Mental Health Screening: A PhRMA Friendly Remedy for Societal Problems

1. Mental Health Screening: A PhRMA Friendly Remedy for Societal Problems Vera Sharav President, AHRP December 12, 2005

2. Orwellian nightmare • New Freedom Commission Recommends • screening the entire US population for mental illness • 52 million school children and 6 million staff • TeenScreen will increases number of children labeled with psychiatric illness • TMAPRx guidelines promote increased sales of highest price psychotropic drugs

3. Mental health crisis or marketing strategy? • The unprecedented increase in children being diagnosed with psychiatric conditions and prescribed psychotropic drugs can be traced to the collaborative efforts of the drug industry, organized psychiatry, and government. • A series of federally sponsored mental health initiatives, promoted the idea that children’s mental health was in crisis, and early intervention is essential. • The Rx intervention: 91% of the time • is drugs.

4. Rx for U.S. children—98% off-label • 1995-1999: psych Rx for <18 increased: • stimulants up -------------------------------------------- 23% • SSRI antidepressants up -----------------------------74% • 7-12 age group increased -----------------------------------151% < 6 age group increased ------------------------------------------ 580% • mood stabilizers up 40-fold --------------------------------- 4,000% • Atypical antipsychotics—increased ------------------------ 300% • IMS Health 2000 • The drugs have not shown benefit >than placebo “No other society prescribes psychoactive medications to children the way we do.”Lawrence Diller, MD, pediatrician

5. Are U.S. Children So Different?IMS

6. “what it means to be mentally healthy is subject to many different interpretations that are rooted in value judgments that may vary across cultures.” A Report of the Surgeon General, 1999 • “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.” • World Health Org • "The DSM-IV criteria remain a consensus without clear empirical data...the behavioral characteristics specified in DSM-IV, despite efforts to standardize them, remain subjective...”p. 1163

7. After 30 years…where’s the science? • “Patients [have] been diagnosed with ‘chemical imbalances’ despite the fact that no test exists to support such a claim...there is no real conception of what a correct ‘chemical balance’ would look like.” Psychiatrist David Kaiser, MD • “After almost 30 years, researchers have not developed any standardized tool for diagnosing or treating psychiatric disorders.” NYT, 2005 • “diagnostic uncertainty surround[s] most manifestations of psychopathology in early childhood”Dr. Benedito Vitiello, NIMH, 2001

8. Mental Health Screening: Eugenics revisited • Eugenics & Psychiatry • Ideologically Driven by Flawed Theories – • Arsenal of unproven biological-genetic theories of mental illness and bad behavior • Eugenicists blamed genes—“bad blood” • Psychiatrists blame “chemical imbalance” But where is the evidence for either?

9. In the absence of science: “Pseudo Science” • Flawed methodology • Eugenics & Psychiatry use invalid surveys to screen for mental & behavioral problems: • suggestive questions • subjective interpretation • lack scientific criteria • open to bias & prejudice

10. TeenScreen: Manufacturing Illness • 14 questions vague, suggestive, loaded— -- “In the last year, has there been a time… • when you felt you couldn't do anything well or that you weren't as good-looking or as smart as other people?” • when you couldn’t think as clearly or as fast as usual?” • “Have you often felt very nervous when you've had to do things in front of people?” 30%-50% screen “positive” as mentally ill What is the scientific criteria?

11. TeenScreen False Claims • TeenScreen promotes itself as: • “a model for early intervention--suicide prevention”http://www.teenscreen.org/cms/content/view/114/147/ • “Screening is an accuratepredictor for mental health problems that may develop into more serious conditions. Screening is the first & often most important step in identifying a condition.” http://www.teenscreen.org/cms/content/view/50/79/ • US Preventive Services Task Force refutes claim: “no evidence that screening for suicide reduces either suicide attempts or mortality. There is little evidence on the accuracy of screening tools.”May 2004

12. TeenScreen —16% accuracy • TeenScreen tested in 7 NYC schools • 1,729 students • 475 students screened “positive.” • However, “84 non-suicidal teens being referred for evaluation for every 16 suicidal youths correctly identified.” Dr. David Shaffer,JAACAP 2004 • 84% false positives invalidates any screening tool

