by Karen R. Effrem, MD
While federal, state, and local officials are trying to improve student safety in the wake of the tragic Parkland, Fla., school shooting, the heightened concern over student mental health has greatly increased efforts to screen students for mental health issues. Two programs in Texas exemplify this push — with potentially ominous implications for student health, privacy, and freedom of conscience.
The first program from Texas Tech University, was described by Politico as follows:
USING TELEMEDICINE TO SCREEN FOR KIDS ‘ABOUT TO BLOW’: Texas Tech University Health Sciences Center President Tedd Mitchell shared glowing reviews of a telemedicine-based violence prevention program while he was in town last week. About 34,000 middle- and high-school kids were assessed as part of the project, created in six school districts around Lubbock after the Sandy Hook, Conn., school massacre. About 3,500 of the kids got counseling via telemedicine, and further winnowing resulted in tele-psychiatric care for about 300 of them, Mitchell told POLITICO. About 25 of the students were removed from school because they were deemed at risk for suicide or homicide, he said.
-“The good news with a program like this is, you can find those kids who are just about to blow,” he said. There were no shootings in schools during the period – a dubious achievement, perhaps, but as a secondary effect, absenteeism dropped and academic performance improved, Mitchell said. [Emphasis in original]
The other program, from the University of Texas Southwestern, seeks to bring mental health care and research into the schools. It is described as follows:
The role-playing session is part of a network of education and research programs UT Southwestern Medical Center is implementing in Texas schools to address a startling rise in teen depression and suicide across the country. By accessing classrooms to identify, study, and treat at-risk youth, experts are raising awareness in a vulnerable age group while obtaining critical data that could change the paradigm of combatting mental illness.
Besides helping students cope, the Risk and Resilience Network will assist scientists in a range of clinical endeavors, from developing blood and brain tests for diagnosis to identifying effective treatments and interventions.
There are so many problems with the foundation of these programs, it is difficult to know where to begin. Let’s start with the admitted subjectivity of mental illness diagnostic criteria. As the latest version of the American Psychiatric Association’s (APA) diagnostic handbook was about to be published, Dr. Dilip Jeste, APA’s president at the time, admitted:
At present, most psychiatric disorders lack validated diagnostic biomarkers, and although considerable advances are being made in the arena of neurobiology, psychiatric diagnoses are still mostly based on clinician assessment.
There are many similar quotes, but this one from the World Health Organization (WHO) is very important, because it deals with the even more complicated developmental issues that prevent accurate psychiatric diagnosis, especially in children and teens:
Childhood and adolescence being developmental phases, it is difficult to draw clear boundaries between phenomena that are part of normal development and others that are abnormal.
If the WHO, which is hardly a conservative, pro-family organization, admits that pediatric diagnosis can be confused due to normal developmental changes, this UT Southwestern program — featuring group psychotherapy sessions in schools that have the potential to amplify normal adolescent angst and blues into full-blown mental illness — hardly seems like a great idea.
The accuracy of mental screening instruments is also important to discuss given that both programs are doing mental screening in the schools. The Columbia Suicide Screen has a false positive rate of 84 percent. Others recommended by the American Academy of Pediatrics have false positive rates of 71 percent and 59 percent. [Those percentages are obtained by subtracting the low positive predictive values, which mean that a person actually has the condition being tested or screened, from 100 percent.]
In addition, the use of Texas students by UT Southwestern as guinea pigs for “developing blood and brain tests for diagnosis to identifying effective treatments and interventions” raises many troubling issues. The studies want to analyze “socio-demographic, lifestyle, clinical, psychological, and neurobiological factors.”
This raises issues of patient and family consent, data privacy, and freedom of conscience. This is especially true when there is already a troubling overlap between academic data that lives forever in state longitudinal data systems (SLDS) and medical, social emotional, and psychological data collected at schools that does not seem to be protected by medical confidentiality law (HIPAA). These changes have come about due to the gutting of FERPA, the federal educational privacy law, during the Obama administration and changes in ESSA, the replacement for No Child Left Behind.
There is definitely a need for more effective treatments for adolescent depression. The current record for children and adolescents is awful. According to the government-funded STAR*D study in which the doctor in the UT Southwestern article is involved, the standard medications used to treat depression, SSRI antidepressants, are only effective for about one third of patients. These drugs are associated with suicidal thoughts and attempted suicide in children and teens. In fact, these medications are under the FDA’s black box warning, the agency’s most serious warning short of a ban. The SSRI drugs are also associated with violent reactions, including murderous rampages like school and other mass shootings.
If combined with other classes of medication like antipsychotics, the effectiveness only increases to about half of patients. However, these other drugs have very serious additional side effects, including permanent abnormal movements, brain damage, obesity, diabetes, and heart attacks.
All of these dangerous efforts are ramping up after school shootings like those in Newtown and Parkland. As previously discussed, the focus on mental screening, especially by poorly trained teachers and school officials, which can lead to inaccurate diagnoses and dangerous, ineffective medications, should be strongly opposed. Students in Texas schools, or those in any other state, should not be used as lab rats for government or pharmaceutical industry researchers.
Root causes like family breakdown and the use of academically inferior, developmentally inappropriate, and psychologically manipulative standards in schools (i.e. Common Core) need review and solutions. Using mental screening and medication for these issues is like trying to put a bandage on broken leg.