SAMHSA Backs Away From TeenScreen & TMAP

SAMHSA Backs Away From TeenScreen & TMAP

Mon, 24 Oct 2005

On October 17, a meeting took place with Charles Currie in Washington DC – with some in attendance by conference call. Currie is the Administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA), the federal agency charged with implementing the Federal Mental Health Action Agenda as the follow-up to the New Freedom Commission (NFC) report.

In attendance were several AHRP Board Members–Allen Jones, Dr. Karen Effrem,* and Dr. Stefan Kruszewski – as well as representatives of several advocacy groups who have been prominent and outspoken critics of mental health screening and psychiatric drugging of children, beginning in early childhood, as recommended by the NFC. Besides AHRP, groups in attendance were: EdWatch, The International Center for the Study of Psychiatry and Psychology (ICSPP), Eagle Forum, The Association of American Physicians and Surgeons (AAPS), The American Psychoanalytic Association, and Mind Freedom. Michael Ostrolenk, founder of the Liberty Coalition and the Medical Privacy Coalition, organized the meeting.

Steps in the Right Direction:

The administration demonstrated a willingness to face its critics and hear our urgent concerns, for which we commend HHS, SAMHSA, and Charles Currie. In addition, several important and positive outcomes occurred at this meeting, for which we also commend the Bush administration. The following key points that are fundamental to this entire controversy over the NFC Report recommendations were reconsidered:

SAMHSA Administrator, Charles Currie indicated that the Bush Administration disavows TeenScreen:

“You will notice that TeenScreen is not a model program nor is it or any other screening program mentioned anywhere in the Federal Mental Health Action Agenda.”

This is an incredible testament to the value of informed and persistent educational efforts against this screening program by AHRP and other groups around the country.

TeenScreen uses vague, subjective questions based on unscientific diagnostic criteria. TeenScreen is itself scientifically not validated, has resulted in high rates of false positives so that normal children who are healthy are misidentified with mental disorders. There is no evidence that screening programs prevent suicide–as is claimed by its promoters. Furthermore, TeenScreen employs passive consent procedures that circumvent parental authority. The net result, so far; is that children are unjustifiably prescribed dangerous and ineffective psychiatric medications. (An AHRP position statement about TeenScreen will be posted shortly on our website).

SAMHSA backs away from TMAP medication algorithms.

The Texas Medication Algorithm Project (TMAP) recommends the atypical antipsychotics and the SSRI – SNRI antidepressants as first line – and sometimes the ONLY treatment. In states that have adopted the TMAP model – as recommended by the NFC Report – the TMAP guidelines are binding. However, a body of scientific evidence recently disclosed to the public has revealed that these drugs lack efficacy and that they are linked to severe, even fatal side effects. The compelling, newly revealed evidence has caused SAMHSA to dissociate from these medication algorithms.

On October 17, Charles Currie said: “The Action Agenda does not support medication algorithms,” and “Medication toolkits have been removed from SAMHSA’s other public materials.”

In a reference to the government sponsored CATIE antipsychotic drug trials (see http://www.ahrp.org/infomail/05/09/20.php), Currie said: “Algorithms needed to be revisited and revised on the basis of what science has taught us about these drugs.”

The absence of scientific evidence to support the TMAP recommendations, coupled with  the serious risks posed by these drugs has been consistently pointed out by AHRP as well as courageous whistle blowers–most notably, AHRP board members Allen Jones (http://www.ahrp.org/infomail/05/10/14.php) and Stefan Kruszewski (http://www.ahrp.org/infomail/04/07/07.php) – who separately uncovered evidence of pharmaceutical company corruption of government officials. This compelling evidence left SAMHSA no other reasonable course.

Currie unequivocally acknowledged that it is the National Association of State Mental Health Program Directors (NASMHPD) that is promoting TMAP around the country. Allen Jones has documented evidence that the meetings of NASMHPD are under the influence of pharmaceutical company representatives; that the industry supports NASMHPD financially; and that many of these state directors serve on pharmaceutical advisory boards. For example, Michael Hogan, chairman of the NFC, is the state director from Ohio, one of the first states to adopt TMAP, who served on an advisory board for Janssen Pharmacia, the manufacturer of Risperidal. Risperdal is an atypical antipsychotic recommended by TMAP as a first-line drug.

AHRP calls for legal, Congressional, and journalistic investigation of this corruption of government officials entrusted with the health and welfare of so vulnerable a population as those with mental health issues.

The critical importance of informed parental consent was reinforced.   Currie unequivocally stated that parental consent must be documented, signed and fully informed. He said in response to a question by Dominic Riccio (of ICSPP) that consent must be “full knowledge” consent “with a parent’s signature before screening,” and that “if screening should lead to step 2 [i.e., further evaluation and treatment], parental consent must be revisited.”

AHRP believes that the language of the Action Agenda, although much improved over the NFC report, should be strengthened with specific binding language to ensure that parental informed consent with “full knowledge” is mandatory before any screening is undertaken. (see below).

Informed parental consent will be emphasized in government mental health grants. Currie responded to a major concern raised by Dr. Effrem about the lack of priority given to parental consent in grants funded by SAMHSA, such as Safe Schools, Healthy Students that inspired a grant from a Minnesota county stating that “…TeenScreen will be administered to all county school districts in the first year of this project to determine needs and baselines,” never once mentioning parental consent for that or in the entire 133 page grant. Dr. Effrem wondered what if any information or emphasis on parental consent is communicated by SAMHSA and other relevant federal agencies to grant applicants.

Mr. Currie then promised to take that information back to the agency and make sure that any requests for application for grants involving children would emphasize parental consent.

