Greegor
January 17th 07, 11:45 PM
Parents have been complaining that TeenScreen is a gross invasion of
privacy.
http://kenoshaparentsunion.org/index.php?option=com_content&task=view&id=34&Itemid=28
Kenosha Parent's Union
Kenosha Parents Union is an organization of parents and community
members working to Kenosha's strengthen public schools
Letter to Sheboygan Psychologist re TeenScreen
Sheboygan South High School
Attn. Dr. Fred Sutkiewicz
School Psychologist
Dear Fred,
Thank you again for meeting with my psychology interns and myself a few
weeks ago. This meeting, combined with the TeenScreen training that I
went through with you about a year ago has helped me better understand
the overall program. Based upon everything I have learned about the
program, I have serious concerns about the program and how it will
negatively impact our community and youth.
As you are well aware by now, I am interested in the TeenScreen program
due to the overwhelming power it has on the students, parents and our
community at large. You personally are in a unique position, given the
sheer number of students you come across and the many other individuals
you will meet as a result of this program (e.g. parents, caregivers,
community groups). I definitely see a need for extending help to those
in need and having an active interest in students' academic and
emotional well being; however, the TeenScreen Program is not the best
course of action for helping our young community. I hope you carefully
review my concerns listed below, do a follow up review of the
information I provided, and do your best to track any potential
benefits and the negative consequences the program. I must also add
that I was pleased to hear that you decided to break from the
TeenScreen Manual protocol, which clearly endorses and uses language
endorsing referrals to medical practitioners (e.g. psychotropic drugs),
and use your best judgment with regards to providing appropriate
referrals.
Due to the multiple other concerns regarding the program, I am
forwarding this letter to the School Board for review as well. If,
after reviewing the information below, you or the school Board would
like to conduct a more point-by-point discussion about the program or
choose not to continuing endorsing the program (e.g. as did several
other school districts such as the Pinellas County School District in
Pinellas, FL, Fresno Unified School District in Fresno, CA- where I did
my graduate work and helped stop the TeenScreen Program from starting)
I would be happy to meet with you to discuss creating a specific
outreach program for our young community, one that may be more cost
effective in the long run.
Since the field of psychology and psychiatry is unlike all other
branches of health and medicine, (e.g. not adhering to the same
rigorous objective standards for diagnosing and instead being quite
subjective in nature, not having even one biological test for any
psychiatric disorder, having poor agreement between mental health
professionals not only for diagnosing, but also for the cause for all
the disorders-often called "illnesses", and having even poorer
agreement from mental health professionals as to the best coarse of
treatment), I was concerned to learn that our local schools began
making psychiatric and psychological referrals based upon a subjective
test that identifies 50% more students as at risk than highly trained
clinicians do (e.g. per the TeenScreen training session that stated
approximately 50% of the students sent to the clinician for an
immediate follow-up mental health screening interview will not be found
in need of an outside referral.) Given the subjective nature of the
mental health field, it also should be concerning that of the 60% of
the student body that takes the TeenScreen test, 16% of the interviewed
students will be referred to an outside "practitioner" or agency. I
know you stated that our community only had approximately 50% screened
and that about 11% were referred to outside practitioners, but I have
not heard back from you with regards as to where these children were
sent to (e.g. psychiatrist or other medical doctor for drugs, family
treatment or individual counseling).
Since I still have not heard where the children are being sent to, and
since I inquired at the training numerous times about the referral
process but was told you could not go into details about the guidance
counselor training or referral process, it is clear the TeenScreen
program does not want to discuss where they are sending these children.
When I am asked to conduct a client-centered consultation and to make
treatment referrals and/or recommendations, the clinical interview and
data collected from this in-depth interview guides the treatment
referrals and recommendations that I make. It appeared much more
appropriate when I heard that the "interviewers" by the volunteer
therapists were able to have some discussion and follow up questioning
when a student was marked as having a "mental illness" or problem.
Unfortunately, Teen Screen does not allow for the one who has all the
information to make the referral, but rather the one individual who was
trained by Teen Screen, who may not have any in depth psychological
training.
Your referral process, debriefing discussion and verbal discussions
with parents will ultimately direct their understanding of any
potential problem, and will also ultimately direct their care (e.g.
family therapist, individuals therapy, Priest, Minister, Rabi,
psychiatrist, neurologist, pediatrician, etc...). Given this, I am
sure you understand the significant and considerable difference between
seeing a individual therapist specializing in child-adolescent therapy,
obtaining skill-based education, and obtaining a average fifteen minute
medical consult where by the data states that 90% of them will walk out
with a prescription for a psychotropic drug.
The mental health field has continually been plagued with each specific
treatment camp claiming to have the best type of treatment for a
particular disorder. However, with recent meta-analysis studies coming
out about the effectiveness of particular treatments, it has become
even more confusing for researchers and practitioners alike to decide
which treatment may serve a particular client best (Kirsch & Moore,
2002; Prevention and Treatment, Vol. 5, #23). Since the mental health
field has not been consistent in determining a "best course of
treatment", nor has agreed that any approach is superior to one or
another, I can only hope you personally decide not to follow other Teen
Screen programs that predominantly and/or only states you will refer to
physicians who in turn prescribes psychotropic drugs. I hope you will
keep categorical referral records, and will allow researchers like
myself access to this data to determine if the program actually has any
benefit.
Regarding the letters that are sent to parents, I am also concerned
that the three letters you handed out to us during the training session
(e.g. one thanking the parent for the follow through on the TeenScreen
recommendation, one stating the parent agreed to the screening but the
child chose not to take the test, and a third stating the parent did
not comply and seek treatment for their child which was against your
and the TeenScreen recommendation) are not the only letters that could
be sent to a parent or child protective agency. I still have not seen
the other letters you were going to forward to us for review.
