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Below I have outlined a letter that was sent to
my local school psychologist about the problems
with the Teen Screen program that he started in
our schools. I made only a few minor
changes for accuracy and numbered the points for
ease of reading. Keep in mind he reported
me to the licensing board in response to this
letter. The board reviewed everything and
sent a letter to us indicating his alligations
that I was acting unethically was "unfounded"
and no action would be taken. Ironically,
he violated the one of the first Ethical
Codes...in that he should have contacted me
first to resolve the concern before contacting
the Board. I, in turn, offered to consult
with him but he never responded to my request to
meet.
Dr. Watson
November 17, 2006
Sheboygan South High School
Dear ...,
Thank you again for meeting with my psychology
interns and myself a few weeks ago. This
meeting, and the TeenScreen training I attended
by you last year, helped me better understand
the overall program. Based upon the review of
the screening program, I have serious concerns
about how it can negatively impact our community
and youth.
As you are aware, I am interested in
TeenScreen due to the overwhelming power
it has on the students, parents and our
community at large. You are in a unique
position, given the number of students you
encounter, and the many other individuals you
will meet as a result of this program, such as
parents, caregivers, and community groups.
I recognize the importance of extending help to
those in need, and in having an active interest
in students’ academic and emotional well being.
However, TeenScreen is not the best course of
action for helping our young community. I hope
you carefully review the concerns listed below,
do a follow up review of the information I
provided, and track any benefits and the
negative consequences the program for future
reference. My interns and I were pleased to
hear that you decided to break from the
TeenScreen protocol Manual, which clearly
endorses and uses language endorsing referrals
to medical practitioners (e.g. psychotropic
drugs), and instead decided to use your own
judgment when telling parents where to obtain
treatment.
Due to multiple and serious concerns regarding
the Teen Screen program, I am forwarding this
letter to the School Board for review as
well. Despite the fact that this program could
in essence increase revenue to the our clinic, I
would rather forgo the increase because of the
serious problems that will result from the
TeenScreen Program. If, after reviewing the
information below, you or the school Board would
like to conduct a point-by-point discussion
about the program, obtain references to any of
the data or information I am providing, or
choose not to endorse the program (i.e. as did
several other school districts including most
recently as last week in Kenosha, WI, and in
Pinellas County School District in Pinellas, FL,
and also in Fresno Unified School District in
Fresno, CA), I would be happy to meet with you
to discuss creating a specific outreach program
for our young community, one that may be more
cost effective in the long run.
Kindest Regards,
Dr. Toby T. Watson, Psy.D.
Clinical & Doctoral Training Director
Clinical Psychologist
Regarding the
TeenScreen Program:
1.
As you are aware, Psychiatry and psychology are
unlike other branches of health and medicine.
They do not adhere to the same rigorous
objective standards for diagnosing, but are
subjective, without a single biological test for
any psychiatric disorder. There is poor
agreement among mental health professionals, not
only for diagnosing and ways to screen if there
is anything to focus upon, but there is also
poor agreement about the cause for all the
disorders - often called “illnesses.” Lastly,
you know the mental health system has even
poorer agreement as to the best treatment
approach for the behaviors we label.
As such, I am concerned that our local schools
began making psychiatric and psychological
referrals based upon a subjective test that identifies
50% more students as at risk than highly trained
clinicians (e.g. as per the
TeenScreen training session that
stated approximately 50% of the students sent to
the clinician for an immediate follow-up mental
health screening interview will not be
found in need of an outside referral). Given
the subjective nature of the mental health
field, it also should be concerning that of
the 60% of the
student body that takes the TeenScreen
test, 16% of
the interviewed students will be referred to an
outside “practitioner” or agency. I
know you stated that our community we only had
approximately 50% screened and that about 11%
were referred to outside practitioners, but I
have not heard back from you with regards as to
where these children were sent (e.g.
psychiatrist or other medical doctor for drugs,
family treatment or individual counseling).
2.
