Go Slow on Mental Health Screening

Michael F. Hogan's letter ("Long-term study needed," Oct. 21) accuses Sheldon Richman of misstatements and "misrepresentations" in his Oct. 17 forum ("Bush's Brave New World"). I contend that the misrepresentations are not coming from Mr. Richman, but from Mr. Hogan.
Despite Mr. Hogan's protestations to the contrary, the New Freedom Commission (NFC) clearly wants universal mental health screening, recommending "screening for mental disorders ... across the life span."

Mr. Hogan himself admits that he wants universal screening but that there are problems with it. Psychiatric Times noted, "Hogan himself has strong feelings about the need for much more thorough screening of children. But he acknowledged that 'science and public opinion' have not advanced to the point where universal mental health screening is acceptable."
There is much agreement that screening is scientifically unsupportable. The authors of psychiatry's Diagnostic and Statistical Manual call mental health diagnostic criteria "subjective" and "social constructions."
The NFC treatment recommendations include lauding the Texas Medication Algorithm Project that is used in other states and pushed by Mr. Hogan in Ohio.
This is despite the fact that members of TMAP were heavily influenced by the pharmaceutical industry to recommend drugs like the Selective Serotonin Reuptake Inhibitors (SSRI) antidepressants. SSRIs are more expensive, not effective in children in 19 of 22 studies, and have severe side effects, including suicidal thoughts and attempts. The suicidality combined with lack of effectiveness caused the Food and Drug Administration to finally require this month its strongest drug warnings, although such data has long been available. While laudable that the NFC calls for study of the long-term effects of psychotropic drugs, nowhere does it mention any of these other problems.
Both Mr. Hogan and the NFC are rightly concerned about suicide. However, suicide is never once mentioned as a possible side effect of the drugs recommended.
The report also fails to mention the U.S. Preventive Services Task Force study showing that screening is useless in preventing suicide.
Mr. Hogan is right that the commission never calls for mandatory treatment. However, neither he nor the report acknowledge or condemn the numerous instances of coercion across the nation.
These incidents where parents have been threatened and charged with child abuse for refusing medication have inspired more than 20 state legislatures and the Congress to introduce or pass measures to prohibit coercion.
Mr. Hogan's support of voluntary programs and parental consent rings hollow, as well. The phrase "parental consent" appears once and the word "voluntary" appears not at all in the NFC report. But if he truly is in favor of voluntary parental consent, then he should soundly endorse Texas Republican Rep. Ron Paul's bill, the Let Parents Raise their Kid's Act, HR 5236.
Given the very real problems of already existing coercion, subjective criteria, dangerous and ineffective medication, and the failure of screening to prevent suicide, none of which are covered in the NFC report, Congress would be wise to withhold the $44 million requested for state grants to implement the NFC recommendations.
Whatever good may come from the other recommendations is completely overshadowed by the loss of freedom and damage that would come from labeling and drugging potentially millions of children based on these unsupportable screening and treatment programs.

DR. KAREN R. EFFREM
Alliance for Human Research Protection Board of Directors
International Center for the Study of Psychiatry and Psychology Board of Directors
Plymouth,Minn.