No Child Left Unmedicated — March 2005

Like most liberal big-spending ideas, this one was slipped into the law under cover of sweet words. It started with the New Freedom Commission on Mental Health created by President George W. Bush’s Executive Order 13263 of April 29, 2002. The Commission issued its report on July 22, 2003. President Bush has instructed 25 federal agencies to develop a plan to implement the Commissions recommendations.

In 2004, Congress appropriated $20 million to finance the recommendations of this New Freedom Commission on Mental Health. Congress also passed the Garrett Lee Smith Memorial Act that included $7 million for suicide screening, and tens of millions more for the Substance Abuse and Mental Health Services Administration and its Center for Mental Health Services. The No Child Left Behind Act already includes $5 million for Mental Health Integration. These funds appear to be part of a larger plan to get more and more people labeled and in the psychiatric system or, as some say, to move children into the psychotherapeutic state.

This Commission on Mental Health laid out a federal plan that could subject all children to mental health screening in school and during routine physical exams. The clear plan is to use the public schools to subject all children to mental examinations, forcing millions of kids to undergo psychiatric screening whether their parents consent or not. The Commission report states on page 58:

“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 Nations schools on any given weekday.”

The Commission wants “routine and comprehensive” testing and mental health screening of every child in America, including preschoolers. The Commission recommends “linkage” of these mental examinations with “state-of-the-art treatments” using “specific medications for specific conditions.” That means prescribing more expensive patented antidepressants and psychostimulant drugs such as Ritalin. Children’s mental health data will be entered into state and federal computer databases and integrated with the child’s other health and education records.

The New Freedom Commission on Mental Health praised the Texas Algorithm Project as a “model” medication treatment plan. It advocates the use of newer, more expensive antidepressants and antipsychotic drugs. But when Allen Jones, an employee of the Pennsylvania Office of Inspector General, revealed that key officials with influence over the medication plan in his state received money and perks from the drug companies, he was fired for talking to the New York Times.

Parental rights are unclear or non-existent under these mental screening programs. Parental rights an depend on who pays for the screening programs, which budgets are used, and who is implementing the programs. Federal consent protections that exist in the Department of Education do not apply if the programs come from Health and Human Services or from a private foundation or university. Even if there are limited protections, the Nanny State and its allies in the mental health community can find ways around them.

What are the rights of youth and parents to refuse or opt out of mental screening? Will they face coercion and threats of removal from school, or child neglect charges, if they refuse privacy-invading interrogations or unproved medications? How will a child remove a stigmatizing label from his records? We don’t know the answers to these questions.

TeenScreen.  
The government bureaucrats who are promoting universal mental health screening for all children are praising a Columbia University based program called TeenScreen as a national model. This program has already been tried out on 43,000 young people in 36 states. It screens 9th and 10th graders for risk of suicide, anxiety disorders, depression, and drug and alcohol disorders.

Columbia University put millions into developing and piloting TeenScreen, but wont say where the funding came from. Leslie McGuire, director of the TeenScreen Program, stated: “Our goal is to get every child in America a mental health check-up before leaving high school.”

Here are some of the very nosy questions that TeenScreen has been asking children:

• “Have you often felt very nervous or uncomfortable when you have been with a group of children or young people, say, like in the lunchroom at school or at a party?
• Have you often felt very nervous when you’ve had things to do in front of people?
• Has there been a time when nothing was fun for you and you just weren’t interested in anything?
• Has there been a time when you had less energy than you usually do?
• Has there been a time when you felt you couldn’t do anything well or that you weren’t as goodlooking or as smart as other people?”

Its easy to see that many teens would honestly answer Yes to those questions, but that certainly doesn’t prove they are crazy or even that they have mental health problems. Nosy questionnaires are very intimidating to many students and their parents, and such use has been a matter of legislation and litigation for several decades.

TeenScreen officials, however, claim that up to one third of the students who undergo screening show some signs of mental health problems, and about half of those are referred to receive mental health services. That means about 15% of the students screened are labeled as having mental health problems, and their treatment can and often does lead toward the use of powerful and sometimes dangerous medications.

It is truly shocking that government employees or others can ask children those ridiculous questions, use them as a basis for deciding whether a child has mental problems, and then refer the kids to mental health providers who are eager to prescribe drugs. It is vitally important that parents insist on prior parental consent before their children are subjected to any mental health screening or to nosy psychological questionnaires, surveys or tests by the government, the schools, private foundations, or universities.

Illinois as model? 
Illinois became the first state to jump on board the new federal plan to subject all children to mental screening. In 2003, the Legislature passed the $10 million Illinois Children’s Mental Health Act creating a Children’s Mental Health Partnership, which is expected to become a model for other states.