Since I still have not heard where the children
are being sent, despite the request, and since I
inquired numerous times at the training session
about the referral process, but was told the
group could not go into details about the
guidance counselor training or referral process,
it is clear the TeenScreen program does not want
to discuss where they are sending these
children. I image this is why it was almost
impossible for me to obtain the training manual
about the program.
When I am asked to conduct a client-centered
consultation and to make treatment referrals
and/or recommendations, the clinical interview
and data collected from this in-depth interview
guides my treatment referrals and
recommendations. The program appeared much more
appropriate when I heard that the “interviewers”
were able to engage in discussion and follow up
questioning when a student was marked as having
a “mental illness” or problem, but
unfortunately, Teen Screen does not allow for
the one who has all the information to make the
referral (e.g. the actual mental health
professional who volunteered time and talked
with the student initially), but rather the
program requires that the one individual
who was trained by TeenScreen, who may not have
any in-depth psychological training, is the one
to make all the referrals.
Your referral process, debriefing discussion,
and verbal discussions with parents will
ultimately direct their understanding of any
potential problem, and will also direct their
choice in treatment (e.g. family therapy,
individual therapy, pastoral counseling,
psychiatrist, neurologist, pediatrician,
etc...). Given this, I am sure you understand
the significant and considerable difference
between seeing an individual therapist
specializing in child-adolescent therapy,
obtaining skill-based education, and obtaining
an average fifteen minute medical consult,
whereby the
data states that 90% of TeenScreen subjects will
walk out with a prescription for a psychotropic
drug.
The mental health field has continually been
plagued with each specific treatment camp
claiming to have the best type of treatment for
a particular disorder. However, with recent
meta-analysis data coming out about the
effectiveness of particular treatments, it has
become even more confusing for researchers and
practitioners alike to decide which treatment
may serve a particular client best (Kirsch &
Moore, 2002; Prevention and Treatment, Vol. 5,
#23). Since the mental health field has not
been consistent in determining a “best course of
treatment”, nor has it agreed upon any approach,
I can only hope you personally decide not to
follow the other TeenScreen
programs that
predominantly and/or only states you will
refer to practitioners/physicians who in
turn prescribe psychotropic drugs. I hope you
will keep categorical referral records, and will
allow researchers like myself access to this
data to determine if the program actually has
any benefit.
Regarding the letters that are sent to parents,
I am concerned that the three letters you handed
out to us during the training session (e.g. one
thanking the parent for the follow through on
the TeenScreen recommendation, one stating the
parent agreed to the screening but the child
chose not to take the test, and a third stating
the parent did not comply and seek treatment for
their child which was against your and the
TeenScreen recommendation) are not the only
letters that could be sent to a parent or child
protective agency. I still have not seen the
other letters you were going to forward to us
for review. Nevertheless, the last letter
indicated above assumes that a parent did not
seek a consultation after hearing that the
TeenScreen check-off list marked their child as
potentially having a “mental illness” or
problem. This letter does not account for the
possibility that a parent sought out another
opinion or even obtained treatment but simply
wants to protect their family privacy from the
school system and government (i.e. they did seek
counseling and simply did not tell the child’s
school about it.) During the training session,
you mentioned a certified letter that would be
sent to parents if they did not respond to
initial letters. Based upon the numerous
attempts to get children screened and the
numerous follow up letters available, it is
clear the goal is to have the parent follow the
TeenScreen/school treatment recommendation.
Again, this places the TeenScreen and the
school’s recommendation in a very
influential and powerful position. To this
extent, I really am interested in your “training
program” for making these recommendations,
especially since my son and daughter could be
potential South High School TeenScreen
statistics.
3.
I am also concerned that during the training
session you made reference to the support of the
TeenScreen Program, but failed to mention
anything about its drawbacks and limitations or
of the mental health professionals who oppose
it. As a researcher, it is difficult to weigh
the pros and cons of a program when discussion
focuses only upon how beneficial it might be,
but fails to produce peer reviewed evidence
demonstrating the benefits and failures of the
program.
