Bush plans to screen whole US population for mental illness

Bmj Journals ^ | 19 June, 2004 | Jeanne Lenzer

[SkyRat]

A sweeping mental health initiative will be unveiled by President George W Bush in July. The plan promises to integrate mentally ill patients fully into the community by providing "services in the community, rather than institutions," according to a March 2004 progress report entitled New Freedom Initiative (www.whitehouse.gov/infocus/newfreedom/toc-2004.html). While some praise the plan's goals, others say it protects the profits of drug companies at the expense of the public.

Bush established the New Freedom Commission on Mental Health in April 2002 to conduct a "comprehensive study of the United States mental health service delivery system." The commission issued its recommendations in July 2003. Bush instructed more than 25 federal agencies to develop an implementation plan based on those recommendations.

The president's commission found that "despite their prevalence, mental disorders often go undiagnosed" and recommended comprehensive mental health screening for "consumers of all ages," including preschool children. According to the commission, "Each year, young children are expelled from preschools and childcare facilities for severely disruptive behaviours and emotional disorders." Schools, wrote the commission, are in a "key position" to screen the 52 million students and 6 million adults who work at the schools.

The commission also recommended "Linkage [of screening] with treatment and supports" including "state-of-the-art treatments" using "specific medications for specific conditions." The commission commended the Texas Medication Algorithm Project (TMAP) as a "model" medication treatment plan that "illustrates an evidence-based practice that results in better consumer outcomes."

Dr Darrel Regier, director of research at the American Psychiatric Association (APA), lauded the president's initiative and the Texas project model saying, "What's nice about TMAP is that this is a logical plan based on efficacy data from clinical trials."

He said the association has called for increased funding for implementation of the overall plan.

But the Texas project, which promotes the use of newer, more expensive antidepressants and antipsychotic drugs, sparked off controversy when Allen Jones, an employee of the Pennsylvania Office of the Inspector General, revealed that key officials with influence over the medication plan in his state received money and perks from drug companies with a stake in the medication algorithm (15 May, p1153). He was sacked this week for speaking to the BMJ and the New York Times.

The Texas project 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. The project was funded by a Robert Wood Johnson grant—and by several drug companies.

Mr Jones told the BMJ that the same "political/pharmaceutical alliance" that generated the Texas project was behind the recommendations of the New Freedom Commission, which, according to his whistleblower report, 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" (http://psychrights.org/Drugs/AllenJonesTMAPJanuary20.pdf).

Larry D Sasich, research associate with Public Citizen in Washington, DC, told the BMJ that studies in both the United States and Great Britain suggest that "using the older drugs first makes sense. There's nothing in the labeling of the newer atypical antipsychotic drugs that suggests they are superior in efficacy to haloperidol [an older "typical" antipsychotic]. There has to be an enormous amount of unnecessary expenditures for the newer drugs."

Drug companies have contributed three times more to the campaign of George Bush, seen here campaigning in Florida, than to that of his rival John Kerry

Credit: GERALD HERBERT/AP

Olanzapine (trade name Zyprexa), one of the atypical antipsychotic drugs recommended as a first line drug in the Texas algorithm, grossed $4.28bn (£2.35bn; 3.56bn) worldwide in 2003 and is Eli Lilly's top selling drug. A 2003 New York Times article by Gardiner Harris reported that 70% of olanzapine sales are paid for by government agencies, such as Medicare and Medicaid.

Eli Lilly, manufacturer of olanzapine, has multiple ties to the Bush administration. George Bush Sr was a member of Lilly's board of directors and Bush Jr appointed Lilly's chief executive officer, Sidney Taurel, to a seat on the Homeland Security Council. Lilly made $1.6m in political contributions in 2000—82% of which went to Bush and the Republican Party.

Jones points out that the companies that helped to start up the Texas project have been, and still are, big contributors to the election funds of George W Bush. In addition, some members of the New Freedom Commission have served on advisory boards for these same companies, while others have direct ties to the Texas Medication Algorithm Project.

Bush was the governor of Texas during the development of the Texas project, and, during his 2000 presidential campaign, he boasted of his support for the project and the fact that the legislation he passed expanded Medicaid coverage of psychotropic drugs.

Bush is the clear front runner when it comes to drug company contributions. According to the Center for Responsive Politics (CRP), manufacturers of drugs and health products have contributed $764 274 to the 2004 Bush campaign through their political action committees and employees—far outstripping the $149 400 given to his chief rival, John Kerry, by 26 April.

Drug companies have fared exceedingly well under the Bush administration, according to the centre's spokesperson, Steven Weiss.

The commission's recommendation for increased screening has also been questioned. Robert Whitaker, journalist and author of Mad in America, says that while increased screening "may seem defensible," it could also be seen as "fishing for customers," and that exorbitant spending on new drugs "robs from other forms of care such as job training and shelter programmes."

But Dr Graham Emslie, who helped develop the Texas project, 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."

[Casloy]

"The plan promises to integrate mentally ill patients fully into the community"

I thought that had already been done. Aren't they called Democrats?

[FairOpinion]

"In all of its forms, however, the right of privacy must be balanced against the state's compelling interests. Such compelling interests include the promotion of public morality, protection of the individual's psychological health, and improving the quality of life."

This is preposterous!

And in addition, these are considered "state's compelling interests", while keeping us alive and unharmed from terrorist attacks isn't. ( Not because it isn't mentioned, but because judges keep ruling against it and civil rights activists claim that the right to privacy is more important. I guess the states interests override privacy, when it's about government intrusion for no particular reason, other than exercise power, but not, when it actually really relates to safety and lives, as in survival.)

[steplock]

THIS would be very much a reason for the Second Amendment, mr bush.

