mental health screening for children and adults is being encouraged by the
federal government in response to strong marketing and lobbying by the
pharmaceutical industry. This concerns everyone, and homeschoolers have extra
reasons for concern. This article discusses how and why screening programs have
been developed, serious problems these programs cause, and what we can do.
In April 2002, President Bush
launched the New Freedom Commission on Mental Health. The Commission conducted
a "comprehensive study of the United States mental health service delivery
system" and developed six goals "as the foundation for transforming
mental health care in America." This article will focus on Goal 4,
"Early mental health screening, assessment, and referral to services are
common practice." (The Commission's executive summary is at
of the next steps is for Congress to provide funding to pursue the goals.
Mental health screening is not yet mandated by the federal government. However,
the Commission's report is clearly a big step in the direction of increased
screening. People concerned about it should act now and not wait until it is
Two points are important in
understanding the Commission. First, much of its work was based on the Texas
Medication Algorithm Project (TMAP), begun in 1995 to treat mentally ill people
in state mental health institutions and prisons. When a similar program was
introduced in Pennsylvania in 2003, a whistleblower in Pennsylvania's Office of
Inspector General revealed TMAP's highly questionable ways of operating. TMAP
included the Texas state university, mental health, and corrections systems and
was financed in part by drug companies, which had a strong influence on its
decisions. TMAP instructed state doctors to treat people labeled as mentally
ill with drugs that are still protected by patents and therefore are much more
expensive than generic drugs and increase drug company profits. When clinical
trials indicated that these drugs were not significantly more effective than
generic drugs, TMAP made its decisions based on "expert consensus
guidelines" developed by simply asking scientists and physicians (many of
whom had received money and other favors from drug companies) to recommend
In 1997-98, TMAP began working on the Texas Children's
Medication Algorithm Project (TCMAP) which also receives funds from drug
companies. An expert consensus panel decided to use on children drugs used on
adults. According to the whistleblower, no studies or clinical trials were done
to support this decision. In fact, the use of two of the drugs (Paxil and
Effexor) on children had already been banned in Britain. Since then, Paxil has
been linked to violent behavior, suicide, and cerebral and cardiac problems in
teens. In June, 2003, the FDA warned that Paxil should not be used for people
under 18 because of the alarming number of suicides by children taking it.
For more details, see
Second, it's important to
understand what's happening in the pharmaceutical industry, where drugs for mental
illness play a very large role. It's well known that drug companies are making
huge profits. (In 2002, "the combined profits for the ten drug companies
in the Fortune 500 [$35.9 billion] were more than the profits for all other 490
businesses put together [$33.7 billion]." "The Truth About the Drug
Companies" by Marcia Angell, The New York Review
of Books, July 15, 2004, pp.
52-58. The drug industry spends enormous amounts of money on lobbying, campaign
contributions, promotion, and to get the FDA and other government agencies to
make decisions that benefit them. Less well known is the fact that despite a
public relations campaign that gives the impression that drug companies need to
charge high prices to cover the costs of research, development, and testing of
new drugs, during the 1990s they spent a staggering 36% of sales revenues on
"marketing and administration," which was two and a half times what
they spend on R & D.
However, since 2000, drug
company profits have been declining, partly because patents have expired or are
about to expire on some popular drugs such as Prozac, Prilosec, Glucophage, and
Claritin. Obviously, a program like increased mental health screening offers
them great opportunities: identify lots of people who can be labeled as "mentally
ill" and maneuver so the treatment of choice is expensive patented drugs
(as has been done in TMAP) rather than less expensive generic drugs, therapy,
or other approaches. (For more information about drug companies, see Angell's
article cited above and her book The Truth About the
Drug Companies: How They Deceive Us and What to Do About It.)
Problems Raised by Mental Health Screening
Even if mental health
screening were increased for the best of reasons (assuming good reasons could
be found), it would raise serious problems. The fact that increased screening
has been recommended by a commission with strong ties to drug companies and
TMAP give us even more reason to examine it closely. Among the problems raised
by mental health screening:
• Those who define mental
illness and decide who is mentally ill have enormous power. Unlike physical
illness where symptoms are often clear and uncontroversial, the definition of
mental illness depends on one's approach to life, self-interest, history, and
belief system. In other words, essentially anyone could be labeled
"mentally ill" depending on the definitions chosen. The groundwork
for labeling many people mentally ill has been laid in the fourth edition of
the Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV), an 886-page
book published in 1994 by the American Psychiatric Association.