Most importantly, there is no peer reviewed
data to suggest that the Teen Screen Program
lowers suicides. Instead, TeenScreen’s own
and co-director, Rob Caruano, has acknowledged
there is no
proof or data available to
demonstrate that the program reduces suicide
rates (Dec. 22,
2004; South Bend Tribune-IN by D. Rumach, “Teen
Screen assesses mental health of high school
students.”) Additionally, TeenScreen was
established in Tulsa, Oklahoma in
1997
. According to a 2003 Tulsa World newspaper
article, Mike Brose, executive director of the
Mental Health Association in Tulsa, stated: “To
the best of my knowledge, this is the highest
number of youth suicides we’ve ever had during
the school year -- a number we find very
frightening.” If the program is supposed to
work, how can you explain this?
Researchers and psychiatrists alike are coming
forth saying TeenScreen is unworkable. Nathaniel
Lehrman, MD, former Clinical Director of
Kingsbro Psychiatric Center in Brooklyn, NY, and
Assistant Clinical Professor of Psychiatry at
Albert Einstein & SUNY Downstate Colleges of
Medicine, stated, “The claim by the director of
Columbia University’s TeenScreen Program that
her program would significantly reduce suicides
is unsupported by the data. Indeed, such
screenings would probably cause more harm than
good. It is impossible, on cursory examination,
or on the basis of the Program’s brief written
screening test, to detect suicidality or “mental
illness,” however we define it.” Dr. Lehrman
and I discussed these issues in person in
October, and he was quite clear that even the
process of screening for mental disorders can
evoke or create psychiatric symptoms, thus
leading to and possibly accounting for all the
False Positives that the
TeenScreen researchers acknowledge. He and I
also agree that by having the screening device
in the schools, with all the pressure to take
the test from teachers, counselors, parents,
etc..., violates the privacy of those in whom
these subjective “diseases” are sought.
Additionally, Dr. Marcia Angell, Harvard Medical
School professor of Ethics and best selling
author, stated
that the TeenScreen Program “is just a way to
put more people on prescription drugs” and that
such programs will boost the sales of
antidepressants even after the FDA in September
ordered black-box warning labels, warnings that
stated that these drugs will not reduce, but
rather create suicidal thoughts or behaviors
in minors (The New York Post, December 5,
2004). As a result of the black-box warning
labels that stated the SSRI
antidepressants cause suicides and suicidal
ideation, even in people who are not suicidal,
sales instantly and sharply fell. Nonetheless,
our school system has adopted a catch-all
screening program that was created by previously
paid drug company representatives and
researchers (e.g. Laurie Flynn).
4.
I am concerned about the inference you made
during the training session last year, an
inference I pointed out during our meeting with
the interns, whereby you stated the decrease in
suicides over the past few decades was the
result of the SSRI antidepressants. As you
recall, you showed a graph demonstrating the
reduction in suicides for our youth; however,
you indicated that the decrease came as a result
of the antidepressants drugs commonly called
SSRI’s coming to the market. This is simply not
true, as there is no data to support such an
inference. Instead, the
FDA and
research has been quite clear: if you take
an SSRI antidepressant drug, such as Prozac,
Paxil, Luvox, or Effexor, you will be
more likely to commit suicide and to have
suicidal ideation, all things being considered.
Because the increase in suicide from taking
SSRIs has been so clearly demonstrated, the
Medicines and Health Products Regulatory Agency
(MHRA), the equivalent to our FDA, in Great
Britain recently banned all but one of
the SSRI’s for anyone under the age of
eighteen. MRHA also noted that it could not
be certain that the one remaining SSRI drug,
Prozac, had caused people to commit suicide
or become suicidal, and stated Prozac
“only worked in one of out ten cases.”
The drug companies are unable to find one study
showing a reduction effect, but yet you
allowed this inference to be made to all the
counselor attendees at South High. I hope
you are not continuing to make this inference,
as it is unethical and inaccurate at best, and
dangerous and proven to be deadly at worst.
5.
Likewise, there is no data proving that
screening will prevent suicides, which is
the reason this screening program came about.
According to The U.S. Preventive Services Task
Force (May 2004):
A. “There is no evidence that screening for
suicide risk reduces suicide attempts or
mortality.”
B. “There is limited evidence on the accuracy
of screening tools to identify suicide risk.”
