“Opponents say the program, which supports efforts in 460 communities in 42 states, has a record of falsely identifying students as suicidal. They also worry that mass screenings at school could jeopardize teens’ medical privacy. Still others believe TeenScreen is at its core a way for some to make money.”
When confronted with his own published findings showing that TeenScreen’s predictability rate is 16% and its false-positive rate is 84%,* Dr. David Shaffer said:
“Sharav misunderstands the study. He said it actually found that of 100 teens who screened positive for mental health problems, 16 percent to 25 percent would have severe problems. He said a later study, not yet published, documents a 13 percent false-positive rate.”
I leave it to readers to do their own arithmetic. Furthermore, what evidence is there to support Dr. Shaffer’s claim that 16% to 25% of children had “severe problems?”
Mental screening programs for children were developed by the DISC Development Group at Columbia University, Division of Child and Adolescent Psychiatry, whose director is Dr. David Shaffer. (DISC = Diagnostic Interview Schedule for Children modeled on the DSM IV)
See: Columbia DISC depression scale, a 22-item questionnaire: http://www.connecticare.com/Provider/Communications/CDDSTeen.pdf
A promotional pitch for the DISC is that it “is designed to be administered by “lay” (clinically untrained) interviewers, which allows a lot of information to be gathered with minimal training and at a relatively low cost.” See: http://chipts.ucla.edu/assessment/pdf/assessments/disc_for_the_web.pdf or http://www.nasbhc.org/TAT/Youth_at_risk_for_MH.htm
Columbia University’s DISC Development Group website shows the interconnectedness between screening and psychoactive drugs. The stated purpose of the Ruane Center for the Early Identification and Treatment of Mood Disorders of the Columbia DISC Development Group is:
- To develop new diagnostic tools based on the NIMH DISC.
- To make the NIMH DISC available to the academic and clinical community at low cost.
- To establish professorship in pediatric psychopharmacology and promote research on the use of psychopharmacological agents in children and adolescents.
- To develop efficient high school programs to screen teenagers for the early signs of manic depression and for suicidal risk.
Thus, DISC begat TeenScreen and BSAD (Brief Screen for Adolescent Depression).
These mini-versions of the DISC questionnaire were developed by Dr. Shaffer and the DISC Development Group and they are used to screen America’s school children. TeenScreen is a 14 item questionnaires competed in 10 minutes, that is aggressively promoted by Columbia and the Bush Administration in schools across America. BSAD is an 8 item questionnaire completed in 5 minutes used by Screening for Mental Health, Inc, who conduct an annual mass Depression Screening Day.
Mental screening is not backed by any scientific evidence of a benefit for those screened. The screening instrument that is used falsely identifies children as depressed and suicidal 84% of the time. In his published report, Dr. Shaffer acknowledges that “in practice a specificity of 0.83…could reduce the acceptability of a school-based prevention program.”
How is it then, that neither the President’s New Freedom Commission, nor officials of the Department of Health Human Services questioned the acceptability of a screening instrument whose 84% false-positive rate renders it scientifically invalid?
Follow the money:
Funding sources for the DISC Development Group and TeenScreen:
Federal government (National Institute of Mental Health and Substance Abuse & Mental Health Services Administration, SAMHSA); pharmaceutical companies whose grants are funneled through the NYS Psychiatric Institute Research Foundation of Mental Hygiene, Inc.; and private foundations (Joy & William Ruane).
TeenScreen National Advisory Council includes Michael F. Hogan, chairman of the President’s New Freedom Commission on Mental Health which recommended the Texas Medication Algorithm Project (TMAP), a prescription guide that Mr. Hogan has promoted in his capacity as state mental health director from Ohio, while serving on an advisory board for Janssen Pharmaceutica.
The TMAP guidelines and the psychiatrists affiliated with the University of Texas Southwestern that formulated TMAP, were bankrolled by the major producers of psychotropic drugs—including Johnson & Johnson (Janssen), Pfizer, Eli Lilly.
TMAP recommendations are contradicted by scientific evidence from the manufacturers’ own controlled clinical trials showing that the TMAP ‘preferred’ drugs failed to demonstrate a benefit, but rather, are linked to severe, even fatal side effects—including cardiovascular damage, liver damage, mania, hostility, aggression, and suicidal behavior. TMAP, dubbed the pharmaceutical industry’s cash cow, has hugely increased profit margins for the manufacturers of TMAP recommended drugs.
Serious questions about conflicts of interest are raised by the composition of the TMAP consensus panel, and by the fact that the New Freedom Commission recommendation of TMAP was under the chairmanship of Mr. Hogan.
Conflicts of interest issues also at issue when considering the two mental screening programs: TeenScreen and Screening for Mental Health, Inc. (SMHI)
Dr. Shaffer, who also serves on the TeenScreen Advisory Council, has long-standing pharmaceutical ties to companies whose drugs are prescribed for children diagnosed with mental disorders. He is a consultant for: Hoffman la Roche, Wyeth (expert trial witness), and a consultant to GlaxoSmithKline (on the matter of paroxetine and adolescent suicide).
