Bush to screen population for mental illness

President Bush plans to unveil next month a sweeping mental health initiative that recommends screening for every citizen and promotes the use of expensive antidepressants and antipsychotic drugs favored by supporters of the administration.

The New Freedom Initiative, according to a progress report, seeks to integrate mentally ill patients fully into the community by providing "services in the community, rather than institutions," the British Medical Journal reported.

Critics say the plan protects the profits of drug companies at the expense of the public.

The initiative began with Bush's launch in April 2002 of the New Freedom Commission on Mental Health, which conducted a "comprehensive study of the United States mental health service delivery system."

The panel found that "despite their prevalence, mental disorders often go undiagnosed" and recommended comprehensive mental health screening for "consumers of all ages," including preschool children.

The commission said, "Each year, young children are expelled from preschools and childcare facilities for severely disruptive behaviors and emotional disorders."

Schools, the panel concluded, are in a "key position" to screen the 52 million students and 6 million adults who work at the schools.

The commission recommended that the screening be linked with "treatment and supports," including "state-of-the-art treatments" using "specific medications for specific conditions."

The Texas Medication Algorithm Project, or TMAP, was held up by the panel as a "model" medication treatment plan that "illustrates an evidence-based practice that results in better consumer outcomes."

The TMAP -- started in 1995 as an alliance of individuals from the pharmaceutical industry, the University of Texas and the mental health and corrections systems of Texas -- also was praised by the American Psychiatric Association, which called for increased funding to implement the overall plan.

But the Texas project sparked controversy when a Pennsylvania government employee revealed state officials with influence over the plan had received money and perks from drug companies who stand to gain from it.

Allen Jones, an employee of the Pennsylvania Office of the Inspector General says in his whistleblower report the "political/pharmaceutical alliance" that developed the Texas project, which promotes the use of newer, more expensive antidepressants and antipsychotic drugs, was behind the recommendations of the New Freedom Commission, which were "poised to consolidate the TMAP effort into a comprehensive national policy to treat mental illness with expensive, patented medications of questionable benefit and deadly side effects, and to force private insurers to pick up more of the tab."

Jones points out, according to the British Medical Journal, companies that helped start the Texas project are major contributors to Bush's election funds. Also, some members of the New Freedom Commission have served on advisory boards for these same companies, while others have direct ties to TMAP.

Eli Lilly, manufacturer of olanzapine, one of the drugs recommended in the plan, has multiple ties to the Bush administration, BMJ says. The elder President Bush was a member of Lilly's board of directors and President Bush appointed Lilly's chief executive officer, Sidney Taurel, to the Homeland Security Council.

Of Lilly's $1.6 million in political contributions in 2000, 82 percent went to Bush and the Republican Party.

Another critic, Robert Whitaker, journalist and author of "Mad in America," told the British Medical Journal that while increased screening "may seem defensible," it could also be seen as "fishing for customers."

Exorbitant spending on new drugs "robs from other forms of care such as job training and shelter program," he said.

However, a developer of the Texas project, Dr. Graham Emslie, defends screening.

"There are good data showing that if you identify kids at an earlier age who are aggressive, you can intervene ... and change their trajectory."

And at this rate (and if this is true), he can start at 1600 Pennsylvania Avenue, and keep his sorry shrinks away from me.