Nevertheless, the last letter indicated above assumes that a parent did
not seek a consultation after hearing that the TeenScreen check off
list marked their child as potentially having a "mental illness" or
problem; however, this letter does not account for the possibility that
a parent sought out another opinion or even treatment but simply wants
to protect their family privacy from the school system and government
(i.e. they did seek counseling and simply did not tell the child's
school about it.) During the training session, you mentioned a
certified letter that would be sent to parents if they did not respond
to initial letters. Based upon the numerous attempts to get children
screened and the numerous follow up letters available, it is clear the
goal is to have the parent follow the TeenScreen referral
recommendation. Again, this places the TeenScreen recommendation in a
very influential and powerful position. To this extent, I really am
interested in your "training program" for making these recommendations,
and I request to see what the TeenScreen Manual recommends, especially
since my son and daughter could be potential South High School
TeenScreen statistic.
I am additionally concerned that during the training session you made
reference to the support of the TeenScreen Program, but failed to
mention anything about the drawbacks and limitations of the program and
of the mental health professionals who admittedly oppose it. As a
researcher, it is difficult to weight the pros and cons of a program
when the program discussion only focuses upon how beneficial it might
be, but yet fails to produce peer reviewed evidence demonstrating the
benefits and failures of the program. Most importantly, there is no
data to suggest that the TeenScreen Program actually lowers suicides.
This program has been running for quite some time now, and I have not
seen any peer reviewed data showing that the TeenScreen actually lowers
suicide. Instead, TeenScreen's own co-director, Rob Caruano, has
acknowledged there is no proof or data available to demonstrate that
the program reduces suicide rates (Dec. 22, 2004; South Bend Tribune-IN
by D. Rumach, "TeenScreen assesses mental health of high school
students.") Additionally, the TeenScreen program was established in
Tulsa, Oklahoma in 1997 . According to a 2003 Tulsa World newspaper
article, Mike Brose, executive director of the Mental Health
Association in Tulsa, stated: "To the best of my knowledge, this is the
highest number of youth suicides we've ever had during the school year
-- a number we find very frightening." If the program is supposed to
work, how can you explain this phenomenon?
Researchers and psychiatrists alike are even coming forth saying
TeenScreen is unworkable. Nathaniel Lehrman, MD, former Clinical
Director of Kingsbro Psychiatric Center in Brooklyn, NY, and Assistant
Clinical Professor of Psychiatry at Albert Einstein & SUNY Downstate
Colleges of Medicine, stated, "The claim by the director of Columbia
University's TeenScreen Program that her program would significantly
reduce suicides is unsupported by the data. Indeed, such screenings
would probably cause more harm than good. It is impossible, on cursory
examination, or on the basis of the Program's brief written screening
test, to detect suicidality or "mental illness," however we define it."
Dr. Lehrman and I discussed these issues in person in October 2005,
and he was quite clear that even the process of screening for mental
disorders can evoke or create psychiatric symptoms, thus leading to and
possibly accounting for all the False Positives that the Teen Screen
researchers acknowledge. He and I also agree that by having the
screening device in the schools, with all the pressure to take the test
from teachers, counselors, parents, etc..., it violates the privacy of
those in whom these subjective "diseases" are sought.
Additionally, Dr. Marcia Angell, Harvard Medical School professor of
Ethics and best selling author stated that the TeenScreen Program "is
just a way to put more people on prescription drugs" and that such
programs will boost the sales of antidepressants even after the FDA in
September ordered black-box warning labels, warnings that stated that
these drugs will not reduce, but rather create suicidal thoughts or
behaviors in minors (The New York Post, December 5, 2004). As a result
of the black-box warning labels that stated the SSRI antidepressants
cause suicides and suicidal ideation, even in people who are not
suicidal, sales instantly and sharply fell. Nonetheless, our school
system has adopted a catch-all screening program that was created by
previously paid drug company representatives and researchers (e.g.
Laurie Flynn).
I am also concerned about the inference you made during the training
session last year, an inference I pointed out during our meeting with
the interns, whereby you stated the decrease in suicides over the past
few decades was the result of the SSRI antidepressants. As you recall,
you showed a graph demonstrating the reduction in suicides for our
youth; however, you indicated that the decrease came as a result of the
antidepressants drugs commonly called SSRI's coming to the market.
This is simply not true, as there is no data to support such an
inference. Instead, the FDA and research has been quite clear: if you
take an SSRI antidepressant drug, such as Prozac, Paxil, Luvox, or
Effexor, you will be more likely to commit suicide and to have suicidal
ideation, all things being considered.
Because the increase in suicide from taking SSRIs has been so clearly
demonstrated, the Medicines and Health Products Regulatory Agency
(MHRA), the equivalent to our FDA, in Great Britain recently banned all
but one of the SSRI's for anyone under the age of eighteen, noting that
the one remaining SSRI drug, Prozac, although they could not be certain
it caused people to commit suicide or become suicidal, "only worked in
1 of our 10 cases". The drug companies are not able to find one
study showing a reduction effect, but yet you allowed this inference to
be made to all the counselor attendees at South High. I hope you are
not continuing to make this inference, as it is unethical and
inaccurate at best and quite dangerous and proven to be deadly at
worst.