C. “There is insufficient evidence that
treatment of those at high risk reduces suicide
attempts or mortality.”
D. “No studies were found that directly
address the harms of screening and treatment for
suicide risk. “
6.
I will address the reason the FDA and the Teen
Screen program did not follow Great Britain’s
actions later, but for now, I believe the SASD
and you personally need to consider the
following concern.
If the Sheboygan Area
School District (SASD) and its counselors who
favor TeenScreen adopt a program that has a
tendency or makes it customary to refer to
“practitioners,” whereby the leading referral is
to a medical doctor, knowing that approximately
90% of psychiatric referrals lead to a
prescription (Journal
of the American Academy of Child Adolescent
Psychiatry, 2002), and the SASD and their
counselors have been made aware of the serious
health problems associated with these
antidepressant, stimulant and
neuroleptic drugs, and finally, if the SASD and
its counselors know that the number of students
referred could exceed the number of students
actually in need of true mental health
assistance (e.g. based upon the difference in
the screening instrument and a clinician’s
expertise), then the Sheboygan School District
and its counselors could be found liable for the
negative consequences that will ultimately
result from this program.
I know of only one case in which someone was
potentially liable and needed to pay for not
medicating a child, yet there are thousands and
thousands of cases in which children are harmed
by these drugs, doctors and school system
recommendations/referrals. I found no less than
four specific cases recently going through the
court system whereby a child or their parents
sued their school district for the TeenScreen
Program. This number does not include the
dozens of cases that came up for teachers,
counselors and school officials referring
students to medical doctors for psychotropic
drugs outside of the TeenScreen Program and
settled outside of court, sealing all documents
from the public eye.
Now that I have addressed several concerns, I
would like to review how and why the program is
being so quickly accepted across the United
States despite the lack of evidence that it
lowers suicides.
7.
I am also concerned about where the TeenScreen
came from. As you know, TeenScreen was
developed by psychiatrist David Shaffer of
Columbia University and New York State
Psychiatric Institute’s Division of Child &
Adolescent Psychiatry. Shaffer is a paid
consultant for pharmaceutical companies that
make psychotropic drugs (see page 21
of Executive Summary report, dated Jan. 21,
2004; American College of
Neuropsychopharmacology, “Preliminary Report of
the Task Force on SSRI’s and Suicidal Behavior
in Youth.”) He has served as an expert
witness for and on behalf of various drug
companies, and he has been a paid consultant for
specific psychotropic drugs. Some of
his suicide surveys are made financially
possible through an educational grant from
Pfizer Inc., once receiving over $1,250,000
from just one of the drug company
(see American Foundation for Suicide Prevention
press release, May 8, 2000.)
In December of 2003, British drug regulators
recommended against the use of SSRI
antidepressants in the treatment of depressed
children under 18 because some of the drugs had
been linked to suicidal thoughts and self-harm.
However, according to a Dec. 11, 2003, New York
Times article, Shaffer, at the request of the
maker of a psychotropic drug, attempted to
block the British findings from being released,
sending a letter to the British drug agency
saying that there was insufficient data to
restrict the use of the drugs in adolescents.
The director of the TeenScreen Program is Ms.
Laurie Flynn. Ms. Flynn and the TeenScreen
Program initially searched the newspapers
throughout the US looking for reports of teens
who had committed suicide. When they found such
a tragedy, the program then sent a letter to the
editors of the local newspaper telling them
about how the TeenScreen Program could be a
“solution” (Goode, E., British Warning on
Anti-depressants Use for Youth, in New York
Times, Dec. 11, 2003.) Like Shaffer,
Flynn also had financial support from
pharmaceutical companies that make psychotropic
drugs. She served as the director of the
National Alliance for the Mentally Ill (NAMI),
which received no less than 11.7 million
dollars from 18 different drug companies from
1996-1999, the largest being Eli Lilly,
maker of Prozac. Ms. Flynn demonstrated her
interest in trying to get children screened,
calling for a “horse to ride” in order to gain
access by an individual within or close to the
school district board (see letter at http://www.psychsearch.net/Flynn_email.pdf).