13. Gov’t Endorsed Mental Health Dragnet • TeenScreen operates at 461 sites in 43 states • 122,000 adolescents screened in 2005 • up from 14,000 in 2003 • --- 350 Colorado students were screened twice: • --- 50% were declared “suicidal” http://mhacolorado.org/aboutUs.html#Americashealth • "This year, we believe we will be able to identify close • to 10,000 teens in need, a 300 percent increase over last year." (Laurie Flynn, Testimony 2004) • TeenScreen— • a conduit for expanding mental health system and increasing use of psychotropic drugs

14. Screening is- just the beginning… “The long-term goal of TeenScreen is not just identification but treatment.” L. Flynn, 2005

15. Dark Side of Screening • Psychiatric label impacts the course of a child’s life • stigma • loss of autonomy • loss of decision-making authority • discrimination • abuse

16. Legacy of Eugenics Schools as screening laboratories • “defectives” & “morons” defined “high grade defectives” lacking self-control: • “restless,” “fidgety,” “cannot keep still,” “odd…”— definition fits diagnostic criteria of psychiatry’s current catch-all diagnosis: • attention deficit hyperactivity disorder--ADHD). Screening for “mental defects” • 72,600 Americans involuntarily sterilized • children as young as 10 were sterilized

17. “Medicating Aliah,” Mother Jones, 2005 13 year old Aliah Gleason

18. Aliah Gleason, Victim of Screening • Aliah is one of 19,404 Texas teens subjected to involuntary mental health “treatment” in a state funded program July-Aug, 2004. • She was: • screened & falsely labeled “suicidal” • abused with physical and “chemical restraints” • forced to take psych “drug cocktails” that were never tested for safety or efficacy • cut off from contact with her parents for 9 months • “Evidence-based” treatment or child abuse?

19. Drugs prescribed for Aliah Gleason, age 13 • SSRI Antidepressants--Zoloft, Celexa, Lexapro, Desyrel • Anti-anxiety drug--Ativan • Two "atypical antipsychotics”-- Geodon and Abilify • An older antipsychotic--Haldol • Two anticonvulsants—Trileptal, Depakote • Anti-Parkinson's drug--Cogentin • At her discharge from a State mental hospital • Aliah was on5different psych drugs • Risperdal was added to her “cocktail” • “Evidence-based” based medicine or child abuse?

20. Most psych drugs not approved for children • Most psych drugs carry “Black Box” warnings--“the most serious warning placed in the labeling of a Rx medication.” • Warnings for antidepressants: “Twofold increased risk of suicidality compared to placebo” • FDA-2005: “suicidal thinking or behavior due to drug can be expected in about 1 out of 50 treated pediatric patients.” • “Behavioral toxicity”—a.k.a. “activation” “emotional lability”– anger, irritability, agitation, hostility, aggression, violent outbursts, mania, psychosis, and suicidal & homicidal behavior

21. Rx “drug cocktails”Compound risks • "it is sedating and would make it difficult for a child to experience the world in a normal way. If you or I were on that regimen we would have a lot of trouble attending to work or school. We don't have any idea what that combination of medications does to a developing child. It may have a number of long-term side effects.” • Dr. Joseph Woolston, Yale University

22. “Rampant drugging of foster children” Investigations across the U.S. found abusive use of psychotropic drugs—as “chemical restraints.” • At greatest risk: disadvantaged, poor children treated within state mental health systems • clinics, hospitals, foster care & juvenile justice 55%—60% foster children • Rx anticonvulsants / antidepressants /antipsychotics • multi-drug “cocktails” • drugged children driven to suicidal violence • Even toddlers <3 are heavily drugged

23. Rx does not reflect severe risks • Depression diagnosis in children (7 to 17) • more than doubled in 5 years: • 1.44 million in 1995-1996 • 3.22 million in 2001-2002 • SSRIs most widely used: • 76% increase in 1995-1996 • 81% increase in 2001-2002 • 11 million Rx SSRIs in 2003 • Psychotherapy declined as SSRIs rose • Stanford U study, 2005 • Rx ignore SSRI failure to demonstrate clinical benefit >placebo in children

24. TMAP—algorithms = Rx blockbuster sales • TMAP(Texas Medication Algorithm Project) • began 1995 under (then) Gov Bush— • Collusion: pharmaceutical companies, U of Texas psychiatrists, mental health & corrections officials. • “Contributions” to Texas Mental Health Dept • Pfizer ----------------------------------- $232,000 • Janssen-J &J------------------------- $224,000 • Eli Lilly---------------------------------- $109,000 • TMAP mandates use of the most expensive psych drugs as first line treatment—without regard for drug hazards.