Likewise, there is no data proving that screening will prevent
suicides, the whole reason this screening program came about to begin
with. According to The U.S. Preventive Services Task Force (May 2004):
A. "There is no evidence that screening for suicide risk reduces
suicide attempts or mortality." B. "There is limited evidence on the
accuracy of screening tools to identify suicide risk." C. "There is
insufficient evidence that treatment of those at high risk reduces
suicide attempts or mortality." D. "No studies were found that directly
address the harms of screening and treatment for suicide risk. "
I will address the reason the FDA and the TeenScreen program did not
follow Great Britain's actions later, but for now, I believe the SASD
and you personally need to consider the following. If the Sheboygan
Area School District (SASD) and its counselors who adopt the Teen
Screen approach adopt a program that has a tendency or makes it
customary to refer to "practitioners", whereby the leading referral is
to a medical doctor (knowing that approximately 90% of psychiatric
referrals lead to a prescription- (Journal of the American Academy of
Child Adolescent Psychiatry, 2002), and the SASD and their counselors
have been made aware of the serious health problems associated with
these antidepressant, stimulant and neuroleptic drugs, and finally if
the SASD and its counselors know that the number of students referred
could exceed the number of student actually in need of true mental
health assistance (e.g. based upon the difference in the screening
instrument and a clinician's expertise), then the Sheboygan School
District and its counselors could be found liable for the negative
consequences that will ultimately result from this program.
I know of only one case in which someone was potentially liable and
needed to pay for not medicating a child, but yet there are thousands
and thousands of cases in which children are harmed by these drugs,
doctors and school system referrals. I found no less than 4 specific
cases recently going through the court system whereby a children or
their parents sued their school district for the TeenScreen Program.
This number does not include the dozens of cases that came up for
teachers, counselors and school officials referring students to medical
doctors for psychotropic drugs outside of the TeenScreen Program and
settled outside of court, sealing all documents from the public eye.
Now that I have addressed several concerns, I would like to review how
and why the program is being so quickly accepted across the United
States despite the lack of evidence that it lowers suicides.
So where did Teen Screen come from? TeenScreen was developed by
psychiatrist David Shaffer of Columbia University and New York State
Psychiatric Institute's Division of Child & Adolescent Psychiatry.
Shaffer is a consultant for pharmaceutical companies that make
psychotropic drugs (see page 21 of Executive Summary report, dated Jan.
21, 2004; American College of Neuropsychopharmacology, "Preliminary
Report of the Task Force on SSRI's and Suicidal Behavior in Youth.")
He has served as an expert witness for and on behalf of various drug
companies, and he has been a paid consultant for specific psychotropic
drugs. Some of his suicide surveys are made financially possible
through an educational grant from Pfizer Inc., once receiving over
$1,250,000 from just one of the drug companies (see American Foundation
for Suicide Prevention press release, May 8, 2000.) In December of
2003, British drug regulators recommended against the use of SSRI
antidepressants in the treatment of depressed children under 18 because
some of the drugs had been linked to suicidal thoughts and self-harm.
However, according to a Dec. 11, 2003, New York Times article, Shaffer,
at the request of the maker of a psychotropic drug, attempted to block
the British findings from being released, sending a letter to the
British drug agency saying that there was insufficient data to restrict
the use of the drugs in adolescents.
The director of the Teen Screen Program is Ms. Laurie Flynn. Ms. Flynn
and the Teen Screen Program initially searched the newspapers
throughout the US looking for reports of teens who had committed
suicide. When they found such a tragedy, the program then sent a
letter to the editors of the local newspaper telling them about how the
Teen Screen Program could be a "solution" (Goode, E., British Warning
on Anti-depressants Use for Youth, in New York Times, Dec. 11, 2003.)
Like Shaffer, Flynn also had financial support from pharmaceutical
companies that make psychotropic drugs. She served as the director of
the National Alliance for the Mentally Ill (NAMI), which received no
less than 11.7 million dollars from 18 different drug companies from
1996-1999, the largest being Eli Lilly, maker of Prozac. Ms. Flynn
demonstrated her interest in trying to get children screened, calling
for a "horse to ride" in order to gain access by an individual within
or close to the school district board (see letter at
http://www.psychsearch.net/Flynn_email.pdf).
Lastly, Ohio Mental Health Director, Michael Hogan, and California
Director Stephen Mayberg are part of the Teen Screen Advisory Board.
Hogan is also part of the New Freedom Commission on Mental Health,
created by President Bush Sr.. The New Freedom Commission on Mental
Health recommends the use of "state-of-the-art treatments" using
"specific medications for specific conditions." The Commission also
praised the Texas Algorithm Project (TMAP) as a model medication
treatment plan. This federal program endorsed the Teen Screen Program
and called it a model program that should be used in all schools,
daycares and agencies. The TMAP program, which sets the stage for the
Teen Screen Program, is a set of guidelines for physicians to use when
deciding what medication to give to a patient for a particular symptom
or psychiatric problem. The program 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 particular state received money and perqs from the drug companies
to have the more expensive drugs listed higher on the TMAP type
program, he was fired for talking to the New York Times.
Pharmaceutical giant Janssen took the lead in exerting influence over
state officials by creating "advisory boards" made up of state mental
health directors who were regularly treated to all expense paid trips
and conferences. By influencing 50 key officials, the company knew
that it would have a good shot at getting a TMAP list adopted in every
state. For example, Ohio Mental Health Director Hogan and California
Director Mayberg, are New Freedom Commission members who control mental
health services in their respective states, and both are also members
of a Janssen advisory board. Hogan has proven to be so useful that Eli
Lilly gave him a Lifetime Achievement Award. In granting the award it
was noted that Hogan had given over 75 paid presentations at
conferences since he accepted the position on Bush's New Freedom
Commission. In every keynote speaker engagement that Hogan has
performed at, he has been paid by a pharmaceutical company and the
conference has been sponsored by a drug company. Interestingly, Bush
Sr., who developed the Freedom Commission on Mental Health, endorsing
TMAP and TeenScreen, was also on Eli Lilly's Board of Directors for
many years, holds heavy stock in pharmaceutical companies, and obtains
huge donations from such companies.