Well, while there may be debate over some of the details, I don't see anything in these comments from President Bush from a few years ago to indicate that this plan isn't true, as the WND and BMJ articles have it.
Millions of Americans, millions, are impaired at work, at school, or at home by episodes of mental illness. Many are disabled by severe and persistent mental problems. These illnesses affect individuals, they affect their families, and they affect our country.
As many Americans know, it is incredibly painful to watch someone you love struggle with an illness that affects their mind and their feelings and their relationships with others. We heard stories today in a roundtable discussion about that -- what the struggle means for family.
Remarkable treatments exist, and that's good. Yet many people -- too many people -- remain untreated. Some end up addicted to drugs or alcohol. Some end up on the streets, homeless. Others end up in our jails, our prisons, our juvenile detention facilities.
Our country must make a commitment: Americans with mental illness deserve our understanding, and they deserve excellent care. (Applause.) They deserve a health care system that treats their illness with the same urgency as a physical illness. (Applause.)
To meet this goal, we've got to overcome obstacles, and I want to talk about three such obstacles this morning. The first obstacle is the stigma, the stigma that often surrounds mental illness -- a stigma caused by a history of misunderstanding, fear, and embarrassment.
Stigma leads to isolation, and discourages people from seeking the treatment they need. Political leaders, health care professionals, and all Americans must understand and send this message: mental disability is not a scandal-- (applause) -- it is an illness. And like physical illness, it is treatable, especially when the treatment comes early.
Today, new drugs and therapies have vastly improved the outlook for millions of Americans with the most serious mental illnesses, and for millions more with less severe illnesses. The treatment success rates for schizophrenia and clinical depression are comparable to those for heart disease. That's good news in America, and we must encourage more and more Americans to understand, and to seek more treatment.
The second obstacle to quality mental health care is our fragmented mental health service delivery system. Mental health centers and hospitals, homeless shelters, the justice system, and our schools all have contact with individuals suffering from mental disorders. Yet many of these disorders are difficult to diagnose. This makes it even harder to provide the mentally ill with the care they need.
Many Americans fall through the cracks of the current system. Many years and lives are lost before help, if it is given at all, is given. Consider this example -- and for the experts in the field, they will confirm this is a story which is often times too true: a 14-year-old boy who started experimenting with drugs to ease his severe depression. That happens.
This former honor student became a drug addict. He dropped out of school, was incarcerated six times in 16 years. Only two years ago, when he was 30 years old, did the doctors finally diagnose his condition as bipolar disorder, and he began a successful program, a successful long-term treatment program.
And to make sure that the cracks are closed, I am honored to announce what we call the new Freedom Commission on Mental Health. It is charged to study the problems and gaps in our current system of treatment, and to make concrete recommendations for immediate provements that will be implemented -- (applause) -- and these will be improvements that can be implemented, and must be implemented, by the federal government, the state government, local agencies, as well as public and private health care providers.
To chair the commission, I've selected Michael Hogan. Dr. Hogan, I appreciate your coming, Michael. (Applause.) Dr. Hogan has served as the Director of the Ohio Department of Mental Health for more than ten years, and is recognized as a leader in this profession. He has been focused, as a state official, on how our mental health system works, and how it doesn't work.
I look forward to the Commission's findings. I look forward to their proposals. I look forward to making progress and fixing the system, so that Americans do not fall through the cracks. (Applause.)
The third major obstacle to effective mental health care is the often unfair treatment limitations placed on mental health in insurance coverage. (Applause.) Many private health insurance plans have developed effective programs to identify patients with mental illnesses, and they help them get the treatment they need to regain their health.
But insurance plans too often place greater restrictions on the treatment of mental illness than on the treatment of other medical illnesses. As a result, some Americans are unable to get effective medical treatments that would allow them to function well in their daily lives.
Our health insurance system must treat serious mental illness like any other disease. (Applause.) And that was Senator Domenici's message to me at the Oval Office. (Laughter.) And it was Nancy's message when we had them up for dinner. (Laughter.) And I want to appreciate the fact that they have worked tirelessly on this problem. (Applause.)
I have a record on this issue. As the Governor of Texas, I signed a bill to ensure that patients who critically need mental health are treated fairly. Senator Domenici and I share this commitment: health plans should not be allowed to apply unfair treatment limitations or financial requirements on mental health benefits. (Applause.)
It is critical that we provide full -- as we provide full mental health parity, that we do not significantly run up the cost of health care. I'll work with the Senator. I will work with the Speaker. I will work with their House and Senate colleagues to reach an agreement on mental health parity -- this year. (Applause.)
We must work for a welcoming and compassionate society, a society where no American is dismissed, and no American is forgotten. This is the great and hopeful story of our country, and we can write another chapter. We must give all Americans who suffer from mental illness the treatment, and the respect, they deserve. (Applause.)
President Says U.S. Must Make Commitment to Mental Health Care
White House website | April, 2002

That last is pretty sweeping, isn't it? How can all Americans who need mental health treatment be located unless all Americans are screened? Given the President's goals, the eventual step must necessarily be universal screening, once this expansion in the purpose and mission of the federal government is undertaken.
Will such screening be compulsory? In any case, will those who decline screening have that fact filed?
One compulsory aspect of the President's expansive vision for federal mental health policy appears to be a desire to require private insurance companies to proved full coverage.
Seems intrusive.