[concerned about politics]

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

I doubt it. The UK "Socialist medical establishment" is not what I'd call "a Bush supporter".

[Just mythoughts]

"Require congresscritters to wear full-face motorcycle helmets when Congres is in session. (Soft heads, you know.)"



A rubber room would be fitting for a vast number of them.

[SkyRat]

I included the adress to the report in my comment.

http://www.mentalhealthcommission.gov/reports/FinalReport/toc.html

If you belive the article at BMJ is biased and unfair, you can still read the original report. I would like to hear why you think it's unfair.

[185JHP]

Loys of DUmmies that wouldn't mind us being made dhimmis...

[AM2000]

And in addition, these are considered "state's compelling interests", while keeping us alive and unharmed from terrorist attacks isn't.

Even if "keeping us alive and unharmed from terrorist attacks" was considered a compelling interest of the state, that could still be used to justify mental screening of the general population. Certainly, the argument could be made, by those looking to justify a general mental screening scheme, that potential terrorists fit a certain psychological profile (or set of profiles), which could be detected through the program.

The problem, as I see it, is not that the definition of states compelling interest isn't inclusive enough, the problem is that it already includes too much.

[FairOpinion]

My point was that this is only a recommendation by a commission and they used that very misleading title, as if it were a done deal and Bush was going to do that.

[Kackikat]

Thanks for the link.

[NewRomeTacitus]

A little too close to National Socialist Germany for my tastes.

[cyborg]

just a little

[SkyRat]

I see. Sorry, seems like I misunderstood you.

[concerned about politics]

My point was that this is only a recommendation by a commission and they used that very misleading title, as if it were a done deal and Bush was going to do that.

The UK has socialized medicine, and this article is from that same medical establishment. It's a Bush "Hit piece."

[FairOpinion]

"The problem, as I see it, is not that the definition of states compelling interest isn't inclusive enough, the problem is that it already includes too much."

Actually, the point I was trying to make is that it includes all the wrong things. Also, I was going off on a bit of tangent, I wasn't talking about psychological screenings being justified by anything, just that some privacy rights, such as looking at Moussaoui's computer, which may have prevented 9-11, can indeed by outweighed by national security concerns. But as usual, the government is being intrusive about all the wrong things.

This mental screening will never fly and nobody is going to propose it in earnest. The commission must have been taking too much of those drugs.

Having the government screen and declare who is sane and who isn't, is akin to the Stalinist era, when they declared anyone, who didn't tow the party line insane,and locked them up in insane asylums.

[AM2000]

What if doctors started psychological screenings as a matter of routine, the same way they check BP and body temp's today every time you go to a doctors office?

My guess is, more than Govt, its the insurance companies that would be interested in information like this.

[steve86]

Depressed Man Diagnosed as "British"
Mon Jun 28, 2004 06:57 AM ET

By Darren Mackenzie

WASHINGTON (Reuters) - George Farthing, an expatriate British man living
in America, was recently diagnosed as clinically depressed, tanked up on
anti-depressants and scheduled for controversial Shock Therapy when
doctors realised he wasn't depressed at all - only British.

'Not depressed, just British' Mr Farthing, a British man whose
characteristic pessimism and gloomy perspective were interpreted as
serious clinical depression, was led on a nightmare journey through the
American psychiatric system.

Doctors described Farthing as suffering with Pervasive Negative
Anticipation - a belief that everything will turn out for the worst,
whether it's trains arriving late, England's chances at winning any
international sports event or even his own prospects to get ahead in
life and achieve his dreams.

"The satisfaction Mr Farthing seemed to get from his pessimism seemed
particularly pathological," reported the doctors. "They put me on
everything - Lithium, Prozac, St John's Wort," said Mr Farthing. "They
even told me to sit in front of a big light for an hour a day or I'd
become suicidal. I kept telling them this was all pointless and they
said that it was exactly that sort of attitude that got me here in the
first place."

Running out of ideas, his doctors finally resorted to a course of
"weapons grade MDMA", the only noticeable effect of which was six hours
of speedy repetitions of the phrases "mustn't grumble" and "not too bad,
really". It was then that Mr Farthing was referred to a psychotherapist.

"Suicidal?" Dr Isaac Horney explored Mr Farthing's family history and
couldn't believe his ears. "His story of a childhood growing up in a
gray little town where it rained every day, treeless streets of
identical houses and passionately backing a football team who never won,
seemed to be typical depressive ideation or false memory. Mr Farthing
had six months of therapy but seemed to mainly want to talk about the
weather - how miserable and cold it was in winter and later how
difficult and hot it was in summer. I felt he wasn't responding to
therapy at all and so I recommended drastic action - namely ECT or shock
treatment".

"I was all strapped down on the table and they were about to put the
rubber bit in my mouth when the psychiatric nurse picked up on my
accent," said Mr Farthing. "I remember her saying 'Oh my God, I think
we're making a terrible mistake'."

Nurse Alice Sheen was a big fan of British comedy giving her an
understanding of the British psyche. "Classic comedy characters like
Tony Hancock, Albert Steptoe and Frank Spencer are all hopeless cases
with no chance of ever doing well or escaping their circumstances," she
explained to the baffled US medics. "That's funny in Britain and is not
seen as pathological at all."

Identifying Mr Farthing as British changed his diagnosis from 'clinical
depression' to 'rather quaint and charming' and he was immediately
discharged from hospital, with a selection of brightly coloured leaflets
and an "I love New York" T-shirt.

[tet68]

I don't have a problem with it if he starts with democrats first, there won't be room for anyone else.

[NewRomeTacitus]

I thought you'd be out watching fireworks

or perhaps attending a "Passion Party".

[cyborg]

LOL well I'm getting man advice from my sister's gay friend. I'll take anything at this point :)