Lastly, Ohio Mental Health Director, Michael
Hogan, and California Director Stephen Mayberg
are part of the TeenScreen Advisory Board.
Hogan is also part of the New Freedom Commission
on Mental Health, created by President Bush,
Senior. The New Freedom Commission on Mental
Health recommends the use of
“state-of-the-art treatments” using “specific
medications for specific conditions.” The
Commission also praised the Texas Algorithm
Project (TMAP) as a model medication treatment
plan. This federal program endorsed the
TeenScreen Program and called it a model program
that should be used in all schools, daycares and
agencies.
The TMAP program,
which sets the stage for TeenScreen, is a set of
guidelines for physicians to use when deciding
what medication to give to a patient for a
particular symptom or psychiatric problem.
The program advocates the use of newer, more
expensive antidepressants and antipsychotic
drugs, but when Allen Jones, an employee of the
Pennsylvania Office of Inspector General,
revealed that key officials with influence over
the medication plan in his particular state
received money and perks from the drug companies
to have the more expensive drugs listed higher
on the TMAP type program, he was fired for
talking to the New York Time.
Pharmaceutical giant Janssen took the lead in
exerting influence over state officials by
creating “advisory boards” made up of state
mental health directors who were regularly
treated to all expense paid trips and
conferences. By influencing 50 key officials,
the company knew that it would have a good shot
at getting a TMAP list adopted in every state.
For example, Ohio Mental Health Director Hogan
and California Director Mayberg, are New Freedom
Commission members who control mental health
services in their respective states, and both
are also members of a Janssen advisory board.
Hogan has proven to be so useful that Eli
Lilly gave him a Lifetime Achievement Award. In
granting the award it was noted that Hogan had
given over 75 paid presentations at conferences
since he accepted the position on Bush’s New
Freedom Commission. In every keynote speaker
engagement that Hogan has performed at, he has
been paid by a pharmaceutical company and the
conference has been sponsored by a drug
company. Interestingly, Bush Sr., who developed
the Freedom Commission on Mental
Health, endorsing TMAP and TeenScreen, was also
on Eli Lilly’s Board of Directors for many
years, holds heavy stock in pharmaceutical
companies, and obtains huge donations from such
companies.
More specific to TeenScreen, their Funding was
said to be given by private donations.
However, TeenScreen and Columbia University
refused to divulge the source of their funding.
Their website says they are funded by private
family foundations, corporations and
individuals, without naming them. One source
did give a clue to their funding: “A large
pharmaceutical company funded the TeenScreen
program in Tennessee”
(http://www.psychsearch.net/teenscreen.html,
see page 4, left, mid-page).
In Florida, Jim McDonough, the director of the
Florida Office of Drug Control, was sent an
email from Flynn threatening to pull funding if
more children were not screened in their
community (e.g. March 22, 2004, “We’ve been
working with David Shern and USF for 18 months
or so and still haven’t got a program
going....At this point I’m inclined to re-think
the use of our resources. We’re sending about
$120k to USF annually. . . . but ultimately
we’re not achieving our goals in the community,”
Flynn wrote.) Flynn later stated to McDonough
that she had to find kids to screen and said, “I’m
looking for a horse to ride here!”
According to Flynn’s testimony in March 2002,
she hopes to screen no less than 7-12 million
new potential drug company customers. I pose
the question, aren’t eight million kids on
Ritalin enough?
8.
Given the information above, I hope this raises
your suspicion as to the “true” agenda to the
TeenScreen Program, and has demonstrated
sufficiently how the program fails to produce
desirable results. The TeenScreen Program is
about making profits, not about helping
children. To this extent, I present some basic
profit calculations. According to the Teen
Screen 10 year
strategy,
TeenScreen wants to make the suicide survey
available to all American children.
Since 1991, the Columbia University Division
of Child and Adolescent Psychiatry has
invested nearly $19
million in the “research” and
development of the Columbia TeenScreen program.
I ask who will reap the financial return?
*There are
47.7 million
(47,700,000) public school students.
*There are
5 million
(5,000,000) private school students.
