whenever you start screening the general population, you get into problems with over-identification of people and an increase in the number of people that go on antidepressants. I am opposed to mandatory screenings of the population, like Teenscreen, which are bonanzas for the pharmaceutical industry, but a major intrusion into the privacy and autonomy of American citizens. In the case of Melanie Blocker-Stokes, she had already been treated with multiple courses of psychotropic drugs and electro-convulsive therapy, so there is no reason to think that her life would have been saved by “screening”. This legislation is typical of much that comes out of an individual tragedy, that results in an intrusion into the personal lives of individuals and the further relinqueshment of individual freedoms to the government. Well isn't it classic that the magazine quotes someone as an authority without noting their alliances with pharma companies? As for the Mother's Act itself, I really don't feel like getting kicked around all over again, so I'll let Bremner's opinions speak for themselves. Posted by Philip Dawdy at July 14, 2009 12:03 AM
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Is there any evidence that screening for mental illnesses leads to that treatment which could foster successful outcomes? If so, what are the outcomes for persons who have been screened pursuant to any screening initiative? Posted by: Joe at July 14, 2009 05:44 AMOf course, any disease state screenings, if such a medical disorder actually exists at all, are conducted by front groups sponsored by big pharma. These groups wear the mask of a support group, and they follow directions of their sponsor to expand the boundaries of a particular medical condition in order to profit. As far as PPD goes, there is a correlation between the severity of this disorder, and the socio-economic class of the woman diagnosted with PPD. The lower the income, the more PPD presents itself. Posted by: Dan Abshear at July 14, 2009 09:25 AMIt can be pretty hopeless trying to debate any topic associated with Scientology/Tom Cruise. The antipsychiatry crowd gets smeared with Scientology enough as it is, but with PPD you're really asking for it. One of the comments on Bremner's response actually read "I’m inclined to say that anything these fear-mongering groups are against — with their ludicrous 'there is no proof that there is such a thing as mental illness' ranting — I’m for." If that line of thinking is as common as I think it is, I almost can't blame pharmaceutical reps and biopsychiatry proponents for exploiting it. And just to preempt the "mental health screenings don't have to involve pharmaceuticals" crowd, the reason many people are "antipsychiatry" is precisely because they've found out the hard way how much psychotropics are the be all and end all of mental health treatment in the mainstream. Posted by: Bryan at July 14, 2009 10:24 AMBryan: You know what I loved even more about the comment, you quote from? The lines that read: "Many mental health disorders limit objectivity, so these people are just not the best judges of what has been done to them and why. They can have their stories and they can share them. But we can’t make policy on this kind of hearsay and paranoia." According to my information, the author of the comment is "disordered" herself - or at least she happily identifies as such. What does that make her own comment?... Oh, and the book she wrote, too? LOL http://uniteforlife.wordpress.com/2009/07/14/motherhood-is-not-a-mental-illness-bremner-on-time/ Let them come get me Philip. They've already tried to take away your cigs, I would hate to see what's next. The mother's act (S. 1375) was introduced during the last congressional session and died in committee. (See http://www.govtrack.us/congress/bill.xpd?bill=s110-1375) To become law it would need to be reintroduced. Posted by: R. at July 14, 2009 12:52 PMIt was reintroduced and passed the house already this year. It's in the Senate and waiting in committee. See uniteforlife.wordpress.com's fax campaign to the HELP committee under Kennedy. Posted by: Amy Philo at July 14, 2009 02:09 PM"Is there any evidence that screening for mental illnesses leads to that treatment which could foster successful outcomes? If so, what are the outcomes for persons who have been screened pursuant to any screening initiative?" Good question. For postpartum depression, there is little evidence on this. A couple studies have followed outcomes from screening to receipt of treatment: these couple of studies have found that "uptake" of treatment is very low: cf: horowitz and cousins 2006. Of the top of my head, I cannot list any others, but I know I have seen one or two that looked at "uptake" of treatment resulting from a screening program. As far as I know, there are NO studies that assess whether outcomes- successful treatment of depression - is better for some group of women in a screened versus equivalent but not-screened health care setting. If anyone believes they have a study that shows this outcome resulting from screening, please post the info. There is great evidence that a very high-level system can turn screening into successful treatment of depression. This is in the literature on screening for depression in primary care. Care must be integrated into primary care, and there must be a good amount of patient choice. My opinion is that M B-S act would lead to a lot of positive screens, but little actual treatment, and little actual treatment that works. At the same time, it would lead to the prescription of a lot of psych drugs for pregnant and breastfeeding women, and would lead to some SSRI-related suicide or homicide in moms, and may likely lead to some bad effects in the nursing children since the drugs will be in the breast milk. So I think the time to invoke