According Internal Revenue Service 990 filings (2001, 2003, 2004) Screening for Mental Health, Inc. received $2,823,425 in “donations” from major pharmaceutical companies, and $5,974,317 from the U.S. Department of Health and Human Services (DHHS).
TeenScreen and SMH, Inc. appear to be engaging in fishing expeditions whose only value is to expand the number of people who will be diagnosed “suicidal” or “depressed.” Children who are screened then “diagnosed” (using DISC), and declared to be “suicidal” or “depressed” are referred for treatment. Psychiatrists invariably prescribe psychotropic drugs, creating lifetime consumers of drugs. While screening and drugging is hugely profitable for both the mental health service and drug industry, children are put at increased risk of harm from the adverse effects of the drugs—including a twofold increase risk of drug-induced suicide.
Big Government is pumping Big Money to implement the President’s NFC Taxpayer money and pharmaceutical money is rapidly infusing mental health organizations who are the recipients of cash “assistance.” These organizations are engaging in heavy-duty lobbying in an effort to divert scarce government resources for massive mental health “outreach” programs that have never been validated as either reliable or effective or helpful.
Mass mental screening which is a cornerstone of the NFC is designed to “catch” mostly healthy children. Most of the time such children are then put on a mental health treadmill whose end goal is psychotropic drugs.
The website of the National Association of State Mental Health Directors states: “The federal Center for Mental Health Services (CMHS) has contracted with the National Association of State Mental Health Program Directors (NASMHPD) to coordinate this project and to collaborate with six subcontractors: the Judge David L. Bazelon Center for Mental Health Law, the Federation of Families for Children’s Mental Health, the National Alliance for the Mentally Ill (NAMI), the National Association of Mental Health Planning and Advisory Councils (NAMHPAC), the National Council for Community Behavioral Healthcare (NCCBH), and the National Mental Health Association (NMHA). Together, the seven organizations have access to the nation’s leading experts in mental health policy at the state and federal levels.” See: Targeted Technical Assistance http://www.nasmhpd.org/targeted_ta.cfm
These stakeholders are engaging in heavy-duty lobbying for increased budgets. See below, Bazelon Center for Mental Health—one of seven organizations to receive hefty DHHS funding: http://www.bazelon.org/takeaction/2006/2-23-06Budget07.htm
The mass screening of U.S. children for presumed risks of suicide and depression is irresponsible. Children are being screened despite the absence of any scientific evidence of a benefit; without proven reliable or validated objective diagnostic criteria; and without convincing evidence demonstrating that currently available treatments are safe and effective. Read: Weighing the risk/ benefit ratio for children prescribed an antidepressant:
* David Shaffer, MD. Columbia Suicide Screen: Validity and Reliability J Amer Acad Child Adoles Psychiatry, 2004, 43: 71-79.
Contact: Vera Hassner Sharav
Arkansas Democrat Gazette
March 11, 2006
Catholic High looking to ID suicidal teens
Students to answer questions that look for warning signs
BY NELL SMITH ARKANSAS DEMOCRAT-GAZETTE
Ninth-graders at Catholic High School in Little Rock will spend about 10 minutes this month answering a series of questions that administrators hope will identify students considering suicide.
The program, known as TeenScreen, uses a 14-question test to help determine which students might be struggling with depression, anxiety disorders and substance abuse and ultimately prevent suicide. Administrators hope the effort will provide a way for teenagers to tell someone they’re having problems before it’s too late.
“Over the years we’ve had students who have committed suicide,” said Brother Richard Sanker, the counselor at Catholic High School. “And students [say], ‘We had not a clue. What’s going on in this person’s mind?’”
But TeenScreen, developed by a Columbia University professor, has come under intense criticism nationally. Opponents say the program, which supports efforts in 460 communities in 42 states, has a record of falsely identifying students as suicidal. They also worry that mass screenings at school could jeopardize teens’ medical privacy. Still others believe TeenScreen is at its core a way for some to make money.
“This whole TeenScreen will inflate the mental health system,” said Vera Hassner Sharav, president of the Alliance for Human Research Protection in New York City. “All those mental health professionals, social workers, everybody will have huge amounts of work. And then the big money is, of course, the pharmaceutical companies.”
Those who endorse Teen-Screen are used to those concerns and defend the program. The screening, which at Catholic High School will be performed by the psychiatry department at the University of Arkansas for Medical Sciences, is voluntary and requires both written parental consent and agreement from the teenager. The screening records are kept confidential, said Dr. Lynn Taylor, associate professor at UAMS and the program leader. UAMS will maintain the records and vows to not share them with school officials.
The screening process, Taylor said, has two parts. Students will first answer questions on paper. Then every student being screened will discuss his answers with a mental health professional. After that “exit interview,” a decision will be made about whether the student should be referred for a formal clinical diagnosis. UAMS will send letters home to parents of teens who screen positive, which include information about how to obtain professional help.
Taylor said local community mental health centers have funding to provide for the psychiatric care of uninsured patients.
“The last thing we want to do is identify a bunch of kids and then not have any way for them to get treatment,” she said.
