Monday, October 02, 2006

Universal mental health testing for children debated

Herald Republican (Indiana)
Universal mental health testing for children debated
Sunday, October 1, 2006

NORTHEAST INDIANA — In an era not all that long ago, people looked at little boys like Craig (not his real name because he still is a student in a northeast Indiana public school) and clucked their tongues as they reprimanded him.

Then, even if he had earned a spanking, and had dutifully received one, they would turn to a fellow adult and sigh, “Ah, but boys will be boys — won’t they?”

That’s not to say that they approved of whatever the boy had done; and, it’s not to imply that spanking is the solution to social, behavioral or emotional problems, then or now. It especially is not to validate or excuse bad behavior in boys by virtue of their gender.

But, according to Craig’s mom, who has other children in a blended family, and who is coping with the same stresses and parenting challenges that other divorced-and-remarried mothers of today face, the modern alternative for addressing this type of behavior in boys like Craig — psychotropic drugs — isn’t acceptable either.

And, even though Craig’s problems have cropped up both at school and at home, she is adamantly against mental health screenings through the schools, either voluntarily or as mandated through Indiana’s 2005 law, Senate Enrolled Act 529.

SEA 529 addresses a number of issues dealing with children, including foster care, daycare, adoption and the formation of a new administrative-level agency called the Division of Child Services. Also within the law is a mandate for the creation of a document called the Children’s Social, Emotional and Behavioral Health Plan, which outlines how the state should deal with children’s mental health issues.

Another part of that SEA 529 mandates that “social, emotional and mental health screening be included as a part of routine examinations in schools and by health care providers.”

Counseling, not drugs

“Craig is very intelligent, and he’s rated very high on IQ tests,” “Sylvia” said. “But his grades were poor because he couldn’t focus. He had other things going on in his life that made him feel depressed, and then something happened at school that caused him to be suspended from going on a school trip, and that was just the beginning of more depression.”

Wanting to do whatever she could to help, Sylvia took her son to a mental health agency for counseling, where he was evaluated and treated.

“They immediately put him on an anti-depressant,” Sylvia said. “And, within a week, he gained almost 20 pounds. It was unbelievable. That’s when I found a note he’d written, saying he was going to kill himself.”

Suicide. One of the reasons given by proponents of universal mental health screening for school children is to prevent suicide. The tests can highlight behaviors, moods, habits or thinking processes that could mean a child is suffering from a mental disorder or depression that possibly could lead to suicide, testing advocates say.

The screenings, given anonymously in schools with parental consent, can help parents decide whether to seek further evaluation of their child’s mental health, as well as give the child a chance to utilize school or outside counseling services, proponents say.

But, opponents claim that, too often, professionals’ “treatment” of mental problems is simply a prescription like what Craig received.

“And that is wrong,” Sylvia said. “For one thing, look at the warnings on the drugs — they say a child shouldn’t be taking those drugs! I had no idea at the time that sometimes they can even cause a child to consider suicide, when they hadn’t before they were on the drugs.

“With my son, he had the (suicide) letter all written. He had the stuff in his room to do it with. Thank God he didn’t go through with it, that I found the note.”

Craig ended up in a hospital. He was treated and released and returned to school. But even though confidentiality is supposed to be the rule in this type of situation, it was soon evident that some faculty didn’t intend to maintain that confidentiality.

Within two weeks, Sylvia was back at the school, this time fighting for her son’s dignity and sense of self-worth. Today things are going “OK,” she said, and she doesn’t want to upset the apple cart by exposing anyone with names, dates or places.

“But I still don’t see a reason for testing for this in school,” she said. “I am completely opposed to this screening in the schools. Instead, I think teachers need to be educated on how to handle kids, even the ‘bad’ ones.

“The schools should make sure teachers communicate with the parents. And, they need to be trained in recognizing real problems from everyday experiences that might upset a child. They need to be sensitive to things like divorce or death. Did a grandparent die yesterday?

“Did your daughter break up with her boyfriend? Or, think: Did you ever feel like, as a kid, that you’d like to commit suicide, but not really consider it? That doesn’t mean you’re suicidal or that you should be on drugs.

“What they should be doing is putting the school people through a course that helps them understand their students’ problems, so they know better how to handle them, things like peer pressure, for example,” Sylvia said.

