Mandatory Mental Health Screening
On July 26 2004, the New Freedom Commission, a 15 member group created by an executive order in 2002, released “Achieving the Promise”, an action plan for transforming mental health care services in America. Goal #4 of the plan, “early mental health screening, assessment, and referral to services are common practice”, recommends mental health screening and early intervention programs, which will identify individuals with symptoms of mental illness and connect them to treatment, become readily accessible in health care facilities, school systems, and criminal justice, juvenile justice, and child welfare systems. Columbia University’s TeenScreen program, which in pilot tests identified 1/3 of participants as mentally ill, was named as a model to achieve goal #4’s mission to improve and expand school mental health programs. The program IMPACT–Improving Mood: Providing Access to Collaborative Treatment for Late Life Depression, was identified as a model program for screening and treating older adults in primary health care settings.
Goal #5 of the plan, “excellent mental health care is delivered and research is accelerated”, named the Texas Medical Algorithm Project (TMAP), a program that would mandate the prescription of brand name pharmaceuticals as a 1st line of treatment for mental disorders, as a model program for providing high quality mental health services. Allen Jones, an investigator for Pennsylvania’s Office of Inspector General, discovered evidence of payment from pharmaceutical companies to government officials that influenced the implementation of the TMAP program and has filed a lawsuit against Johnson & Johnson and related companies that initiated the program. The screening programs combined with TMAP has been identified as a marketing strategy to expand the pharmaceutical industry’s consumer base and the New Freedom Commission has been under continual criticism for their recommendation.
The Substance Abuse Mental Health Administration (SAMHSA) has responded by not including TeenScreen or TMAP in the Federal Mental Health Action Agenda, which is influenced by the New Freedom Commission. However, states are still free to implement the programs with federal grants, legislative efforts to mandate mental health screenings are taking place in many states, and the Garrett Lee Smith Act, the 1st youth suicide prevention bill signed into law Oct. 21 2004, gives preference for grants to states that use screening programs as an intervention and prevention strategy. This research topic is devoted to compiling information on the initiative to implement mental health screening programs.
Commission Members/ Commission Recommendations
The New Freedom Commission was established by Executive Order 13263 issued on April 29, 2002 by President George W. Bush. The mission of the New Freedom Commission, a 15 member body appointed by the President, was to conduct a comprehensive study of US mental health service delivery systems and advise the President on methods of improving the system to enable adults and children with serious mental illness to participate fully in the community. The Commission was charged with identifying effective mental health treatments and services and formulating policy options that could be implemented by public and private providers. The New Freedom Commission’s recommendations of the TeenScreen and TMAP programs has put the Commission under public scrutiny for its relationship to the pharmaceutical industry. This subtopic is devoted to compiling information on the 15 members of the New Freedom Commission and their recommendations.
An article on the pharmaceutical industry influence on the development of TMAP and the New Freedom Initiative with a long list of resources for further research.
The groundbreaking Mother Jones article on the pharmaceutical industry sponsorship of the TMAP program and the real life consequences for an adolescent who tested positive for a mental illness.
The court documents of Allen Jones who filed suit for protection to report his findings as an investigator for Pennsylvania’s Office of Inspector General. The documents report his findings of Pennsylvania politicians accepting bribes from pharmaceutical executives to implement the TMAP protocol. html
Stephen Barias’ “Conservative Groups Press Currie on Screenings”. Psychiatric Times. Jan 1 2006. and annoucement of a debate hosted by the National Academies between Vera Sharav of AHRP and Dr. David Shaffer, developer of TeenScreen.
Screening Companies/ Screening Tests
The initiative to screen for mental disorders can be traced back to 1895 when the American Psychological Association (APA) established a committee to investigate the feasibility of creating a standardized test for mental health. In the early 1980s, a series of articles promoting the use of computers as a tool in psychological evaluations were published in medical, education, and psychological journals. The concept of large-scale mental health screenings was introduced in 1991 through Screening for Mental Health, Inc.’s National Depression Screening Day. Since then, a new industry for mental health screening programs has emerged with companies offering a cost-effective method to deliver mental health services in a variety of settings. This subtopic is devoted to compiling information on the screening companies and test that compose the new mental health screening industry.
An overview of Columbia University’s National TeenScreen program. In an effort to dispel the criticism TeenScreen refers to as, “the intentionally deceptive misinformation…proliferating through one or two individuals on the internet,” the website now has a FAQ devoted to setting the record straight.