*Seventeen percent (17%) of the kids screened by
TeenScreen accept counseling (8,959,000)
based upon TeenScreen’s own low
estimates.
*According to TeenScreen, 9.9% of the kids
screened are drugged (5,217,300). TeenScreen
says less than ten percent (10%) are
prescribed some type of drug. This means that a
whopping 60% of kids who accept referral
counseling as a result of the suicide survey
wind up on drugs. Keep in mind these are
TeenScreen’s own numbers; actual figures may
be, and I am sure they are, much higher.
*One example prescription for a common
psychotropic drug is
$15.56 per
day.
*5,217,300 students (customers) x $15.56 per day
= $81,181,188 per day.
*$81,181,188 x 365 days a year =
$29,631,133,620 annually !
That’s nearly 30 billion dollars per year in
pharmaceutical sales courtesy of the TeenScreen
program.
Multiply that by a lifetime of addiction due to
down or up regulation of neuro-processing, and
it is no wonder why drug companies are tripping
over themselves to sponsor screening of
everyone in the United States (i.e. It is
mandated a few states already that every
pregnant woman and child, infant to 18 years
old, be mentally screened by every pediatrician,
school and day care every year. That is
three screenings per year, every year!). In one
Colorado
shelter study looking at TeenScreen, involving
over 350 youths, they found that over 50% were
at risk of suicide and 71% screened positive for
psychiatric disorders. That’s not
science, that’s a dream come true for drug
companies.
9.
Having presented all this, I would be happy to
work with the SASD if they are interested in
creating a specific program to address emotional
well being for our children. I think it is
noteworthy that a recent study comparing
cognitive psychotherapy to antidepressant
medication (Paxil) was published in the Archives
of General Psychiatry. The research was done at
the University of Pennsylvania and Vanderbilt
University using 240 patients. It was funded
by the National Institutes of Health (NIH), and
confirmed that the use of psychotherapy
intervention worked at least as well as the SSRI,
even with moderately to severely depressed
patients (keeping in mind that up to 90% of the
medication effect can be explained by placebo
effect-sugar pill; Antonuccio, D.,
Antidepressants: A Triumph of Marketing Over
Science?, In Prevention & Treatment,
Volume 5, Article 25, posted July 15, 2002.)
The study went on to report that if the patients
stopped taking the psychiatric drug, they were
twice as likely not to develop a
relapse of depression. The researchers called
for the American Psychiatric Association (APA)
to revise their treatment guidelines to
discourage the use of drugs for depressed
individuals, and yet our own school system is
adopting a program calling for more children to
be drugged.
I respectfully request that the following data
and information be made public and given to all
parents prior to encouraging any subjective
mental health screening in the schools, as I
believe the real issue here is parental rights
related to what they deem appropriate for their
children. I do not believe the Federal or local
government should interfere and have any
legitimate authority to direct a family’s
intimate health matters. I believe the parents
of Sheboygan should have a right to know about
hidden agendas and what could occur if
they disagree with the recommendations of the
School Counselor. I am asking that the SASD
offer an opinion regarding if they or any of the
TeenScreen referral agents are willing to report
parents to the Department of Health and Family
Services if a parent chooses not to follow the
recommendation and medicate their children or if
they disagree with the screening device that
states their child has a mental disease, as in
the cases of Matthew Smith and Shaina Dunkle who
died of medication toxicity after their parents
were coerced into placing their children on
drugs by their school and the screening program.
One last example and “nightmare”, as reported
by Aliah Gleason, was when she was taken from
her home, not allowed parental contact for five
months, was placed in foster care, and was
forced to take psychiatric drugs after a quick
screening device at her school told them she was
ill and in need of a referral to a
“practitioner.” These are tough questions that
have not been answered as of yet, and I believe
they need to be addressed before any child is
torn between a well-intentioned school district,
school counselor, profit driven program, and an
unknowing parent. I will be asking that the
SASD allow me and a group of other concerned
parents and professionals be allowed to address
the board at their next meeting.
Kindest Regards,
Dr. Toby Watson, Psy.D.
Clinical and Doctoral Training Director
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