More specifically to Teen Screen, their Funding was said to be given by
private donations; however, TeenScreen and Columbia University refused
to divulge the source of their funding. Their website says they are
funded by private family foundations, corporations and individuals,
without naming them. One corner of their Internet site did give a clue
to their funding: "A large pharmaceutical company funded the TeenScreen
program in Tennessee (http://www.psychsearch.net/teenscreen.html, see
page 4, left, mid-page). In Florida, Jim McDonough, the director of
the Florida Office of Drug Control, was sent an email from Flynn
threatening to pull funding if more children were not screened in their
community (e.g. March 22, 2004, "We've been working with David Shern
and USF for 18 months or so and still haven't got a program going....At
this point I'm inclined to re-think the use of our resources. We're
sending about $120k to USF annually. . . . but ultimately we're not
achieving our goals in the community," Flynn wrote.) Flynn later
stated to McDonough that she had to find kids to screen and said, "I'm
looking for a horse to ride here!" According to Flynn's testimony in
March 2002, she hopes to screen no less than 7-12 million new potential
drug company customers.
I pose the question, aren't eight million kids on Ritalin enough?
I hope this raises your suspicion as to the "true" agenda to the Teen
Screen Program, and has demonstrated sufficiently how the program fails
to produce desirable results. The Teen Screen Program is about making
profits, not about helping children. To this extent, I present some
basic profit calculations. According to the Teen Screen 10 year
strategy, TeenScreen wants to make the suicide survey available to all
American children.
Since 1991, the Columbia University Division of Child and Adolescent
Psychiatry has invested nearly $19 million in the "research" and
development of the Columbia TeenScreen program. I ask who will reap
the returns?
There are 47.7 million (47,700,000) public school students.
There are 5 million (5,000,000) private school students.
17% of the kids screened by TeenScreen accept counseling (8,959,000).
Seventeen percent (17%) may be a low percentage, but I am only taking
numbers supplied by TeenScreen.
According to TeenScreen, 9.9% of the kids screened are drugged
(5,217,300). TeenScreen says less than ten percent (10%) are
prescribed some type of drug. This means that a whopping 60% of kids
who accept referral counseling as a result of the suicide survey wind
up on drugs. Keep in mind these are TeenScreen's own numbers; actual
figures may be much higher.
One example prescription for a common psychotropic drug is $15.56 per
day.
5,217,300 students (customers) x $15.56 per day = $81,181,188 per day.
$81,181,188 x 365 days a year = $29,631,133,620 annually.
That's nearly 30 billion dollars per year in pharmaceutical sales
courtesy of the TeenScreen program.
Multiply that by a lifetime of addiction due to down or up regulation
of neuroprocessing, and it is no wonder why drug companies are tripping
over themselves to sponsor screening of everyone in the United States
(e.g. It is mandated that every pregnant woman and child, infant to 18
years old, be mentally screened by every pediatrician, school and day
care every year. That is three screenings per year, every year!). In
one Colorado study over 350 youths were suicide screened using
TeenScreen's survey. They found that over 50% were at risk of suicide
and 71% screened positive for psychiatric disorders at a youth homeless
shelter. That's not science, that's a dream come true for drug
companies.
Having presented all this, I would be happy to work with the SASD if
they are interested in creating a specific program to address emotional
well being in our children. I think it is noteworthy to acknowledge
that just recently yet another study comparing cognitive psychotherapy
to antidepressant medication (Paxil) was just published in the Archives
of General Psychiatry. The research was done at the University of
Pennsylvania and Vanderbilt University using 240 patients. It was
funded by the National Institutes of Health (NIH), and confirmed that
the use of psychotherapy intervention worked at least as well as the
SSRI, even with moderately to severely depressed patients (i.e. keeping
in mind that up to 90% of the medication effect can be explained by
placebo effect-sugar pill; Antonuccio, D., Antidepressants: A Triumph
of Marketing Over Science?, In Prevention & Treatment, Volume 5,
Article 25, posted July 15, 2002.) The study went on to report that if
the patients stopped taking the psychiatric drug, they were twice as
likely to develop a relapse of depression. The researchers called for
the American Psychiatric Association (APA) to revise their treatment
guidelines to discourage the use of drugs for depressed individuals.
I would respectfully request that the following data and information be
given to all parents prior to any screening, as I believe the real
issue here is parental rights related to what they deem appropriate for
their children. I do not believe the government should interfere and
have any legitimate authority to direct a families intimate health
matters. I believe there is a right to know about hidden agendas and
what could occur if they disagree with the recommendations of the
School Counselor. I also ask that the SASD offer an opinion regarding
if they are willing to report parents to the Department of Family
Services if the parents choose not to medicate their children or agree
with the screening device that states their child has a mental disease
(i.e. as in the cases of Matthew Smith and Shaina Dunkle who died of
medication toxicity after their parents were coerced into placing their
children on drugs by their school.) Other examples include the
nightmare that Aliah Gleason went through when she was taken from her
home, not allowed parental contact for five months while she was placed
in foster care, and ultimately forced to take drugs due to the
incorrect screening outcomes and misinformed school district. These
are tough questions that have not been answered as of yet, and I
believe they need to be addressed before child is torn between a
well-intentioned school district, school counselor, profit driven
program and parent.
Kindest Regards,
Dr. Toby Watson, Psy.D.