According to The DSM-IV, a
very wide range of behavior can be defined as abnormal and indicative of mental
illness. For example, in an article in Harpers Magazine, L. J. Davis reviewed the DSM-IV's description of
several adolescent disorders (including Attention-Deficit/Hyperactivity
Disorder and Oppositional Defiant Disorder) and concludes, "A close
reading of the text reveals that the illnesses in question consist of failure
to listen when spoken to, talking back, annoying other people, claiming that
somebody else did it, and (among a lot of other stuff familiar to parents)
failure to clean up one's room. According to the DSM-IV, adolescence is a
mental disorder." ("The Encyclopedia of Insanity–A Psychiatric
Handbook Lists a Madness for Everyone" by L. J. Davis, Harpers
Magazine, February, 1997)
As two other authors put it,
"As you reflect on conversations you have had during recent weeks, you
recall that your cousin, a young stockbroker, complained of not sleeping well;
a colleague at work, who is single, appears to always choose to be alone after
work; … your supervisor's 10-year-old is in trouble at school; … and your
sister can't stop obsessing about a former boyfriend. In addition, you are
really worrying about an upcoming speech. According to DSM-IV, each of the
behaviors above is listed as a criterion for one or more mental
Us Crazy: DSM—The Psychiatric Bible and the Creation of Mental Disorders by Herb Kutchins and Stuart Kirk, pp. 21-22, italics
• Increasing mental health
screenings will be easier because there is already an existing structure for
screening and labeling children as part of the Individuals with Disabilities
Education Act (IDEA).
• Labeling people as mentally
ill is a way of blaming individuals, parents, and families rather than social
service agencies, schools, the economy and financial inequalities, racism, etc.
• These mental health
screening programs are set up so that drug companies, public school districts,
social service agencies, prison systems, some professionals in the mental
health field, etc. stand to gain financially. Such financial incentives
obviously make it more likely that people will be misdiagnosed and
unnecessarily labeled and treated.
• Screening preschoolers and
children in elementary schools is being justified by the argument that early
detection will prevent more serious problems from developing. However,
sometimes "early detection" catches a person in a weak moment or
makes a mountain out of a mole hill, turning a behavior that a child would have
outgrown given some time, support, and love into an "emotional
disturbance," undermining the confidence of the child and their family,
and becoming a self-fulfilling prophecy.
• Much controversy surrounds
the treatment of mental illness. The use of drugs is promoted by drug companies
to increase its profits. Drugs are chosen by some patients, families of
patients, and professionals because they seem easier to use and give faster
results than therapy or other approaches. They are promoted by HMOs and
insurance companies because they are sometimes cheaper than other approaches.
However, many people question whether drugs really work and are concerned about
their safety. Many of these drugs have not been tested; programs like TMAP use
"expert consensus guidelines" instead. Many consumers do not like
taking drugs and object to their side effects. Many people object to drugging
Additional Reasons for Homeschoolers to Be
• People who are considered
to be marginal or "different" are particularly vulnerable in a
program such as mental health screening. Professionals are eager to force them
into conventional institutions such as public schools. This screening provides
an excellent opportunity to identify, label, and redirect them. Just think of
all the people who think you have to be "a little bit crazy" to want
to homeschool. Just think of all the people who think there's something wrong
with kids who don't do well in conventional school settings and who learn
better when they're allowed to pursue their own interests and learn in their
own way at their own pace.
• Mental health screening
provides a legally sanctioned way for professionals to interfere with or stop
homeschooling. This is especially true because some children have, quite
understandably, reacted to difficulties in school (such as problems with
teachers, bullying, and labeling) by becoming anxious or developing other
behaviors that are listed in the DSM-IV. Many parents have found that simply
removing their children from school and homeschooling them has solved the
problem and was far superior to labeling the children "mentally ill"
and treating them with drugs.
• Mental health screening of
both children and parents could be required when complaints are filed against
homeschoolers, including allegations of child abuse and neglect. Mental health
screening would make it more difficult to resolve such complaints.
• Public school districts are
already trying to get homeschoolers to enroll so they can increase the tax
money they receive based on enrollment. This plus the money mental health
professionals and drug companies would earn provides powerful financial
incentives for screening homeschoolers for mental illness and labeling some of
them as ill.
Sharing Our Concerns With Others
It's worth considering
several points that may be raised by people who either support increased
screening or feel that they do not need to be concerned about it, including
legislators and their aides.