But critics of the program question the validity of the questionnaire itself. UAMS officials declined to provide the questionnaire to the Arkansas Democrat-Gazette, citing copyright concerns. But social worker Ashley Hurst said the screen asks basic questions, such as whether the teen has had recent thoughts about suicide or has ever tried to commit suicide.
Other questions ask about feeling sad and concerns about substance abuse. Some questions ask students to rate their feelings on a scale of one to five.
“The screen is 14 questions, 10 minutes. What could that tell you?” said Sharav.
She notes that one study by David Shaffer, who developed TeenScreen, found the test had an 84 percent false-positive rate.
That means the screen “would result in 84 nonsuicidal teens being referred for further evaluation for every 16 youths correctly identified,” the study said.
“What kind of screen has such a high false-positive rate? It’s worthless,” Sharav said.
Shaffer said Sharav misunderstands the study. He said it actually found that of 100 teens who screened positive for mental health problems, 16 percent to 25 percent would have severe problems.
He said a later study, not yet published, documents a 13 percent false-positive rate.
Screening officials also acknowledge that it’s possible for students to say they’re not suicidal when, in fact, they’re contemplating it. Teens who want to hide a substance abuse problem from their parents, for example, could easily answer falsely.
“Probably everyone’s not going to be truthful,” Taylor said. “But some adolescents who are really worried about their substance abuse may be wanting help, and they may be truthful.”
As for the complaint that TeenScreen is simply a way for pharmaceutical companies to target new customers, the national program says it does not make treatment recommendations, and the organization accepts no money from pharmaceutical companies. The program offers free training and screening materials to program providers, such as UAMS, and helps some communities find operational funding. The UAMS program is using about $20,000 in state funds, Taylor said.
UAMS will start its TeenScreen program at Catholic High, and plans to implement the program at Warren High School next.
The Russellville School District has been screening eighth-graders there for about three years. That program has increased participation every year, said Carol Amundson Lee, the director of the behavioral health grant for the company contracted to do the screenings.
Catholic High’s Sanker became interested in TeenScreen after hearing a presentation about it and thought it would be a good service for students at his school, a private all-boys school where a student committed suicide in 2004.
Nationally, boys commit suicide more frequently than girls by about five to one, Shaffer said. In Arkansas in 2004, two children between the ages of 10 and 14 committed suicide, while 11 teenagers between 15 and 19 killed themselves. The two children under 15 were girls, while eight of the older adolescents were boys. Suicide was the second leading cause of death among males age 15 to 24 in 2003, the latest data for such rankings.
Still, not every ninth-grader at Catholic High School will be screened. Of the 169 freshmen, 67 have agreed to be screened, while 64 have declined. The remaining 38 have not returned the Teen-Screen consent form.
Citing confidentiality concerns, school administrators declined to provide names of students or parents to be interviewed for this story. Sanker and Principal Steve Straessle said they’ve heard very few negative comments about the program.
Parents who have expressed concerns wanted to know how the information would be protected, Straessle said. Others worried that if they declined to consent to the screenings, school officials might think the parents believed something was wrong with their son.
“Catholic High has sought assistance from UAMS to address the rising tide of teen depression,” Straessle wrote in a letter to parents introducing the program, “and in turn UAMS has introduced Catholic High to a revolutionary program called TeenScreen.”
Letters to the Editor are accepted only from Arkansas residents: http://www.arkansasonline.com/Info/voices.asp
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From: Lee Carty at the Bazelon Center for Mental Health Law [mailto:firstname.lastname@example.org]
Sent: Thursday, March 09, 2006 1:38 PM
Subject: Bazelon Alert: Will you help prevent suicide in 2007?
The Suicide Prevention Action Network (SPAN-USA) is one of the Bazelon Center’s partners in the Campaign for Mental Health Reform. The Bazelon Center played a role in enactment of the Garrett Lee Smith Memorial Act (PL 108-355) (see our September 2004 Policy Reporter) and we believe SPAN-USA’s message, below, will interest you.
To take action, just type in your zip code and click on the “Go” button at the top.
ADVANCE SUICIDE PREVENTION
Ask federal legislators to support suicide prevention in FY 2007
As the second session of Congress begins, SPAN USA asks you to share our FY 2007 public policy priorities with your legislators. In 2004, President Bush signed the Garrett Lee Smith Memorial Act (PL 108-355), the first federal authorization for youth suicide early intervention and prevention. Congress has supported appropriations in both FY 2005 and FY 2006 for this important initiative. In spite of this progress, much work remains to be done. It is important for your federal legislators to be aware of and support the next steps necessary to advance suicide prevention. SPAN USA has five public policy priorities for FY 2007 that require legislative attention. Please take a moment to ask your federal legislators to support:
Full FY 2007 appropriation of $40 million for the Garrett Lee Smith Memorial Act (PL 108-355);
Passage of mental health parity legislation;
Appropriation of $1.5 million for CDC to expand the National Violent Death Reporting System to six more states;
Development of legislation targeting senior suicide early intervention and prevention; and
Establishment of the Action Alliance for Suicide Prevention, a public/private partnership to advance the National Strategy for Suicide Prevention.
We strongly encourage you to personalize this letter by adding your story and including statistics from your state and/or county.
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