Clinical Depth Psychologist
Clinical and Doctoral Training Director
International Center for the Study of Psychiatry and Psychology Board
Member
privacy.
http://kenoshaparentsunion.org/index.php?option=com_content&task=view&id=34&Itemid=28
Kenosha Parent's Union
Kenosha Parents Union is an organization of parents and community
members working to Kenosha's strengthen public schools
Letter to Sheboygan Psychologist re TeenScreen
Sheboygan South High School
Attn. Dr. Fred Sutkiewicz
School Psychologist
Dear Fred,
Thank you again for meeting with my psychology interns and myself a few
weeks ago. This meeting, combined with the TeenScreen training that I
went through with you about a year ago has helped me better understand
the overall program. Based upon everything I have learned about the
program, I have serious concerns about the program and how it will
negatively impact our community and youth.
As you are well aware by now, I am interested in the TeenScreen program
due to the overwhelming power it has on the students, parents and our
community at large. You personally are in a unique position, given the
sheer number of students you come across and the many other individuals
you will meet as a result of this program (e.g. parents, caregivers,
community groups). I definitely see a need for extending help to those
in need and having an active interest in students' academic and
emotional well being; however, the TeenScreen Program is not the best
course of action for helping our young community. I hope you carefully
review my concerns listed below, do a follow up review of the
information I provided, and do your best to track any potential
benefits and the negative consequences the program. I must also add
that I was pleased to hear that you decided to break from the
TeenScreen Manual protocol, which clearly endorses and uses language
endorsing referrals to medical practitioners (e.g. psychotropic drugs),
and use your best judgment with regards to providing appropriate
referrals.
Due to the multiple other concerns regarding the program, I am
forwarding this letter to the School Board for review as well. If,
after reviewing the information below, you or the school Board would
like to conduct a more point-by-point discussion about the program or
choose not to continuing endorsing the program (e.g. as did several
other school districts such as the Pinellas County School District in
Pinellas, FL, Fresno Unified School District in Fresno, CA- where I did
my graduate work and helped stop the TeenScreen Program from starting)
I would be happy to meet with you to discuss creating a specific
outreach program for our young community, one that may be more cost
effective in the long run.
Since the field of psychology and psychiatry is unlike all other
branches of health and medicine, (e.g. not adhering to the same
rigorous objective standards for diagnosing and instead being quite
subjective in nature, not having even one biological test for any
psychiatric disorder, having poor agreement between mental health
professionals not only for diagnosing, but also for the cause for all
the disorders-often called "illnesses", and having even poorer
agreement from mental health professionals as to the best coarse of
treatment), I was concerned to learn that our local schools began
making psychiatric and psychological referrals based upon a subjective
test that identifies 50% more students as at risk than highly trained
clinicians do (e.g. per the TeenScreen training session that stated
approximately 50% of the students sent to the clinician for an
immediate follow-up mental health screening interview will not be found
in need of an outside referral.) Given the subjective nature of the
mental health field, it also should be concerning that of the 60% of
the student body that takes the TeenScreen test, 16% of the interviewed
students will be referred to an outside "practitioner" or agency. I
know you stated that our community only had approximately 50% screened
and that about 11% were referred to outside practitioners, but I have
not heard back from you with regards as to where these children were
sent to (e.g. psychiatrist or other medical doctor for drugs, family
treatment or individual counseling).
Since I still have not heard where the children are being sent to, and
since I inquired at the training numerous times about the referral
process but was told you could not go into details about the guidance
counselor training or referral process, it is clear the TeenScreen
program does not want to discuss where they are sending these children.
When I am asked to conduct a client-centered consultation and to make
treatment referrals and/or recommendations, the clinical interview and
data collected from this in-depth interview guides the treatment
referrals and recommendations that I make. It appeared much more
appropriate when I heard that the "interviewers" by the volunteer
therapists were able to have some discussion and follow up questioning
when a student was marked as having a "mental illness" or problem.
Unfortunately, Teen Screen does not allow for the one who has all the
information to make the referral, but rather the one individual who was
trained by Teen Screen, who may not have any in depth psychological
training.
Your referral process, debriefing discussion and verbal discussions
with parents will ultimately direct their understanding of any
potential problem, and will also ultimately direct their care (e.g.
family therapist, individuals therapy, Priest, Minister, Rabi,
psychiatrist, neurologist, pediatrician, etc...). Given this, I am
sure you understand the significant and considerable difference between
seeing a individual therapist specializing in child-adolescent therapy,
obtaining skill-based education, and obtaining a average fifteen minute
medical consult where by the data states that 90% of them will walk out
with a prescription for a psychotropic drug.
The mental health field has continually been plagued with each specific
treatment camp claiming to have the best type of treatment for a
particular disorder. However, with recent meta-analysis studies coming
out about the effectiveness of particular treatments, it has become
even more confusing for researchers and practitioners alike to decide
which treatment may serve a particular client best (Kirsch & Moore,
2002; Prevention and Treatment, Vol. 5, #23). Since the mental health
field has not been consistent in determining a "best course of
treatment", nor has agreed that any approach is superior to one or
another, I can only hope you personally decide not to follow other Teen
Screen programs that predominantly and/or only states you will refer to
physicians who in turn prescribes psychotropic drugs. I hope you will
keep categorical referral records, and will allow researchers like
myself access to this data to determine if the program actually has any
benefit.
Regarding the letters that are sent to parents, I am also concerned
that the three letters you handed out to us during the training session
(e.g. one thanking the parent for the follow through on the TeenScreen
recommendation, one stating the parent agreed to the screening but the
child chose not to take the test, and a third stating the parent did
not comply and seek treatment for their child which was against your
and the TeenScreen recommendation) are not the only letters that could
be sent to a parent or child protective agency. I still have not seen
the other letters you were going to forward to us for review.