• Some may claim that
mentally ill people really do need help. It's true that there are people who
need or want help, and they should certainly get it. However, they are far more
likely to be harmed than helped by a program of mental health screening
strongly influenced by drug companies intent on increasing their profits,
supported by professionals who have received money and other favors from drug
companies, and promoted by lawmakers who have received lots of money from drug
• Some people may argue that
they aren't afraid to be screened because neither they nor their children are
mentally ill. But as pointed out above, the symptoms listed in the DSM-IV are
general, broad, and widespread. It may be difficult to get through a screening,
especially one conducted by someone who has a strong financial incentive to
label as many people mentally ill as possible.
• Other people may argue that
the current screenings are only demonstration projects aimed at marginal groups
like prisoners, young people in the juvenile justice system, and families
involved with social services. But the Commission's report makes it clear that
the goal is to screen many adults and children. The report states, "The
early detection of mental health problems in children and adults–through
routine and comprehensive testing and screening–will be an expected and typical
occurrence." In addition, many programs are started with assurances that
they are only for a small group in need and then spread to a much wider group.
For example, IDEA, originally for children with disabilities, has resulted in
the screening of nearly all preschool children, the labeling of 10% of the
school age population, and the wide use of Ritalin and other drugs. These drugs
are now being seriously questioned, but they continue to be used, despite their
obvious costs to children, families, and taxpayers, largely because
professionals and institutions are committed to the program and the drugs.
What We Can Do
• We can learn more about
mental health screening from the books, articles, and web sites above and other
• We can work to minimize the
risks and damage that increased mental health screening does to our families.
We need to be aware that screenings can be done by school counselors and
officials, doctors and other health care providers, employees of clinics and
hospitals, social service workers, juvenile justice authorities, etc. People
may not be told that the questions they are being asked are part of a mental
health screening. The questions may sound reasonable, sometimes even
example, here are some questions from a widely used questionnaire designed to
be answered by parents of children ages 27 through 32 months or roughly 2 1/2
years old. (For information about this questionnaire see:
Does your child
cling to you more than you expect?
Does your child seem
too friendly with strangers?
that it's not easy to get these questions right. Children can't be either too
clingy or too outgoing.]
Does your child seem
more active than other children her age?
Can your child
settle himself down after periods of exciting activity?
Does your child
follow routine directions? For example, does she come to the table or help
clean up her toys when asked?
Can your child move
from one activity to the next with little difficulty, such as from playtime to
Scoring on this screening
makes it easy for a child to be referred for a mental health assessment. For
example, there are 28 questions like the ones listed above. A score of 5 points
is assigned each time a parent answers the question "sometimes." A
score of 57 (in other words, a response of "sometimes" on 12 or more
of the 28 questions) or higher leads to a referral.
In addition to the questions
above, there are open-ended questions such as:
Has anyone expressed
concerns about your child's behaviors? If you checked "sometimes" or
"most of the time," please explain.
Do you have concerns
about your child's eating and sleeping behaviors or about her toilet training?
If so, please explain.
Is there anything
that worries you about your child? If so, please explain.
questionnaire (available at: http://www.aseba.org/index.html) to be completed
by parents of children ages 6 to 18 and widely used in schools includes
questions such as the following:
About how many close
friends does your child have? (Do not include brothers & sisters)
Do any of the
following describe your child now or within the past 6 months?
Clings to adults or
Daydreams or gets
lost in his/her thoughts
Doesn't seem to feel
guilty after misbehaving
Feels too guilty
Fears going to
Feels or complains
that no one loves him/her
Not liked by other
Prefers being with
Prefers being with
Showing off or
Too shy or timid
When we are asked questions
such as these or asked to complete questionnaires, we can find out what our
rights are. We can ask which questions or questionnaires are mandatory, which
we can refuse to answer, and how the information we provide will be used. If
the person asking us the questions cannot answer our questions in this regard,
or if they insist that we have to answer questions we don't feel comfortable
answering, or if we are told that information is mandatory but we don't want to
provide it for reasons of privacy or anything else, we can ask to see the
statute that requires that we provide such information. For more information on
problems with screening, see the WPA handbook, pages 199-203.
• We can inform others,
including other homeschoolers, relatives, friends, neighbors, members of
organizations to which we belong, including churches and civic and recreational
• We can inform our state and
federal legislators about this issue and state our position on this program and
on having any agency fund all or part of it. Although legislators are strongly
influenced by drug companies' lobbying and money, they do need votes from
citizens even more than they need campaign contributions.
From WPA Newsletter #82 December 2004 pp 10-13