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Patrick D Hahn

Patrick D Hahn
Baltimore, Maryland, USA
June 07
I used to wash trucks for a living.


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DECEMBER 22, 2011 10:03AM

Just say No to TeenScreen

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one pill makes you taller 

TeenScreen, a program sponsored by the National Center for Mental Health Checkups of Columbia University, offers “free tools and materials to health care, educational and community-based professionals to screen for depression and mental illness in adolescents.” Their website states “Our active federal and state policy efforts encourage expanded availability of mental health screenings and early identification of mental illness for all adolescents” and reminds readers that “Suicide is the third-leading cause of death among 10-24 year olds.” 

Screening takes place in schools, primary care settings, and “community-based sites.” Subjects complete a short questionnaire, either on paper or online. Apparently there is more than one version of the questionnaire, and none of the versions is available on the TeenScreen website, but sample questions I have culled from reputable news sources include “In the past month, how much of a problem have you had with feeling unhappy or sad?” and “Have you often felt very nervous when you've had to do things in front of people?Something like 30% of subjects who take the test are judged to be in need of further assessment. About half of those are referred for a complete evaluation.  

Why do they do this? The TeenScreen website states: 

"The U.S. Preventive Services Task Force (USPSTF) recommends annual depression screening for all 12-18 year olds. This recommendation was based on the task force’s findings that:

  • adolescent depression is associated with serious long-term morbidities and risk of suicide
  •  screening questionnaires can effectively identify depression in adolescents; and
  • effective treatments are available."

The first point is stunningly banal. Of course depression is associated with a risk of suicide. Happy people do not kill themselves. We already knew that.  

 The second point is also stunningly banal. Since depression is defined by your responses to a list of questions (and not, as some would have you believe, by documenting some fabled “chemical imbalance” in your brain), all they are saying is that your responses to a list of questions effectively predicts your responses to another, similar  list of questions. That’s not really very surprising. 

As for the third point: Anyone who has taken the trouble actually to read the article in Pediatrics upon which the USPSTF based its recommendations knows that the authors explicitly state there is no data showing that screening youths for depression leads to any favorable outcome, let alone a reduction in suicide rates.  

The folks at TeenScreen sure do like the phrase “evidence-based.” But where is the evidence that screening for mental illness accomplishes anything besides increasing the likelihood of being labeled “mentally ill,” and of becoming a client of the psychopharmaceutical industry? It’s time to stop assuming that these are good outcomes.   

The TeenScreen website states, “The TeenScreen National Center…does not advocate for any specific treatment.” But these days, psychiatric treatment is virtually synonymous with drugs. The drugs of choice for depression are Selective Serotonin Reuptake Inhibitors, or SSRI’s. A meta-analysis by David Healy and Chris Whitaker found that SSRI’s doubled the risk of suicide.  

There’s more. There was a time when bipolar disorder was diagnosed in children so rarely that most clinicians believed that juvenile bipolar disorder did not exist. Well, no one disputes that it exists now. A study published in the American Journal of Psychiatry found that half of prepubertal children treated for depression became bipolar during a ten-year follow-up period. Hundreds of thousands of young people have been saddled with a crippling, possibly lifelong mental illness as a result of these drugs.  

Oh, by the way: a study of subjects receiving outpatient treatment for bipolar disorder found that eighty percent of patients diagnosed with bipolar disorder were prescribed SSRI’s, and eighty percent of them were prescribed atypical antipsychotics. Both classes of drugs are associated with an increased risk of suicide in patients with bipolar disorder.  

Since the outcome for individuals with these conditions has gotten far worse since these drugs were introduced (a point they readily concede in the psychiatric literature), what basis do they have for saying these treatments are “effective” at anything besides fattening the profits of the drug companies? Given that we are already spending zillions to propagandize young people to “Just say No to drugs,” does any of this make any sense? 

So is all this a ploy to make more money for Big Pharma? The TeenScreen website states, “The TeenScreen National Center does not receive support or funding from the pharmaceutical industry…” 

So where do they get their funding from? According to their website, in 2010 they received less than one percent of their funding from non-profit public charities and individual owners. The remaining 99+ percent came from “private family foundations.”  

Which private family foundations? They don’t provide a comprehensive list, but they do coyly note that “We have received generous core support from the Carmel Hill Fund, a private foundation, as well as the Sallie Foundation and individual donors.”  

A Google search immediately led me to the official website for the Carmel Hill Fund, which describes the organization as a “private foundation established by Mr. William Ruane in 1986, [which] supports social service, mental health, and education initiatives.”  