Nevertheless, the last letter indicated above assumes that a parent did
not seek a consultation after hearing that the TeenScreen check off
list marked their child as potentially having a "mental illness" or
problem; however, this letter does not account for the possibility that
a parent sought out another opinion or even treatment but simply wants
to protect their family privacy from the school system and government
(i.e. they did seek counseling and simply did not tell the child's
school about it.) During the training session, you mentioned a
certified letter that would be sent to parents if they did not respond
to initial letters. Based upon the numerous attempts to get children
screened and the numerous follow up letters available, it is clear the
goal is to have the parent follow the TeenScreen referral
recommendation. Again, this places the TeenScreen recommendation in a
very influential and powerful position. To this extent, I really am
interested in your "training program" for making these recommendations,
and I request to see what the TeenScreen Manual recommends, especially
since my son and daughter could be potential South High School
TeenScreen statistic.
I am additionally concerned that during the training session you made
reference to the support of the TeenScreen Program, but failed to
mention anything about the drawbacks and limitations of the program and
of the mental health professionals who admittedly oppose it. As a
researcher, it is difficult to weight the pros and cons of a program
when the program discussion only focuses upon how beneficial it might
be, but yet fails to produce peer reviewed evidence demonstrating the
benefits and failures of the program. Most importantly, there is no
data to suggest that the TeenScreen Program actually lowers suicides.
This program has been running for quite some time now, and I have not
seen any peer reviewed data showing that the TeenScreen actually lowers
suicide. Instead, TeenScreen's own co-director, Rob Caruano, has
acknowledged there is no proof or data available to demonstrate that
the program reduces suicide rates (Dec. 22, 2004; South Bend Tribune-IN
by D. Rumach, "TeenScreen assesses mental health of high school
students.") Additionally, the TeenScreen program was established in
Tulsa, Oklahoma in 1997 . According to a 2003 Tulsa World newspaper
article, Mike Brose, executive director of the Mental Health
Association in Tulsa, stated: "To the best of my knowledge, this is the
highest number of youth suicides we've ever had during the school year
-- a number we find very frightening." If the program is supposed to
work, how can you explain this phenomenon?
Researchers and psychiatrists alike are even coming forth saying
TeenScreen is unworkable. Nathaniel Lehrman, MD, former Clinical
Director of Kingsbro Psychiatric Center in Brooklyn, NY, and Assistant
Clinical Professor of Psychiatry at Albert Einstein & SUNY Downstate
Colleges of Medicine, stated, "The claim by the director of Columbia
University's TeenScreen Program that her program would significantly
reduce suicides is unsupported by the data. Indeed, such screenings
would probably cause more harm than good. It is impossible, on cursory
examination, or on the basis of the Program's brief written screening
test, to detect suicidality or "mental illness," however we define it."
Dr. Lehrman and I discussed these issues in person in October 2005,
and he was quite clear that even the process of screening for mental
disorders can evoke or create psychiatric symptoms, thus leading to and
possibly accounting for all the False Positives that the Teen Screen
researchers acknowledge. He and I also agree that by having the
screening device in the schools, with all the pressure to take the test
from teachers, counselors, parents, etc..., it violates the privacy of
those in whom these subjective "diseases" are sought.
Additionally, Dr. Marcia Angell, Harvard Medical School professor of
Ethics and best selling author stated that the TeenScreen Program "is
just a way to put more people on prescription drugs" and that such
programs will boost the sales of antidepressants even after the FDA in
September ordered black-box warning labels, warnings that stated that
these drugs will not reduce, but rather create suicidal thoughts or
behaviors in minors (The New York Post, December 5, 2004). As a result
of the black-box warning labels that stated the SSRI antidepressants
cause suicides and suicidal ideation, even in people who are not
suicidal, sales instantly and sharply fell. Nonetheless, our school
system has adopted a catch-all screening program that was created by
previously paid drug company representatives and researchers (e.g.
Laurie Flynn).
I am also concerned about the inference you made during the training
session last year, an inference I pointed out during our meeting with
the interns, whereby you stated the decrease in suicides over the past
few decades was the result of the SSRI antidepressants. As you recall,
you showed a graph demonstrating the reduction in suicides for our
youth; however, you indicated that the decrease came as a result of the
antidepressants drugs commonly called SSRI's coming to the market.
This is simply not true, as there is no data to support such an
inference. Instead, the FDA and research has been quite clear: if you
take an SSRI antidepressant drug, such as Prozac, Paxil, Luvox, or
Effexor, you will be more likely to commit suicide and to have suicidal
ideation, all things being considered.
Because the increase in suicide from taking SSRIs has been so clearly
demonstrated, the Medicines and Health Products Regulatory Agency
(MHRA), the equivalent to our FDA, in Great Britain recently banned all
but one of the SSRI's for anyone under the age of eighteen, noting that
the one remaining SSRI drug, Prozac, although they could not be certain
it caused people to commit suicide or become suicidal, "only worked in
1 of our 10 cases". The drug companies are not able to find one
study showing a reduction effect, but yet you allowed this inference to
be made to all the counselor attendees at South High. I hope you are
not continuing to make this inference, as it is unethical and
inaccurate at best and quite dangerous and proven to be deadly at
worst.
