1 Boring Old Man

Teen Screen: Should We Be Testing for Mental Illness?
^{The push is on to early identify youth with mental disorders. Do we really know how? Fourth in a series on medical screening}
The Tyee – British Columbia
By Alan Cassels

25 July 2011

"When left untreated, mental illness can lead to devastating consequences. These include drug and alcohol abuse, violence, school failure, involvement in the criminal justice system, and the loss of critical developmental years that can never be recaptured." (Teen Screen)

Most parents believe that they’d be the first to know if their child was depressed or at risk for suicide. Yet according to a group promoting teen mental illness screening, such as the Teen Screen National Centre for Mental Health Checkups at Columbia University, "80 per cent of mentally ill youth are not identified and do not receive services." Could it really be so? These advocates are pushing to get every teenager in the U.S. screened for mental health problems, contending that "screening can help find those youth who are suffering from undiagnosed mental illness or are at risk for suicide, make their parents aware of their children’s difficulties, and help connect them with mental health services that can save their lives." Like all medical screening, this one sounds reasonable on the surface. Teen suicide and depression are well known, and prevalent. If teenagers have undiagnosed and untreated mental health problems, and if we could do something to screen teenagers for mental illness — and help divert them from a path of destruction — why wouldn’t we do it?

Unfortunately, when it come to types of medical screening that look good in theory but are largely unworkable in practice, mental health screening is probably the archetype. The mental health "Teen Screen" program is riven with gross conflicts of interest and inappropriate political influence, all which has led to the rapid uptake and prescribing of some of the most dangerous drugs on the planet. Back in 2002 under George Bush, the president’s New Freedom Commission on Mental Health was formed and it recommended, among other things, mental health screenings for "consumers of all ages," including preschool children. The Commission cited Teen Screen as a "model program." From early on, this screening program always smacked of a way to deliver millions of teenage children into the waiting arms of pharmaceutical marketers. The Commission recommended that mental illness treatments should follow a certain standard medication protocol and chose the now infamous Texas Medication Algorithm Project (TMAP) as its model.

If the model acted like it was set up by the pharmaceutical industry, it’s because it basically was, requiring, among other things, that physicians treat patients with the newest, most expensive brand-name antidepressants and antipsychotics over older, cheaper, some might say "proven" drugs. The adoption of the Texas Medication Algorithm Project was a boon for the pharmaceutical industry, causing the cost of psychotropic medication for Medicaid — the U.S. federal healthcare program for people on low incomes — to increase sharply. The Lone Star State spent millions on developing and promoting the guidelines, supported by funding that came partly from the Robert Wood Johnson Foundation, which has half its assets invested in the drug giant Johnson and Johnson…

Undoubtedly, mental health problems around the world cause immense human suffering and misery, and there are few jurisdictions anywhere in the world where there is adequate support for and treatment of people with mental illness. But with mental screening programs and all their attendant problems, one is left wondering if identifying more and more people as mentally sick is really the way to go to reduce the level of human misery.

Alan Cassels is a drug policy researcher at the University of Victoria and is co-author of Selling Sickness. This is the fourth in a series of articles on medical screening by Alan Cassels. He once drafted a consumer’s guide to online genetic testing which you can find it on his website here.