by Karen R. Effrem, MD
In the rush to “do something” to respond to the horrific and tragic Parkland shooting in Florida, a Florida Senate committee considered bills on Monday that greatly expand mental screening and profiling of students, “harden” security at schools, fund more school resource officers, and arm teachers and others that volunteer and undergo extensive training and criminal background checks as well as a psychiatric evaluation. These were recommendations that came from three task forces put together by Governor Rick Scott that met last week.
The gun control debate and proposal to arm teachers dominated the discussion while the very dangerous and problematic mental health proposals went through unnoticed. These proposals include:
We have already written extensively in the context of social emotional learning about the problems of turning already over-burdened teachers into psychotherapists with a few hours of training when psychiatrists and psychologists are trained for years. And despite those years of training, there are many admissions from psychiatric experts and groups that psychiatric diagnostic standards are nebulous, especially for children, and that they are unable to accurately predict which people, even those with identified mental illness, will become violent.
Dr. Dilip Jeste, president of the American Psychiatric Association at the time the 5th Edition of the Diagnostic and Statistical Manual was published in 2013, has recently written:
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.
Dr. John Monahan, an expert psychologist involved in studies trying to predict violent behavior, as well as other experts interviewed by The Washington Post after the Sandy Hook shooting, made it clear that trained psychiatrists closely following patients are not able to do so:
Over the years, studies have shown that psychiatrists’ accuracy in identifying patients who would become violent was slightly better than chance — “obviously not good enough, given what’s at stake for public safety as well as for civil liberties,” said John Monahan, a University of Virginia psychologist who helped direct the MacArthur study.
In other words, psychiatric diagnosis is guesswork, and predicting violent behavior in known patients, much less children briefly screened, does not work even when done by experts. So, given the possibility for misdiagnosis that has no medical privacy protection in schools and will be added to longitudinal databases, training teachers for a few hours to screen and diagnose mental illness seems foolish and dangerous.
Mental screening for “at-risk” students is notoriously inaccurate. One study of a mental health screening instrument called TeenScreen admitted that the survey “would result in 84 non-suicidal teens being referred for evaluation for every 16 youths correctly identified.” This is very dangerous when treatment could include psychiatric medications that have harmful or even fatal side effects, such as suicide, homicide, aggression and hostility, heart problems, brain changes, and many more.
The problem with mental screening in general and with labeling “at-risk” children with a psychiatric label is that the already admittedly subjective diagnostic criteria discussed above are even more difficult to apply to children. The World Health Organization has said (and there are many similar quotes available here):
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.
Other psychological experts interviewed, even after the horrible Sandy Hook shooting, for The Washington Post story quoted above were opposed to expanded mental screening of children and teens:
“There is no instrument that is specifically useful or validated for identifying potential school shooters or mass murderers,” said Stephen D. Hart, a psychologist at Simon Fraser University in Vancouver who is the co-author of a widely used evaluation tool. “There are many things in life where we have an inadequate evidence base, and this is one of them…”
…“I think people are going toward wanting all their kids to be screened in high school for mental illness and violence risk — and that’s a bad idea,” said Gina M. Vincent, a forensic psychologist at the University of Massachusetts Medical School.
“We can’t go out and lock up all the socially awkward young men in the world,” said Jeffrey W. Swanson, a professor of psychiatry and behavioral sciences at Duke University.
The great irony of Sandy Hook, Parkland, and many other school and mass shootings is that the perpetrators were already involved in the psychiatric system, and many — an estimated 90 percent according to British psychiatrist Dr. David Healy — were already receiving medications or withdrawing from them at the time of their crimes. There is a known association between antidepressants like Prozac and violent behavior. There is also evidence of new or worsening aggression or hostility associated with drugs to treat ADHD like Ritalin. The Parkland shooter was reported in several places to be on ADHD medication and undergoing treatment for depression that may have included antidepressants.
Here is a list of major school shooting where information about medication association could be found in media reports derived from and documented by www.SSRIstories.org:
|17||Medications for ADHD & possibly depression, both of which are associated with increased or new hostility and violence||Parkland, Fla.||2018|
|10||On and off of medications and in and out of psychiatric hospitals||Umpqua Community College
|1||Prozac & Risperdal||Seattle Pacific University||2014|
|1||“Prescription antidepressant”||Sparks, Nev.||2013|
|3||Court documents that shooter was suffering from “hallucinations, psychosis, and fantasies”||Cleveland, Ohio||2012|
|1||Zoloft + ADHD Med||Huntsville, Ala.||2011|
|6||Prozac||Northern Illinois University||2008|
|33||Psych med found in shooter’s effects||Virginia Tech||2007|
|11||Prozac||Red Lake, Minn.||2005|
|3||“Diagnosed as a paranoid schizophrenic”||Appalachian Law School, Va.||2005|
|5||Ritalin||West Paducah, Ky.||1997|
|2||Xanax + Several other drugs||South Carolina||1988|
In addition to all of these problems, data from psychiatric screenings and assessments that occur in school does not appear to be protected by the medical privacy law HIPPA, but is only covered by the severely outdated and gutted education privacy law FERPA. This means that these highly subjective and inaccurate screenings will follow a child for life in states’ longitudinal data systems.
Also, consent is not mentioned once in the Florida legislation, despite federal legal requirements and professional ethical requirements of parental consent for the mental health assessment and treatment of minors. A lawsuit against the school that mentally screened an Indiana teenager without consent ultimately brought down the TeenScreen program.
Finally, increasing the number of school psychologists and social workers may help increase the availability of counseling for students with issues, but it may also lead to an increase in over-labeling and over-medicating of children.
Let us hope the Florida legislature hears the truth from many parents and experts before making such rushed and flawed decisions.