“DISC Predictive Scales (DPS): Efficiently Screening for Diagnosis”. Christopher Lucas et. al. J. Am. Acad. Child Adolesc. Psychiatry, 40:4, April 2001.
The Signs of Suicide (SOS) Prevention Kit is one of the primary screening programs for Screening for Mental Health Inc., and ha recieved a majority of grants allocated through the Garrett Lee Smith Act.
The Youth Risk Behavioral Survey was an annonymous mental health screening program distributed by the Massachussettes Department of Education every odd numbered year to select schools. Funding for the program has ceased but the results from the tests given in 2001 and 2003 are still available, and indicate a reduced amount of suicidal, aggressive, and dangerous behaviors among adolescents.
“An Evaluation of State EPSDT Screening Tools”. Issue Paper #3 on Contracting for Managed Behavioral Health Care by the Bazelon Center for Mental Health Care.
SAMHSA’s Businesses Materials for a Mental Health Friendly Workplace: Executives Packet. The Booklet recommends the use of an Employee Assistance Program (EAP).
A list of Employee Assistance Programs (EAP) marketed to corporations to increase the productivity of the workforce. Many EAP’s use mental health screening programs.
A Press Briefing on Presidents Fiscal Year ’07 budget and low income programs that mentions the Bush Administration’s support of the TeenScreen program.
An editorial prepared by the Commonwealth Education Organization that claims surveys influence those who take them and that the TeenScreen program will increase the suicidal tendancies of those who participate.
Depression-Screening.org sponsored by the National Mental Health Association.
The New Freedom Commission and supporters of goal #4 have stressed that the recommendation for universal mental health screenings does not signify mandatory mental health screening. Despite this, legislation has been introduced in states, such as Minnesota, to include mental health screenings as a part of mandatory health screenings for children. Millions of dollars in SAMHSA grants have been allocated for mental health screenings, and the Garrett Lee Smith Act and the Positive Aging Act provide preference for grants to those that utilize screening programs. This subtopic is devoted to compiling information on the legislative efforts to mandate mental health screenings.
The SAMHSA 2006 budget. SAMHSA requests $1,948,000 to pilot mental health screenings through the use of Columbia’s Teen Screen and Mental Health Inc.’s Signs of Suicide in the Dept. of Education’s Safe Schools/Healthy Students programs p.13-14. On p.25 $2,000,000 is alloted to establish surveillance measures on the mental health needs of the population. P. 30 documents the dramatic increase in spending for suicide prevention in children and adolescents; from $7,000,000 in 2005 to $18,000,000 in 2006. html pdf
The Garrett Lee Smith Act that federally mandates the use of Early Prevention and Intervention Strategies as they are outlined by the Suicide Prevention Resource Center, the national body established to develop, implement, and evaluate suicide prevention programs that emphasize the use of mental health screening.
The Garrett Lee Smith Act was passed by a unanimous vote in the Senate. The Bazelon Center for Mental Health Law has compiled a list of all Senators and House Members who supported the bill. http://www.bazelon.org/takeaction/s2634supporters.htm
An overview of state and federal support for mental health screening listed on the teenscreen website. New Mexico, Nevada, and New York were recently awarded a SAMHSA grant from the Garrett Lee Smith Act to implement TeenScreen as a part of their suicide prevention strategy. This is a link to the suicide prevention plans in development by every state.
H.R. 2629 is a Bill currently being reviewed by the House subcommittee on Select Education. It plans to amend the Older Americans Act of 1965 to provide for mental health screenings.
Dr. Karen Effrem. “Huge Mental Health Victory for MN Families: MN parents and children protected from mental health coercion and universal screening.” Edwatch. July 18, 2005. An article detailing the success of grassroots organizations in defeating efforts to institute mandatory mental health screenings in kindergarten in the 2005 MN legislative session. Efforts to pass legislation calling for mandatory K-12 mental health screenings have reappeared in MN in 2006.
This link is the lawsuit filed by the parents of a daughter subjected to the teenscreen test in the Indiana school system. The test flagged her positive for 2 mental health diagnosis and suggested she be referred to a mental health facility for treatment. The parents are suing for lack of parental consent to the examine and violation of privacy.
An article and a call to action co-authored by members of the Alliance for Human Research Protection, Aspire, and Antidepressant Facts stating that mandatory mental health screenings is in violation of the Protection of Pupil Rights Amendment Act of 1998 (PPRA) that mandates all schools or contractors make available informational materials to parents for inspection and obtain a written consent form for all surveys, analysis, or evaluations given to students through the Dept. of Ed.