AHRP will follow this particular issue very closely to make sure that parental consent is not circumvented so that children are protected from dubious mental health services. And AHRP will also work to develop a consent form for all government sponsored medical research that provides truly informed consent.

There was acknowledgement of other important concerns.  Other participants raised many other issues that AHRP is concerned about and is following. Mr. Currie acknowledged the importance of each one. They will each need further discussion and clarification by SAMHSA and include:

  1. Data Privacy and mental health data bases – Raised by the American Psychoanalytic Association and AAPS
  2. Alternative treatments to medication – Raised by Mind Freedom
  3. Funding of treatments other than medication – Raised by ICSPP and Mind Freedom

Remaining Concerns and Disappointments:

While significant strides were made in the areas discussed above, there were other issues raised that were far less well answered that must be revisited in order to ensure freedom and safety for American citizens involved in mental health treatment and research and to prevent others who do not need it from becoming unnecessarily involved. Those issues include:

Undoing what has already been wrought – SAMHSA administrator made the following statement during his briefing: “The New Freedom Commission is not the official position of the Bush administration.”

Although that is nice to hear, but practically speaking, that statement means very little. In addition, Congress appropriated $20 million for the implementation of state mental health transformation grants to implement the NFC recommendations including screening in the current fiscal year and the US House has passed $26 million for the same grants this year, so we will definitely be seeing more state legislation and more state plans to do screening.

The Illinois Children’s Mental Health Act has been enacted whose preliminary implementation plan proposed to mental health screen ALL children 0-18 and all pregnant women for mental illness and never once used the phrase “parental consent.” That draft implementation plan clearly referenced the New Freedom Commission, saying, “Align systems of care with the President’s New Freedom Report, particularly the child and adolescent recommendations.” (http://www.isbe.state.il.us/iicc/pdf/icmhp_preliminary_plan.pdf) Although Illinois legislators were appalled when finally understanding what they passed, very little has been done to undo the enormous damage and loss of freedom that this law will implement.

Minnesota attempted to enact legislation that would have screened the mental health of children as young as three as part of the required screening for kindergarten entry. The Senate author of this bill clearly referenced the New Freedom Commission in his presentation of the bill in committee as witnessed by Dr. Effrem. Texas also attempted to enact legislation that called for “screening for co-occurring physical, mental, and substance-abuse disorders,” and use “integrated treatment strategies,” such as TMAP. That language is right out of the NFC recommendations. The Minnesota and Texas bills were thankfully stopped by the informed testimony and grassroots work of EdWatch and Eagle Forum respectively and other state and national groups. (See http://www.edwatch.org/updates05/071805-mhv.htm and http://www.edwatch.org/updates05/060105-TX.htm.

In how many more states will this same battle need to be fought? Unless SAMHSA actually stops funding grants that include screening and TMAP style treatment and the Bush administration puts out some sort of statement to the states that it does not recommend either of these, Currie’s statement is merely symbolic.

SAMHSA Administrator claims agency lacks position on pending legislation – When asked by Dr. Effrem about support of pending federal legislation, HR 181 – The Parental Consent Act by Rep. Ron Paul that prohibits coerced screening and HR 1790 – The Child Medication Safety Act by Rep. John Kline that prohibits coerced psychiatric medication, and that establishes in law the very good statements in the Action Agenda about parental consent so that those statements live on after this administration, Mr. Currie said that he couldn’t take any position on legislation.

This is very disappointing given that Joe Faha, SAMHSA’s Congressional liaison issued a position statement on Congressman Paul’s amendment to the Fiscal Year 2006 Labor/ HHS/Education Appropriations bill that would have denied funding for screening that did not require active, informed voluntary parental consent. This position statement distorted the intent of the Paul amendment and contributed to its defeat and was quoted on the TeenScreen website. (See http://www.teenscreen.org/cms/images/stories//samhsa%20response.pdf)

Little concern for the potential harm of mental health screening – When asked by Dr. Effrem about the four year grants received by Columbia University to study the potential harm of the screening process itself, Currie merely stated that if he was in his current position in four years, which he doubted, that he would be very interested in the outcome of that study. When pressed further about whether any screening program should proceed until this study was completed, he stated that the Action Agenda did not propose any specific mental health screening program. Although it is good that the Agenda has backed away from TeenScreen, SAMHSA, HHS, and The Departments of Education and Justice are still currently funding grants that include mental health screening.

AHRP believes that any grants involving mental health screening should be suspended until that study is completed and other data is reviewed.

Barely scratching the surface – Although AHRP greatly appreciates the opportunity for this meeting and the important progress made, this is a very complicated issue that has enormous implications for the health and freedom of every American. The length and structure of the meeting precluded serious discussion of many other crucial issues that AHRP will be working to bring up for discussion and action, such as:

  • Is it constitutionally and ethically proper for the federal government to be involved in screening or promoting scientifically unproven, dubious mental health interventions?
  • What is the scientific justification behind all of the recommended mental health screening initiatives and what is the evidence that the benefits of the recommended psychiatric drug treatment outweigh the risks – such as specified in the Black Box warnings of each and every recommended drug ?
  • The Action Agenda targets foster children, children in the welfare and juvenile justice systems, refugees, and crime and terror victims for mental health interventions. What is the scientific basis for selecting these particular children and adults for unproven interventions?
  • Finally, what is the scientific evidence for the downward progression from the New Freedom Commission report that recommends beginning mental health screening of preschoolers to statements of the Federal Mental Health Action Agenda that such mental health interventions should begin with INFANTS?

* In the spirit of full disclosure, Dr. Effrem also serves on the boards of EdWatch and ICSPP.

Contact: Vera Hassner Sharav
212-595-8974
veracare at ahrp org