Likewise, there is no data proving that screening will prevent
suicides, the whole reason this screening program came about to begin
with. According to The U.S. Preventive Services Task Force (May 2004):
A. "There is no evidence that screening for suicide risk reduces
suicide attempts or mortality." B. "There is limited evidence on the
accuracy of screening tools to identify suicide risk." C. "There is
insufficient evidence that treatment of those at high risk reduces
suicide attempts or mortality." D. "No studies were found that directly
address the harms of screening and treatment for suicide risk. "
I will address the reason the FDA and the TeenScreen program did not
follow Great Britain's actions later, but for now, I believe the SASD
and you personally need to consider the following. If the Sheboygan
Area School District (SASD) and its counselors who adopt the Teen
Screen approach adopt a program that has a tendency or makes it
customary to refer to "practitioners", whereby the leading referral is
to a medical doctor (knowing that approximately 90% of psychiatric
referrals lead to a prescription- (Journal of the American Academy of
Child Adolescent Psychiatry, 2002), and the SASD and their counselors
have been made aware of the serious health problems associated with
these antidepressant, stimulant and neuroleptic drugs, and finally if
the SASD and its counselors know that the number of students referred
could exceed the number of student actually in need of true mental
health assistance (e.g. based upon the difference in the screening
instrument and a clinician's expertise), then the Sheboygan School
District and its counselors could be found liable for the negative
consequences that will ultimately result from this program.
I know of only one case in which someone was potentially liable and
needed to pay for not medicating a child, but yet there are thousands
and thousands of cases in which children are harmed by these drugs,
doctors and school system referrals. I found no less than 4 specific
cases recently going through the court system whereby a children or
their parents sued their school district for the TeenScreen Program.
This number does not include the dozens of cases that came up for
teachers, counselors and school officials referring students to medical
doctors for psychotropic drugs outside of the TeenScreen Program and
settled outside of court, sealing all documents from the public eye.
Now that I have addressed several concerns, I would like to review how
and why the program is being so quickly accepted across the United
States despite the lack of evidence that it lowers suicides.
So where did Teen Screen come from? TeenScreen was developed by
psychiatrist David Shaffer of Columbia University and New York State
Psychiatric Institute's Division of Child & Adolescent Psychiatry.
Shaffer is a consultant for pharmaceutical companies that make
psychotropic drugs (see page 21 of Executive Summary report, dated Jan.
21, 2004; American College of Neuropsychopharmacology, "Preliminary
Report of the Task Force on SSRI's and Suicidal Behavior in Youth.")
He has served as an expert witness for and on behalf of various drug
companies, and he has been a paid consultant for specific psychotropic
drugs. Some of his suicide surveys are made financially possible
through an educational grant from Pfizer Inc., once receiving over
$1,250,000 from just one of the drug companies (see American Foundation
for Suicide Prevention press release, May 8, 2000.) In December of
2003, British drug regulators recommended against the use of SSRI
antidepressants in the treatment of depressed children under 18 because
some of the drugs had been linked to suicidal thoughts and self-harm.
However, according to a Dec. 11, 2003, New York Times article, Shaffer,
at the request of the maker of a psychotropic drug, attempted to block
the British findings from being released, sending a letter to the
British drug agency saying that there was insufficient data to restrict
the use of the drugs in adolescents.
The director of the Teen Screen Program is Ms. Laurie Flynn. Ms. Flynn
and the Teen Screen Program initially searched the newspapers
throughout the US looking for reports of teens who had committed
suicide. When they found such a tragedy, the program then sent a
letter to the editors of the local newspaper telling them about how the
Teen Screen Program could be a "solution" (Goode, E., British Warning
on Anti-depressants Use for Youth, in New York Times, Dec. 11, 2003.)
Like Shaffer, Flynn also had financial support from pharmaceutical
companies that make psychotropic drugs. She served as the director of
the National Alliance for the Mentally Ill (NAMI), which received no
less than 11.7 million dollars from 18 different drug companies from
1996-1999, the largest being Eli Lilly, maker of Prozac. Ms. Flynn
demonstrated her interest in trying to get children screened, calling
for a "horse to ride" in order to gain access by an individual within
or close to the school district board (see letter at
http://www.psychsearch.net/Flynn_email.pdf).
Lastly, Ohio Mental Health Director, Michael Hogan, and California
Director Stephen Mayberg are part of the Teen Screen Advisory Board.
Hogan is also part of the New Freedom Commission on Mental Health,
created by President Bush Sr.. The New Freedom Commission on Mental
Health recommends the use of "state-of-the-art treatments" using
"specific medications for specific conditions." The Commission also
praised the Texas Algorithm Project (TMAP) as a model medication
treatment plan. This federal program endorsed the Teen Screen Program
and called it a model program that should be used in all schools,
daycares and agencies. The TMAP program, which sets the stage for the
Teen Screen Program, is a set of guidelines for physicians to use when
deciding what medication to give to a patient for a particular symptom
or psychiatric problem. The program 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 particular state received money and perqs from the drug companies
to have the more expensive drugs listed higher on the TMAP type
program, he was fired for talking to the New York Times.
Pharmaceutical giant Janssen took the lead in exerting influence over
state officials by creating "advisory boards" made up of state mental
health directors who were regularly treated to all expense paid trips
and conferences. By influencing 50 key officials, the company knew
that it would have a good shot at getting a TMAP list adopted in every
state. For example, Ohio Mental Health Director Hogan and California
Director Mayberg, are New Freedom Commission members who control mental
health services in their respective states, and both are also members
of a Janssen advisory board. Hogan has proven to be so useful that Eli
Lilly gave him a Lifetime Achievement Award. In granting the award it
was noted that Hogan had given over 75 paid presentations at
conferences since he accepted the position on Bush's New Freedom
Commission. In every keynote speaker engagement that Hogan has
performed at, he has been paid by a pharmaceutical company and the
conference has been sponsored by a drug company. Interestingly, Bush
Sr., who developed the Freedom Commission on Mental Health, endorsing
TMAP and TeenScreen, was also on Eli Lilly's Board of Directors for
many years, holds heavy stock in pharmaceutical companies, and obtains
huge donations from such companies.