This Illinois plan calls for periodic social and emotional developmental examinations to be administered to all children, and for all women to be interrogated for depression during pregnancy and up to a year postpartum. Since the treatment options pushed by the state and the psychiatric community seem to be focused on pharmaceutical interventions, we should address the relevance of the new studies that indicate that antidepressants taken by pregnant women can affect their unborn babies.

When the Illinois plan was showcased in 2004 with five public hearings stacked with bureaucrats and social service workers, a political tempest erupted, with state legislators saying they had no idea this was what they had voted for.

The Illinois plan includes periodic developmental exams for children from birth to 18 years of age, a statewide data-reporting system to track information on each person, social-emotional development screens with all mandated school exams (K, 4th, and 9th), and report cards on children’s social-emotional development.

The Illinois plan also includes requiring the Illinois State Board of Education to incorporate social and emotional standards as part of the mandated Illinois Learning Standards. This inevitably opens up screening children for politically incorrect attitudes and non-conformity with liberal attitudes of so-called tolerance.

Its hard to see how this plan can avoid leading to diagnosis for political reasons. Schools in Ithaca, New York, are already grading first and second graders on tolerance and giving grades on their report cards under “Lifelong Learning Skills.”

Subjective and unreliable. 
It is bad enough that federal and state governments are involved in any way in determining the mental health of their citizens, but to make matters worse the criteria used by the psychiatric and psychological community to determine a diagnosis of mental illness are subjective, culturally biased, and unreliable. Even the so-called experts admit that mental health diagnoses are inherently subjective.

The 1999 Surgeon Generals report on mental health admitted that there are serious conflicts in medical literature about the definitions of mental health and mental illness. The very definitions are rooted in value judgments that vary across cultures.

The diagnosis of mental illness is far more difficult and in many cases impossible, as compared to the diagnosis of medical disorders. The former is based on behaviors as observed by others and subjective reporting, while the latter is based on objectively verifiable physical signs.

Mental illness diagnoses are especially difficult for children because the normal child is developing so rapidly and doesn’t stay the same long enough to make stable measurements. The diagnostic criteria are vague. Because of inherent subjectivity and lack of objective verification, its all too easy for a psychiatrist to label disagreement with political and/or social beliefs to be a mental disorder.

We also have to be concerned about social workers who play a major role in many families lives, especially as more and more family functions are taken over by the school and state. Many social workers and other similarly trained mental healthcare practitioners have been trained mostly in post-modern sociology and leftist ideology. This can give them built-in biases against gun ownership, homeschoolers, dicipline, spanking, parental rights, extended families, and what they consider overemphasis on religion and morality.

More and more physicians are asking questions about family gun ownership as part of routine health examinations. When mental health screening is integrated with academic reports, it becomes very easy to go over the line into judging deviations from political correctness as symptoms of some kind of mental disorder.

Not only are the diagnostic criteria vague and subjective and some peoples motivations questionable, but even one of the stated purposes of mental health screening programs — to prevent suicide — has been shown to be useless and perhaps even counterproductive.

The U.S. Preventive Services Task Force reported that it “found no evidence that screening for suicide risk reduces suicide attempts or mortality. There is limited evidence on the accuracy of screening tools to identify suicide risk in the primary care setting, including tools to identify those at high risk.”

The diagnostic criteria and screening instruments are problematic and some researchers now say that the antidepressant drugs are no better than placebos in alleviating depressive symptoms in children and teens. Nevertheless, in 2002, the last year for which total figures are available, doctors wrote nearly 11 million prescriptions for anti-depressants to teenagers and children.

Antidepressants don’t provide any long-term improvement in academic achievement, athletic skills, social skills, or reduced anti-social behavior. At best, they offer short-term assistance; at worst they hide the actual problems and contribute to them.

Then there is Attention Deficit Disorder (ADD) and the psychostimulants used for its treatment. The criteria used for diagnosing ADD are notoriously subjective, and over-diagnosis is believed to be widespread.

Recent research at Harvard Medical Schools McLean Hospital and the University of TexasSouthwestern has reported depressive symptoms in rats that are exposed to Ritalin early in life. These findings raise concerns that Ritalin and other stimulants used to treat Attention Deficit Disorder in young children may permanently alter the brain and lead to depression in adulthood. One of the findings of this work is that the effect of Ritalin doesn’t go away as the child grows up.

We face the additional problem that the long-term safety and effectiveness of psychiatric medications on children have never been proven. The side effects of some suggested medications in children can be severe. They include suicide, violence, psychosis, cardiac toxicity, and growth suppression. That sounds like a list of everything bad that can happen.

Nevertheless, we have seen a tremendous increase in the prescription of psychiatric drugs to children. We’ve had a 300% increase in psychotropic drugs for 2- , 3-, and 4-year-olds. Several school shooters, including Eric Harris (Columbine) and Kip Kinkel (Oregon) were on antidepressants or stimulants or both at the time of their crimes.