“But, today, the answer seems to be, ‘Let’s just drug them so we don’t have to say ‘no’ or deal with the real problem. And I just don’t see a reason for that. With my son, we got a new counselor and he’s NOT on medication, and he’s doing fabulous now.”

No conflicts

Accused of having several conflicts of interest while serving on a committee charged with writing Indiana’s Children’s Social, Emotional and Behavioral Health Plan, Robert Postlethwait, of Indianapolis, flatly denied that his interest in Indiana’s school mental health plan was anything other than as a parent.

He has a family member with a mental disorder, he said, and he served as a “family representative” on the task force that formed and wrote the health plan because he was asked to by the task force’s director, Karen Schunk. (He was the only parent representative on the task force, according to a roster provided by Schunk.) He also was a member of the Indiana Mental Health Commission, the group to which the task force was to make its recommendations, but he has resigned from that group, he said.

“So a potential for conflict there doesn’t really exist, does it?” Postlethwait said in an interview this past week.

However, Postlethwait’s affiliations with the mental health industry — and the drugs used to treat mental disorders — include a nearly 30-year stint with Eli Lilly & Co., with his last position there as president of the neuroscience unit. (Two products of that department are Zyprexa, a drug used for treating schizophrenia and bipolar disorder, and Prozac, a drug for depression, obsessive-compulsive disorder and panic disorder, as well as certain eating disorders.)

Postlethwait also contributed enough money at its start-up a few years ago to DarPharma, a company that develops drugs for psychiatric diseases, that he was mentioned in the North Carolina Triangle Business Journal for helping the new company reach a $3.3 million fundraising goal.

Then, in 2004, DarPharma announced that it had added Postlethwait to its board of directors. He also serves on the advisory board for TeenScreen, a controversial in-school mental health screening test that currently is the center of a lawsuit in Mishawaka, which claims that a child was administered the TeenScreen test without parental consent.

He is a member of the National Alliance for the Mentally Ill, and served for four years on the board of directors of the American Foundation for Suicide Prevention.

His education includes a bachelor of science in chemical engineering and a masters in business administration.

Postlethwait also served on President George W. Bush’s New Freedom Commission, which recommended universal mental health screening for children, specifically mentioning TeenScreen as a “model” program.

But none of his prior or present affiliations have anything to do with his reasons for serving on the children’s mental health task force, Postlethwait insisted. He stressed that the plan the task force produced does not call for mandatory testing but, rather, spells out clearly that parental involvement and parental consent are essential if children are tested.

However, he also said he didn’t know that SEA 529 mandates the testing for Indiana children birth through age 22 with the word “shall,” and asked to be sent a copy of the part of the law that does say that. (It is Section 79, IC 20-19-5, Section 2, subsection (5).)

He reiterated that nobody on the task force intended the testing to be mandated.

“The plan is what it is,” Postlethwait said. “I guess you could make a case that the task force didn’t fulfill its obligations under the law (if SEA 529 says the agency was supposed to include it).”

Plan has pluses

“I think a big plus for this plan is that the parents are to be involved in bringing them closer to a situation with their child,” Postlethwait said. “I’m very involved with common sense parenting. I think parental involvement is a main thing needed in today’s world.

“The best part of this plan is the interaction of people with each other, whether its the parents or the family including siblings, to understand what really happens at the grassroots level.”

Two important components essential to a child’s mental health have come out of this plan, Postlethwait added. One is that it recognizes that parents’ involvement with their children is very important. The other is that, under this plan, not only the children but their families and even their siblings, can receive needed help, from meeting court dates to securing medical appointments, with a continuum of care that includes a team working with the family.

“A big part of this is just being aware of what this policy will do for them,” Postlethwait said. “I don’t know if (presenting this type of care) in the schools is the answer. But there are some models, for example, one in Houston, with a community-in-the-schools program that have shown improvement in outcomes.

“Lives have been saved — and it’s important to do that where the kids are, whether it’s with coaches or parents or teachers. One could say school is the place where behavior and emotions are observed, so that would be the place to identify those things (that point toward mental disorders).

“I don’t have all the answers. But if I can help other parents, other families, out of a situation, that’s what I want to do. I just want to contribute help from a parent’s point of view.”

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