An article in Psychiatric Times, , Conservative Groups Press Currie on Screening, (below) reported about a meeting attended by several "conservative interest groups" of concerned citizens with Charles Currie, the Administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA). If "conservative" means being concerned about protecting health, life-safety and dignity of children and the integrity of the parent-child relationship, then if the shoe fits...

The groups who were represented raised concerns about the government policy of mass mental screening of America's school children--often without valid, informed parental consent. Mental screening is the first step in an orchestrated expansion program that increases patient rolls . Most who screen "positive"  leads to labeling children with psychiatric disorders, followed by prescriptions for psychotropic drugs.

AHRP board member, Allen Jones (who attended the meeting) is the former investigator in the Pennsylvania Inspector General's office who blew the whislte on TMAP the government endorsed, pharmaceutical enrichment program, stated:
"The article highlights the need for SAMSHA administrator Charles Currie to publicly and definitively articulate the Administration's views regarding TeenScreen, TMAP and the status of the New Freedom Commission recommendations. Currie has said one thing behind closed doors, and with his actions and through his subordinates, quite another to the public. Where does he stand on these issues? We still do not know, but we must know. Has Currie attempted to placate critics while bowing to pharma interests? The American people deserve answers and a clear articulation of Currie's agenda."

A letter (below) from the Graduate Policy Felowship Progam of the National Academies of Science, Engineering and Medicine, confirms the forthcoming debate between  Dr. David Shaffer, head of Child and Adolescent Psychiatry, Columbia University, and  Vera Sharav. The debate is scheduled for February 22, from 12:30--2:00.  The public is invited, and there is time for Q & A, so I do hope some of you will attend.

Contact: Vera Hassner Sharav
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Psychiatric Times
January 1, 2006
Conservative Groups Press Currie on Screening
By: Stephen Barlas

Conservative interest groups extracted commitments from Substance Abuse and Mental Health Services Administration (SAMHSA) Administrator Charles Currie to consider new restrictions on how states use the new mental health Transformation Grants, the first round of which SAMHSA announced last September. At a meeting with Currie on Oct. 17, he promised to consider requiring states to obtain parental consent before screening children for mental health problems when those screening programs are paid for with Transformation Grant money. That is not now a requirement. Currie also agreed to evaluate current mental health screening and treatment programs for effectiveness, a move SAMHSA set in motion in August.

Underlying the groups' agenda was their belief that many mainline screening and treatment programs-such as TeenScreen and the Texas Medication Algorithm Project (TMAP)-are thinly veiled Trojan horses for the pharmaceutical industry. In a press release following the meeting, Vera Hassner Sharav, founder of the Alliance for Human Research Protection (AHRP), stated that the National Association of State Mental Health Program Directors (NASMHPD) is promoting TMAP around the country. She alleged 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."
She said Michael F. Hogan, chairman of the New Freedom Commission and state mental health director from Ohio, a state that adopted TMAP, served on an advisory board for Janssen Pharmaceutica Products, L.P., the manufacturer of Risperidal (risperidone), an antipsychotic recommended by TMAP as a first-line drug. When contacted by Psychiatric Times, Hogan declined to address any connection he might have, or have had, with Janssen.

The Oct. 17 meeting was held a few weeks after SAMHSA awarded $92.5 million over five years to seven states. The money will be used to restructure state mental health programs. The Substance Abuse and Mental Health Services Administration published a Mental Health Action Agenda that laid out possible means toward that end.
The Action Agenda, in turn, is influenced by the recommendations of President Bush's New Freedom Commission, which Hogan chaired.

Many conservative groups at the meeting with Currie misinterpreted the New Freedom Commission's recommendations as backing wholesale mental health screening of children. They asked Currie to ensure that states using Transformation Grant money for screening children obtain prior consent from parents. They urged Currie to disavow Columbia University's widely-used TeenScreen program and the TMAP, according Sharav's press release. In addition to AHRP, other groups at the meeting included: EdWatch, International Center for the Study of Psychiatry and Psychology, Eagle Forum, Association of American Physicians and Surgeons, American Psychoanalytic Association, and Mind Freedom.

Mark A. Weber, associate SAMHSA administrator, who attended the meeting, told PT Transformation Grants are primarily aimed at helping states convert their mental health infrastructure, not providing mental health services. A portion of the grant money can be used for mental health screening of children and adults. There are no published guidelines on how screening must be conducted or which screening programs can or cannot be used. There is no requirement that states obtain prior consent from parents before screening children. Weber said that Currie committed to considering adding language the next time SAMHSA sends out a request for proposals for these grants clarifying the parental consent issue.

Currie did not disavow TeenScreen, as Sharav's press release implied. States are free to use that program, Weber emphasized. According to its Web site, TeenScreen assesses children for depression risk factors; it does not lead to a diagnosis, much less a treatment recommendation. Two forms of consent, active and passive, can be used to obtain parents' permission for the screening. Currently, 98.2% of TeenScreen sites use active parental consent, which requires parents to sign a consent form if they want their child to participate in screening. Passive consent (waiver-of-consent or opt-out consent) requires parents to return a provided form only if they do not want their child to participate.
Sharav's press release claimed: "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."