How about the Sallie Foundation? A Google search for the “The Sallie Foundation” (with quotation marks) produced all of 75 hits. The website charityhappenings.org refers to the organization as “The Sallie Foundation to Benefit TeenScreen & the Columbia University Psychiatric Department.” The Columbia University Medical Center website notes that “The Sallie Foundation made gifts totaling $700,000 to enhance research and clinical care initiatives in the Department of Psychiatry.” Elsewhere they note that “The Sallie Foundation made a gift of $100,000 to support children’s initiatives in the Department of Psychiatry.” Apparently, the sole function of the Sallie Foundation is to funnel money to the Columbia University Department of Psychiatry and TeenScreen. None of the links mention any other recipient of funds from this organization.  

And where does the Sallie Foundation get its funding from? You can’t log on to their website and find out, because they don’t seem to have one. I checked every one of the links, and none of them led to anything that could be construed as an official website. Very strange, for a foundation that deals in grants reaching (at least) the high six figures.  

So TeenScreen makes a point of telling you their National Center does not take money from the drug companies, but they do take money from a shadowy organization that get its money from… where? There doesn’t seem to be any way to find out.  

That’s.. kinda interesting.  

Oh, as long as we’re on the subject of money: before accepting her current position,  TeenScreen Executive Director Laurie Flynn spent sixteen years as the Executive Director  the National Alliance on Mental Illness, whose 2010 Annual Report lists among their sponsors AstraZeneca, the maker of the antipsychotic drug Seroquel; Bristol-Myers Squibb, the maker of the antipsychotic drug Abilify; Forest Laboratories, the maker of the antidepressant drug Lexapro; Eli Lilly, the maker of the antipsychotic drug Zyprexa; Pfizer, the maker of the antipsychotic drug Geodon; Corcept Therapeutics, the maker of the drug Corlux for psychotic depression; Dainippon Sumitomo Pharma, the maker of the antipsychotic drug Lonasen; GlaxoSmithKline, the maker of the antidepressant drug Paxil; Ortho-McNeil-Janssen Pharmaceuticals, the maker of Concerta for ADHD; Lundbeck, the maker of the antianxiety drug Tranxene; Novartis, the maker of the antipsychotic drug Clozaril; Otsuka America Pharmaceutical, which co-markets Abilify with Bristol-Myers Squibb; Sunovion, the maker of the antipsychotic drug Latuda; and Shire, the maker of Adderall for ADHD. Not to mention Psychiatric Solutions Inc., which owns and operates psychiatric hospitals and manages psychiatric units for people with illnesses such as schizophrenia and manic depression.  A 2009 article in the New York Times noted that for the period 2006-2008, fully three-fourths of NAMI’s funding came from the drug companies.  

If you followed up the links I provided in the above paragraph, you’ll know that in just the past five years, the first five companies I mentioned have paid literally billions of dollars to settle US Department of Justice claims against them for illegal marketing of psychotropic drugs. No doubt that have all come out well ahead. If an individual with that kind of history of lawlessness came to your home to fix your sink trap, would you open the front door? 

Would a sane society allow characters like these anywhere near its children? And does anybody see a potential downside to talking up the idea of suicide with our children, as if that is what we expect of them? That might lead to unintended consequences.  

The TeenScreen website notes there is no data showing that talking to young people about suicide leads to an increase in suicide rates. I’m willing to believe this is true, but to make that point without mentioning that there also is no data showing that programs like TeenScreen lead to a decrease in suicide rates is the height of mendacity.   

Photo via Wikimedia Commons



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I anyone has any first-hand experience with "TeenScreen" (who thinks up these names?) I'd like to hear from you.
If anyone has any first-hand experience with "TeenScreen" (who thinks up these names?) I'd love to hear from you.
One of the papers linked to on the TeenScreen website is “School-Based Suicide Prevention With African American Youth in an Urban Setting” by Melanie Brown and Julie Grumet. The authors mention, in passing, that 17% of the students who consented to screening were absent the day screening was conducted, and they also mention that the turnover rate of high school principals in the District of Columbia may be as high as 40%.

If 17% of students are absent on any given day, and if a school gets a new principal every two-and-a-half years, I’d say they have more urgent priorities than screening for depression.
I don't have any experience with "TeenScreen", therefore I thank you for writing about it. There's so much in your piece to comment with due respect to your post. I agree with the second paragraph in your second comment here, though, and to me it sums up the spirit in this piece.