Executive Order
Community-based Alternatives for Individuals with Disabilities

Fact Sheet

By the authority vested in me as President by the Constitution and the laws of the United States of America, and in order to place qualified individuals with disabilities in community settings whenever appropriate, it is hereby ordered as follows:

Section 1. Policy. This order is issued consistent with the following findings and principles:

(a) The United States is committed to community-based alternatives for individuals with disabilities and recognizes that such services advance the best interests of Americans.

(b) The United States seeks to ensure that America's community-based programs effectively foster independence and participation in the community for Americans with disabilities.

(c) Unjustified isolation or segregation of qualified individuals with disabilities through institutionalization is a form of disability-based discrimination prohibited by Title II of the Americans With Disabilities Act of 1990 (ADA), 42 U.S.C. 12101 et. seq. States must avoid disability-based discrimination unless doing so would fundamentally alter the nature of the service, program, or activity provided by the State.

(d) In Olmstead v. L.C., 527 U.S. 581 (1999) (the "Olmstead decision"), the Supreme Court construed Title II of the ADA to require States to place qualified individuals with mental disabilities in community settings, rather than in institutions, whenever treatment professionals determine that such placement is appropriate, the affected persons do not oppose such placement, and the State can reasonably accommodate the placement, taking into account the resources available to the State and the needs of others with disabilities.

(e) The Federal Government must assist States and localities to implement swiftly the Olmstead decision, so as to help ensure that all Americans have the opportunity to live close to their families and friends, to live more independently, to engage in productive employment, and to participate in community life.

Sec. 2. Swift Implementation of the Olmstead Decision: Agency Responsibilities. (a) The Attorney General, the Secretaries of Health and Human Services, Education, Labor, and Housing and Urban Development, and the Commissioner of the Social Security Administration shall work cooperatively to ensure that the Olmstead decision is implemented in a timely manner. Specifically, the designated agencies should work with States to help them assess their compliance with the Olmstead decision and the ADA in providing services to qualified individuals with disabilities in community-based settings, as long as such services are appropriate to the needs of those individuals. These agencies should provide technical guidance and work cooperatively with States to achieve the goals of Title II of the ADA, particularly where States have chosen to develop comprehensive, effectively working plans to provide services to qualified individuals with disabilities in the most integrated settings. These agencies should also ensure that existing Federal resources are used in the most effective manner to support the goals of the ADA. The Secretary of Health and Human Services shall take the lead in coordinating these efforts.

(b) The Attorney General, the Secretaries of Health and Human Services, Education, Labor, and Housing and Urban Development, and the Commissioner of the Social Security Administration shall evaluate the policies, programs, statutes, and regulations of their respective agencies to determine whether any should be revised or modified to improve the availability of community-based services for qualified individuals with disabilities. The review shall focus on identifying affected populations, improving the flow of information about supports in the community, and removing barriers that impede opportunities for community placement. The review should ensure the involvement of consumers, advocacy organizations, providers, and relevant agency representatives. Each agency head should report to the President, through the Secretary of Health and Human Services, with the results of their evaluation within 120 days.

(c) The Attorney General and the Secretary of Health and Human Services shall fully enforce Title II of the ADA, including investigating and resolving complaints filed on behalf of individuals who allege that they have been the victims of unjustified institutionalization. Whenever possible, the Department of Justice and the Department of Health and Human Services should work cooperatively with States to resolve these complaints, and should use alternative dispute resolution to bring these complaints to a quick and constructive resolution.

(d) The agency actions directed by this order shall be done consistent with this Administration's budget.

Sec. 3. Judicial Review. Nothing in this order shall affect any otherwise available judicial review of agency action. This order is intended only to improve the internal management of the Federal Government and does not create any right or benefit, substantive or procedural, enforceable at law or equity by a party against the United States, its agencies or instrumentalities, its officers or employees, or any other person.

GEORGE W. BUSH

THE WHITE HOUSE,
June 18, 2001.

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