More specifically to Teen Screen, their Funding was said to be given by
private donations; however, TeenScreen and Columbia University refused
to divulge the source of their funding. Their website says they are
funded by private family foundations, corporations and individuals,
without naming them. One corner of their Internet site did give a clue
to their funding: "A large pharmaceutical company funded the TeenScreen
program in Tennessee (http://www.psychsearch.net/teenscreen.html, see
page 4, left, mid-page). In Florida, Jim McDonough, the director of
the Florida Office of Drug Control, was sent an email from Flynn
threatening to pull funding if more children were not screened in their
community (e.g. March 22, 2004, "We've been working with David Shern
and USF for 18 months or so and still haven't got a program going....At
this point I'm inclined to re-think the use of our resources. We're
sending about $120k to USF annually. . . . but ultimately we're not
achieving our goals in the community," Flynn wrote.) Flynn later
stated to McDonough that she had to find kids to screen and said, "I'm
looking for a horse to ride here!" According to Flynn's testimony in
March 2002, she hopes to screen no less than 7-12 million new potential
drug company customers.
I pose the question, aren't eight million kids on Ritalin enough?
I hope this raises your suspicion as to the "true" agenda to the Teen
Screen Program, and has demonstrated sufficiently how the program fails
to produce desirable results. The Teen Screen Program is about making
profits, not about helping children. To this extent, I present some
basic profit calculations. According to the Teen Screen 10 year
strategy, TeenScreen wants to make the suicide survey available to all
American children.
Since 1991, the Columbia University Division of Child and Adolescent
Psychiatry has invested nearly $19 million in the "research" and
development of the Columbia TeenScreen program. I ask who will reap
the returns?
There are 47.7 million (47,700,000) public school students.
There are 5 million (5,000,000) private school students.
17% of the kids screened by TeenScreen accept counseling (8,959,000).
Seventeen percent (17%) may be a low percentage, but I am only taking
numbers supplied by TeenScreen.
According to TeenScreen, 9.9% of the kids screened are drugged
(5,217,300). TeenScreen says less than ten percent (10%) are
prescribed some type of drug. This means that a whopping 60% of kids
who accept referral counseling as a result of the suicide survey wind
up on drugs. Keep in mind these are TeenScreen's own numbers; actual
figures may be much higher.
One example prescription for a common psychotropic drug is $15.56 per
day.
5,217,300 students (customers) x $15.56 per day = $81,181,188 per day.
$81,181,188 x 365 days a year = $29,631,133,620 annually.
That's nearly 30 billion dollars per year in pharmaceutical sales
courtesy of the TeenScreen program.
Multiply that by a lifetime of addiction due to down or up regulation
of neuroprocessing, and it is no wonder why drug companies are tripping
over themselves to sponsor screening of everyone in the United States
(e.g. It is mandated that every pregnant woman and child, infant to 18
years old, be mentally screened by every pediatrician, school and day
care every year. That is three screenings per year, every year!). In
one Colorado study over 350 youths were suicide screened using
TeenScreen's survey. They found that over 50% were at risk of suicide
and 71% screened positive for psychiatric disorders at a youth homeless
shelter. That's not science, that's a dream come true for drug
companies.
Having presented all this, I would be happy to work with the SASD if
they are interested in creating a specific program to address emotional
well being in our children. I think it is noteworthy to acknowledge
that just recently yet another study comparing cognitive psychotherapy
to antidepressant medication (Paxil) was just published in the Archives
of General Psychiatry. The research was done at the University of
Pennsylvania and Vanderbilt University using 240 patients. It was
funded by the National Institutes of Health (NIH), and confirmed that
the use of psychotherapy intervention worked at least as well as the
SSRI, even with moderately to severely depressed patients (i.e. keeping
in mind that up to 90% of the medication effect can be explained by
placebo effect-sugar pill; Antonuccio, D., Antidepressants: A Triumph
of Marketing Over Science?, In Prevention & Treatment, Volume 5,
Article 25, posted July 15, 2002.) The study went on to report that if
the patients stopped taking the psychiatric drug, they were twice as
likely to develop a relapse of depression. The researchers called for
the American Psychiatric Association (APA) to revise their treatment
guidelines to discourage the use of drugs for depressed individuals.
I would respectfully request that the following data and information be
given to all parents prior to any screening, as I believe the real
issue here is parental rights related to what they deem appropriate for
their children. I do not believe the government should interfere and
have any legitimate authority to direct a families intimate health
matters. I believe there is a right to know about hidden agendas and
what could occur if they disagree with the recommendations of the
School Counselor. I also ask that the SASD offer an opinion regarding
if they are willing to report parents to the Department of Family
Services if the parents choose not to medicate their children or agree
with the screening device that states their child has a mental disease
(i.e. as in the cases of Matthew Smith and Shaina Dunkle who died of
medication toxicity after their parents were coerced into placing their
children on drugs by their school.) Other examples include the
nightmare that Aliah Gleason went through when she was taken from her
home, not allowed parental contact for five months while she was placed
in foster care, and ultimately forced to take drugs due to the
incorrect screening outcomes and misinformed school district. These
are tough questions that have not been answered as of yet, and I
believe they need to be addressed before child is torn between a
well-intentioned school district, school counselor, profit driven
program and parent.
Kindest Regards,
Dr. Toby Watson, Psy.D.
Clinical Depth Psychologist
Clinical and Doctoral Training Director
International Center for the Study of Psychiatry and Psychology Board
Member