FDA supervision? 
In 2004, the Food and Drug Administration finally responded to public pressure to warn against risks associated with antidepressants given to minors. In October, the FDA ordered that all antidepressants must carry “black box” warnings saying that antidepressants “increase the risk of suicidal thinking and behavior” in children who take them. The FDA’s action, which followed a recommendation of its advisory panel, was the result of data showing that, on average, 2% to 3% of children taking antidepressants have increased thoughts about suicide.

The FDA decision came some ten months after regulators in England declared that most antidepressants are not suitable for children under 18.

The pharmaceutical companies exercise a powerful influence on the studies and on the approval process of various drugs. The FDA finally announced in 2005 that persons who receive pay or perks from the pharmaceutical companies may not serve on panels that approve the drugs.

Under universal screening programs, any thousands if not millions of children could receive stigmatizing diagnoses that could handicap them for the rest of their lives. “State-of-the-art treatments” will result in many thousands of children being medicated by expensive, ineffective, and often even dangerous drugs. It is unclear what effect the FDA decision will have on the Mental Health Commissions stated desire to increase the availability of pharmaceutical options to schoolchildren.

Parents rights. 
The real issue is the fundamental right of parents to decide what medical treatment is appropriate for their own children. Coerced mental health screening programs have no place in a free society. Neither does coerced medication. The government does not own you or your children, and it has no legitimate authority to interfere in your family’s intimate health matters.

Since we also know that psychiatric diagnoses are inherently subjective, and the drugs usually prescribed to treat so-called mental illnesses can produce serious side effects, we need to be even more concerned with these types of government programs.

Unfortunately, we have too many examples of parents being coerced to give psychotropic drugs to their children. This happened even before any universal mental health screening programs have been implemented statewide. The parents can be and have been threatened that they cannot send their child to school, or even that child protective services will take their child away, if they do not give the child the ordered psychotropic drug. Tragic examples include Matthew Smith and Shaina Dunkle who died of medication toxicity after their parents were coerced into placing their children on drugs by the schools.

Parents are calling for a federal law to prohibit coerced drugging with psychoactive medicine of children in government schools, as well as to ban any federally funded or supported universal or mandatory mental health screening programs. Rep. John Kline (R-MN) will soon be introducing the Child Medication Safety Act to cover all psychoactive drugs and protect all children in any educational setting that receives federal funds. This bill would extend to all children the protections passed last year in the IDEA reauthorization.

Rep. Ron Paul (R-TX) has introduced the Parental Consent Act of 2005 (H.R. 181) to forbid federal funds from being used to establish or implement any universal or mandatory mental health screening programs. His bill also says that no federal education funds may be paid to any local educational agency that uses the refusal of a parent or legal guardian to provide express, written, voluntary, informed consent to mental health screening as the basis of a charge of child abuse or education neglect.

What’s wrong with mental health screening? 
First, the plan is unconstitutional because it overrides parents rights to the care and control of their own children. After all, who owns the children, parents or the government?

Second, mental diagnoses are subjective, and this is admitted by the experts. There is no scientific agreement on the definition of mental health or of mental illness.

Third, mental diagnoses are even less scientific for children. The younger the child, the less accurate is any diagnosis because a normal child is constantly changing.

Fourth, medications are already over-prescribed and children over-medicated even though medications don’t usually work on children, the medications have not been tested on children or tested for long-term effects, and there are numerous examples of medications causing suicide, death or crimes.

Fifth, suicide prevention is given as a major reason for mental screening, but there is no evidence that mental screening or medications or school courses prevent suicide.

Sixth, mental screening results in stigmatizing children with a label that may be false, that is impossible to erase from his record, and that may handicap him as an adult (such as preventing him from joining the Armed Services, getting some types of jobs, or buying a gun).

Seventh, universal mental screening presents a real danger that the schools or the child protection agency may coerce parents to submit their kids to mental interrogation, screening, treatment or education under threat of retaliation.

Eighth, there is a real danger that universal mental screening will be used for politically motivated purposes, to identify and change the attitudes of children whose religious or social views may not be politically correct.

Action Items:

1. Tell your Members of Congress to eliminate all federal funding for mental health screening or for encouraging the states to engage in mental health screening.
2. Tell your school board members that you don’t want schools to engage in any mental health screening.
3. Tell your state legislators to oppose all funding for mental health screening in the schools, and to forbid all plans to integrate mental health information with academic information.
4. Be alert to stop any mental health tests from being integrated with academic standards.
5. Tell your state legislators that your state should have Protection of Pupil Rights legislation to prevent schools from asking students nosy psychological or psychiatric questions, or questions about their family, without prior, informed, written parental consent.
6. Tell your Members of Congress to support Ron Paul’s Parental Consent Act, H.R. 181, and Rep. John Kline’s Child Medication Safety Act (as soon as it is introduced).