a M B-S screening mandate would be after we finally accept that therapy is a much better treatment choice compared to psych drugs. Posted by: medsvstherapy at July 15, 2009 06:09 AMHey, I suggest you go on over to the PsychCentral blog and check out the rip roaring debate that's going on over the Mothers' Act and Doug's post. Thanks Doug for being a voice of reason in all this. And thanks to Amy for sharing her story and getting Time to publish it. Posted by: Sara at July 15, 2009 02:51 PMeven if it is passed, probably won't get funded. what gets funded properly? and then it will go to seed. Posted by: jenna at July 20, 2009 08:57 PMThe Mean And Unclean TeenScreen A ridiculous mental health initiative was unveiled by President Bush in July 2004, after being established in 2002. The plan promises to integrate mentally ill patients fully into the community by providing "services in the community, rather than institutions- according to a March 2004 progress report entitled, ‘New Freedom Commission on Mental health’, Executive Order 13263.. It is a federal action agenda that is being initiated. Bush established the New Freedom Commission on Mental Health in April 2002 to conduct a comprehensive study of the United States mental health service delivery system, so he told the public. This includes over 50 million children targeted for mental health screening in over 100,000 schools in the United States. The American Psychiatric Association (APA), who has an overt affinity for pharmaceutical industry funds, supports this Commission. In fact, the Bush administration was very appreciative of the efforts of the APA to suppress mass media coverage of facts and stories raised by others exposing plans to screen others for mental illness. The 15 person commission issued its recommendations in July 2003. Included in this commission is the aggressive mental health screening of children performed by TeenScreen, which is in partnership with the National Alliance on Mental Illness (NAMI). TeenScreen is unnecessary, because there is already an existing structure for screening and labeling children as part of the Individuals with Disabilities Education Act (IDEA). Furthermore, due to rapid developmental changes with children, it is very difficult to accurately diagnose these children. TeenScreen clearly is simply a government sponsored market expander for those in the pharmaceutical industry who market psychotropic drugs. SSRIs, a frequently prescribed class of medications, generates close to 200 million prescriptions in the United States that approaches a cost of 20 billion dollars a year. On TeenScreen’s own website, it states that it believes any funding from pharmaceutical companies could create the appearance of a possible inducement to recommend treatment, yet TeenScreen does not prohibit funds from drug companies. Medicaid is the largest payer of mental health services- with 1 out of every 5 dollars spent by Medicaid goes to psychotropic drugs. Nearly 3 million children are receiving more than one psychotropic drug at one time without merit or efficacy provided by these drugs, overall. The cost is on average over 100 dollars a month for each child for these drugs. Mental health screening programs have never been proven to prevent suicide, the apex of TeenScreen, according to the organization. The Commission chose to have TeenScreen assess children at public schools because these school districts get more money for every student that is labeled mentally ill or disabled. The US Preventative Special Task Force, sponsored by the Agency of Healthcare Research and Quality, which is part of the Department of Health and Human Services, stated in 2004 that there is no evidence that mental health screening for suicide risk reduces suicide attempts or mortality. Presently, this task force now supports TeenScreen. Why they do now is unknown. Those who lead TeenScreen contradict themselves. Leslie McGuire, TeenScreen’s director, and formerly a leader at NAMI, stated that TeenScreen was not affiliated with or funded by drug companies. She also stated that TeenScreen does not involve treatment and does not recommend or endorse any particular kind of treatment for the youth who are identified by them as at risk by their screenings. Some insist on the truth, and others avoid the truth. After getting passive consent from the parents of the children TeenScreen desires to screen, TeenScreen asks a series of questions to children that they believe will indicate mental disorders- with the focus being those children who are potentially suicidal, completely disregarding the fact that a score on a rating scale alone is not sufficient to diagnose such mental illnesses as depression. The number of positive responses from the questions answered by the children will determine by TeenScreen if mental illness exists. However, a score is positive if a child refuses to answer any of the questions given to them by TeenScreen. The positive indications are catalysts for referrals of children for treatment. Yet TeenScreen does not disclose where these children are sent for treatment to anyone. These questions are not given to the parents of the child screened. This violates the Protection of Pupil Rights Amendment. However, the questions can be obtained on websites such as: www.teenscreentruths.com. The passive consent deception is that they ask the parents on a form to return the form to the school only if they do not want their child to participate in the screening. Also, the consent form does not state that there is no scientific proof to back up the screening, yet will be used to label the child mentally ill. Also, initially, TeenScreen stated that if their mental health screening program is approved by the Board of Education as part of the educational program, parental consent is not necessary. The Board of