States are also free to use TMAP, Weber said. The TMAP is a set of guidelines for physicians treating severely mentally ill patients within Texas' publicly funded mental health care system. They were developed by the University of Texas Southwestern and have been used in the state since 1997. Findings published in 2004 showed two to three times greater improvement in patients with major depressive disorder who were treated according to TMAP guidelines (Arch Gen Psychiatry 61[7]:669-680).

The conservative groups have assailed TMAP, which they say is being promoted by NASMHPD. In a press release Sharav explained that TMAP "recommends the atypical antipsychotics and the [selective serotonin reuptake inhibitor-serotonin norepinephrine reuptake inhibitor] antidepressants as first line-and sometimes the ONLY treatment. ... 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."
Weber explained that SAMHSA has not disassociated itself from TMAP. Andrew D. Hyman, director of the office of government relations at NASMHPD, told PT, "I truly doubt Mr. Currie is stepping away from tools such as TMAP, which serve to ensure better medical management techniques and better outcome."
Currie told the groups that he supported reevaluating TMAP and other approaches toward providing mental health services as new science becomes available. In August, SAMHSA had already started the wheels turning in that direction by publishing a notice in the Federal Register announcing its intent to develop a National Registry of Evidence-Based Programs and Practices (NREPP) in the area of substance abuse treatment and mental health services. It already has an NREPP for substance abuse prevention programs, and rates those as promising, effective or model; some programs receive no rating, which implies they are ineffective. State programs use those ratings as guidance.

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    Advisers to the Nation on Science, Engineering, and Medicine

Christine Mirzayan Science and Technology Policy Mailing Address:
Graduate Policy Fellowship Program 500 Fifth Street, NW, WS 809
Washington, DC 20001
www.nationalacademies.org/policyfellows

February 2, 2006
Ms. Vera Sharav
President
Alliance for Human Research Protection
142 West End Avenue
Suite 28P
New York, NY 10023

Dear Ms. Sharav:

I am writing to confirm your participation in a seminar entitled “Screening for Mental Illness in
Youth: Good Preventive Medicine?” on February 22, 2006 from 12:30-2:00 PM at the National
Academies—National Academy of Sciences, National Academy of Engineering, Institute of Medicine,
and National Research Council.

This seminar, conducted by the National Academies’ Christine Mirzayan Science and Technology
Policy Graduate Fellowship Program, is one in a series that focuses on a compelling science and
technology issue. Please note that the seminar is for educational purposes only and is not connected to a
National Academies’ project, report or committee. No report or summary will be produced from this
seminar.

We have invited Dr. David Shaffer from the Department of Child & Adolescent Psychiatry,
Columbia Presbyterian Medical Center to present his views on the scientific basis and benefits associated
with broad-based mental health screening of teenagers. Based on your efforts through AHRP to educate
about the medical and social concerns associated with this type of screening, we believe that you would
make an invaluable contribution to the discussion.

In addition to specific information you would like to convey, we are asking that both speakers
address the following questions during the seminar:
• What scientific data is available to support the reliable identification of youth at risk
for mental health problems?
• What are the steps taken after identifying a child at risk for mental health problems?
• Are there any social considerations that might impinge on the effectiveness of mental
health evaluations?
• How does broad-based mental health screening compare to alternative prevention
methods?

The seminar is 90 minutes long. Each panelist will be allotted 15 minutes for a short presentation,
followed by 40 minutes of questions and discussion. The audience will include members of our
fellowship class and National Academies’ staff who are interested in the topic. In addition, we will invite
relevant university and medical departments; government agencies, including local educational boards;
and interested non-profit, advocacy, and policy groups. The seminar is open to the public, so in addition
to individuals from other organizations, members of the press may be in attendance—hence, you may be
quoted. Prior to the seminar, you are invited to attend an informal lunch with our seminar group, if your
schedule permits.

We request that you kindly send us a short biography, which we will include in our publicity fliers.
You can email it to me using the address I’ve provided below. In order to give you more information
about the members of our seminar group, we have included our short biographical sketches.
To provide some more background, the fellowship program is in its 10th year. It is designed to
engage graduate science, engineering, medical, veterinary, business, public policy, and law students in the
analysis that informs the creation of science and technology policy and to familiarize them with the
interaction of science and technology with the government. If you would like to know more about the
program, please visit the website at http://www.national-academies.org/policyfellows.

As you are aware, there is no travel budget for this seminar, nor can we offer compensation for your
time. Unfortunately, panelists who do not live locally must travel at their own expense. We hope this will
not be a problem.

As a follow-up, we will contact you in the next few days to answer any questions and to reconfirm
your availability to participate. Should you have questions or feedback in the meantime, I can be reached
at the contact information below.

Sincerely,


Kathryn Miller-Jensen
Science and Technology Policy Graduate Fellow
(202)334-3979
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National Academies’ Christine Mirzayan Science & Technology Policy Graduate Fellowship Program
2006 Winter Seminar Group on Screening for Mental Illness in Youth: Good Preventive Medicine?

Kristin Bullok, Ph.D.
Eleanore Edson, Ph.D.
Giovanna Guerrero, Ph.D.
Kathryn Miller-Jensen
Scott Rowan
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