Screening a child's mind

Should every child be tested for mental-health problems? Although there are no present plans, a federal report stirs fears the US will require it eventually.

Throughout last summer and into the fall the news crept across websites and spilled onto talk radio: The Bush administration was planning to screen every American child for mental-health problems and put those deemed in need of help on powerful psychotropic drugs. Parental rights would be taken away, and the stigma of mental illness would stain the school records of innocent children. Libertarians and conservatives, home-schoolers and psychiatric rights groups, expressed their concerns.

Yet so far, the fears seem overblown - or at least premature. By the time Congress passed its enormous spending bill late last fall, only $20 million of new money was appointed as a grant to states to explore new ways of coordinating their "fragmented" mental-health services. The provision contained no mandate that the money be spent to screen children.

But that hasn't kept critics from worrying about future moves.

"We're pretty encouraged because the federal [screening] program doesn't exist yet," says Jeff Deist, a spokesman for Rep. Ron Paul (R) of Texas, a leading congressional opponent of federally mandated mental-health testing. But the congressman is concerned that the US Department of Health and Human Services "will go forward and sort of agitate for this" in the next budget cycle, he says.

"There's this modern tendency to overmedicalize everything and to treat a rambunctious child ... or a sullen child as mentally ill when that's just his personality or he's a high-strung kid," Mr. Deist says. "We would rather be accused of being alarmist than just stand back and let this gather quiet momentum."

Antiscreening groups point to a report from the New Freedom Commission on Mental Health, appointed by President Bush in 2002, as the source of their concerns. The report, issued in July 2003, spoke of the benefits of widespread mental-health screening of Americans of all ages. It also noted that schools provide a promising venue for administering such evaluations for both students and adult school workers.

But some activists saw the report as a veiled recommendation that could turn into a harmful policy. That interpretation became widespread. In a memo last month, the Congressional Research Service tried to clear up just what the report said.

"[T]he Commission did not recommend mandatory screening of all children to identify those at risk of mental-health problems because the research on screening for children is inadequate," wrote two CRS researchers. The article added that "school mental- health programs must provide any screening or treatment services with full attention to the confidentiality and privacy of children and families."

The commission's biggest concern was that efforts to help those with mental illness at the state and federal level were too "fragmented" across different agencies, from the Social Security Administration to Medicare and Medicaid, says Michael Hogan, who was chairman of the now- disbanded New Freedom Commission, and current director of the Ohio Department of Mental Health. That fact has been lost in the furor over screening, he says.

The commission decided that recommending universal screening would be "a little premature and probably controversial even though we thought in the long run, it probably might be the right thing to do," Mr. Hogan says.

Mental-health issues "ought to be moved into the mainstream," he continues, and schools and even preschools "ought to have access to mental-health professionals. It makes more sense to give 16-year-olds an annual checkup of their mental and emotional wellness, and ask them if they're using drugs, than it does to give otherwise healthy young people a physical. That seems to me to be relatively common sense. But we're not ready for that."

The commission did recommend that mental-health screening be done in foster care and juvenile-justice settings where mental-health problems have already been shown to be "legion," he says.

Mental disorders, particularly for adolescents, Hogan says, "can be lethal," and are the leading cause of suicide among them. "Most young people who have a mental illness never get treatment, never see a mental-health professional," he says.

Even if all children were screened, it's not clear that government would mandate the use of antidepressants or other psychotropic drugs for those with disorders.

Both Hogan and screening opponents agree that more long-term testing needs to be done to ensure the safety of psychotropic drugs when used by children and teens. That view was expressed in the commission's report, he points out, long before studies showing links between certain antidepressants and teen suicides made international headlines.

Nevertheless, more and more children around the world are being prescribed drugs to calm or stimulate them, according to a November article in the British Medical Journal.

For example, between 2000 and 2002, the number of children and teens in Britain taking prescription tranquilizers, stimulants, or antidepressant drugs rose by 68 percent, the article said. It concluded "We believe the use of psychotropic medications in children is a global health issue, which should be studied in partnership with pharmaceutical companies, governments, and researchers."

"The pharmaceutical companies have been heavily involved in pushing programs like this, and they have an obvious, overt economic interest," says Sheldon Richman, a senior fellow at the Future of Freedom Foundation in Fairfax, Va. "They'll sell a lot more drugs if they can get more people diagnosed and put on them. We ought to be concerned about that."