Education corrected TeenScreen soon afterwards. Nor does the consent form describe the treatment possible with psychotropic drugs, and the dangers of these drugs. And, if the parent refuses the recommended course of treatment by TeenScreen, a referral to the local child welfare agency might be made, which could result in their child being taken away from home and forcibly drugged. This scares me. Equally deceptive is the fact that TeenScreen advises local schools on how to circumvent federal law. The Protection of Pupil Rights Act (PPRA) protects the rights of parents by making instructional materials available for their inspection if the materials are to be used in connection with a survey, analysis, or evaluation in which their child is participating. It also requires written parental consent before minors are required to take part in such a survey, analysis, or evaluation. The focus on those who are suicidal is a bit ridiculous, since suicide rates in this age group have fallen greatly for the past several years now. And if that is the goal of TeenScreen, their methodology is incomplete: Do they ask if the student has been, or is, irritable and apathetic? No. Wow- what experts they have at TeenScreen…….. TeenScreen tacitly considers the pharmaceutical industry their sponsor, as indicated by the amount of money this industry gives NAMI, which is about 3 million dollars a year. Eli Lilly is the top briber of NAMI, as they are the top drug company with the most prescribed psychotropic drugs, unfortunately. Front groups, they are, that wear the masks of advocacy groups. Over half of the revenue of such groups comes from the pharmaceutical industry. TeenScreen is no different. Ironically and sadly, lawsuits have been filed against TeenScreen for misdiagnosing children who have been prescribed psychotropic drugs, and have committed suicide likely as a result of the drugs prescribed to them. TeenScreen links students with those who can pharmacologically treat them for unlikely mental disorders- to further grow the number of kids already on psychotropic drugs- which exceeds 10 million children. If students are assessed by the TeenScreen staff, and are found to require additional services, are connected with a case manager to arrange for appropriate intervention. Really? Intervention, when discussing the practice of medicine, is generally a derogatory term used by critics of a medical model in which patients are viewed as passive recipients receiving external treatments provided by the physician that have the effect of prolonging life. Enough said. TeenScreen has and does bribe students to take the questions they provide that are clinically worthless with such things as movie passes, gift certificates, and so forth. TeenScreen also instructs schools on how to circumvent the PPRA for students, or the Hatch Amendment. There are other legal liabilities that may be created in school districts that implement the TeenScreen program. It was sold to others that TeenScreen primarily was preventing the incidences of suicide, and this is baseless and without merit. First of all, the rare teen suicides have been declining over the years. Some children likely are void of a concept of suicide. The screening is a 10 minute computer test with 14 questions that was developed in the psychiatric department of Columbia University. This is hardly enough information from a child to determine their mental status. And TeenScreen is the perfect example of a flawed mental health screening organization. They ask about thoughts of suicide in their questions of students, but do not ask if the student has a plan for suicide. Nor do they ask if a student has a family history of suicide. Not asked is whether the student has physical illness that is out of control, a risk factor for suicide. Not asked is if the student has any family and community support for their issues. Of the symptoms the student acknowledges experiencing while answering the questions of TeenScreen, not asked is the duration of these symptoms. TeenScreen does not ask if the student has access to firearms- which is the most common method of suicide. TeenScreen is nothing more than a front group for their big pharma sponsors who market psychotropic drugs, as teenscreen wears the mask of a support group for the youth. The activities of TeenScreen not only potentially damage children, but also invade their privacy quite obviously, and it is allowed too often, I say with great sadness. The staff of TeenScreen, as well as the employees of public schools, are in fact practicing medicine without a license, and are committing slander and libel by stating that a student has a mental problem in writing, or to anyone else. So far, now likely to increase with the addition of primary care doctor offices as targets for TeenScreen, there are greater than 500 TeenScreen sites in most states in the U.S. This decision by TeenScreen to screen kids at these doctor offices will assure quicker prescriptions unneeded for the kids, likely. TeenScreen’s quick start guides for their primary care focus include tips for interpreting the screening questionnaire results, tips on making a referral for patients identified as being at possible risk, as well as tips for coding and reimbursement. If referred to a psychiatrist by a primary care doctor, there is a 90 percent chance that this doctor will prescribe a psychotropic drug for them that they likely do not need. If nothing else, TeenScreen may eventually increase teen suicides once many of the misidentified mentally flawed students are prescribed psychotropic drugs. There are few if any benefits associated with TeenScreen, except increased profits for pharmaceutical companies, yet their objectives are potentially damaging to children. There are concerns about the potentially for unnecessarily causing neurological damage to these students prescribed psychotropic drugs, as well as increased substance abuse and drug dependence. By the pharmaceutical industry using these front organizations, they compromise scientific integrity under the color of authority. TeenScreen will increase drug use rather than prevent mental illness and the utilization of alternative treatment modalities. TeenScreen is said to have a certified mental health professional as part of their screenings. I’m not sure what this person does for them, though. According to Wikipedia: The Certified Mental Health Professional (CMHP) certification is designed to measure an individual’s competency in performing the following job tasks. The job tasks are not presented in any particular order of importance. 1. Maintain confidentiality of records relating to clients’ treatment. The certified mental health professionals of TeenScreen only do a small fraction of their tasks- all that is necessary to get drugs for the students, ultimately. As stated earlier, TeenScreen partners with the mental health front group, NAMI. TeenScreen is led by a former head of NAMI- the front group that is a whore for those psychotropic companies in the pharmaceutical industry. And TeenScreen shares the same unethical behavior as their sponsor. For example NAMI, did not disclose that Eli Lilly’s marketing manager, Gerald Radke, ran its entire operation at one time. Radke, starting in 1999, worked for NAMI as a Lilly-paid management consultant. Then, Radke left Eli Lilly and served as NAMI’s paid interim executive director until 2001. After NAMI, he ran the Pennsylvania Office of Mental Health and Substance Abuse, and now serves the Pennsylvania Health Department. Lilly, on average, pays NAMI about a million dollars a year, and these executive loans are mutually beneficial for both. NAMI receives more than half its budget from some pharmaceutical companies. NAMI came under scrutiny by U.S. Senator Charles E. Grassley in April of 2009. Senator Grassley's investigation of NAMI confirmed that a majority of their funding was coming from the pharmaceutical companies. They are a front group, and not a national mental health advocacy group as perceived to be. To further prosper on this government initiative involving 25 federal agencies, TeenScreen got assigned the Hilton of required Pharmacy Benefit Managers (PBMs), which is the Texas Medication Algorithm Project (TMAP), a similar program Bush started as Governor of Texas, as a "model" medication treatment plan that "illustrates an evidence-based practice that results in better consumer outcomes." TMAP was ultimately developed by the pharmaceutical industry- particularly those companies that market psychotropic drugs, in 1997. This theory that the primary purpose of the commission was to recommend implementation of TMAP based algorithms on a nationwide basis for profit. TMAP, which requires the use of newer, more expensive drug, has itself has been the subject of controversy in Texas, Pennsylvania and other states where efforts have been made to implement its use. Developed when Bush was governor of Texas, TMAP began as an alliance of individuals from the University of Texas, the pharmaceutical industry, and the mental health and corrections systems of Texas. Through the guise of TMAP, the drug industry has methodically influenced the decision making of elected and appointed public officials to gain access to citizens in various mental health settings. The project was funded by a Robert Wood Johnson grant and by several drug companies. Lilly's Zyprexa is one of the atypical antipsychotic drugs recommended as a first line drug in the Texas scheme. About 70 percent of Zyprexa sales are paid for by government health care programs, such as Medicare and Medicaid. All together Lilly reportedly contributed $103,000 to support TMAP. Heather Lusk, an Eli Lilly representative, said contributions to TMAP were "educational" grants made by a company grants office. What is being done about this very concerning and authoritarian program that is damaging children? Presently there is a bill to prohibit the use of federal funds for any universal or mandatory mental health screening programs, H.R. 2387, The Parental Consent Act. Such screenings violate the right of parents to direct and control the upbringing of their children. Also, not consenting as parents with the recommendations of mental health screeners should not be a catalyst for a charge of child abuse or education neglect. Ron Paul spoke before the House of Representatives in 2004 to introduce the Let Parents Raise Their Kids Act, which forbids federal funds from being used for any universal or mandatory mental health screening f students without the express, written, voluntary, informed consent of their parents or legal guardians. This bill protects the fundamental right of parents to direct and control the upbringing and education of their children, as it should be. And there is The Parental Consent Act of 2005, or HR 181, which assures the right of parents to direct and control the upbringing and education of their children. There is also the Child Medication Safety Act of 2007 to protect children and their parents from being coerced into administering a controlled substance in order to attend school, and for other purposes. Yet there is already an Act in place that is has the ability to form this screening function based on the Individuals with Disabilities (IDEA) act, and not TeenScreen. Of course, the pharmaceutical companies would not profit if this were to occur. Yet the best action can and should be done by others. By parents. By many parents who should know about this program. If one desires to contact TeenScreen: Leslie McGuire, M.S.W. Dan Abshear Posted by: Dan at July 26, 2009 12:50 PMPost a comment
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