25. TMAP Primary beneficiaries • Texas Medicaid Expenditures 1998-2003: • Pfizer: Zoloft, Geodon, Neurontin -- $ 233 Million • J & J (Janssen): Risperdal ------------ $ 272 Million • Lilly: Prozac, Zyprexa ------------------ $ 403 Million CBS-KEYE News Investigation • TMAP boosted U.S. sales nationally: • Sales: antidepressants -- $13 billion • Sales: antipsychotics --- $8.8 billion

26. Antipsychotics safety hazards Approved only for adults with schizophrenia and bipolar • Warnings include Black Box: • increased risk of death in elderly • hyperglycemia & diabetes mellitus-insulin resistance; • acute weight gain—100lbs not unusual; • cardiovascular complications; seizures; • akathisia—a catalyst for suicidal and homicidal behavior 8,000 patients sued Eli Lilly: Zyprexa-induced diabetes. $700 million settlement.

27. U.S. Sales of antipsychotics:TMAP expands a small market

28. Medicaid Pays the Bill • Since 2000 mental health costs increase • >more than 50% • 63% of mental health spending= public funds • > $300 billion per year • Report, Parity-Plus: A Third Way Approach to Fix America’s Mental Health System, June 22, 2005 by the Progressive Policy Institute. • “Nationwide, Medicaid programs purchase an estimated 60% to 75% of antipsychotic drugs.” San Francisco Chronicle, October 23, 2005

29. California Expenditure: New Antipsychotics • Cost of 4 of 10 top MediCal meds • Drug (brand name) Amount spent • 1. Zyprexa $248.9 million • 2. Risperdal $162.1 million • 4. Seroquel $142.3 million • 10. Abilify $68 million • Total Cost----------------------$621--million San Francisco Chronicle, October 23, 2005

30. TMAP guidelines Rx for disaster • Atypical antipsychotics safety hazards surpass all other Rx psychoactive drugs • Between 1996 to 2000 Texas Medicaid use of atypical antipsychotics in children 2 years + increased >494%. • from $28 million to $177 million in 2004. Similar increases wherever TMAP was adopted “Of youth receiving antipsychotics, 42.9% had no history of or current psychosis.”JBHSR, 2004

31. TMAP Impact Rx AntipsychoticsChildren • TennCare: 1996-2001 • Antipsychotics Rx in children nearly doubled • from 23 per 10,000 kids in 1996 • to 45 per 10,000 kids in 2001 • most dramatic increase • 6 to 12 kids (93% rise) • 13 to 18 teens (116% rise) • Use among preschool children (up 61%)

32. TeenScreen paved the way— for TMAP to scoop them away— A second wave is underway— as ever younger children are falling prey — perhaps never again to see the clear light of a drug free day – Where have all the children gone? They’re being led astray by state licensed sorcerers h

33. Beyond Orwell:screening infants & the unborn • Dr. Adrian Angold (Duke) declared: • One in 10 children aged 2 to 5 has “severe psychiatric illness [and] such conditions begin very early in life, perhaps even in the womb.” BBC 11-2005 • He recommends • “screening for and treating these disorders in babies and infants is the way forward.”

34. Pathologizing the joy & laughter of childhood • "During the manic phase of the illness • children may experience exceedingly • high self-esteem,an inflated sense of power or ability or may act as though they are in charge at home or school. They may act extremely happy, silly and giddy,but their moods can change rapidly.” • “Mania can be confused with [ADHD]” • "We hope that by comparing these drugs and drug combinations, we might be able to find better ways to control this severe illness” Dr. Luby Press Release, 2005

35. “Bipolar Child” epidemic—U.S. Diagnostic Aberration • "Historically considered rare,childhood-onset bipolar disorder is now being reported more often, although its frequency remains an area of some controversy.” (Carlson, 1990) • “It is now recognized that pediatric bipolar disorders are highly prevalent and that they seriously disrupt the lives of children and adolescents…” (NIMH) • “We are seeing an increasing number of very young children, ages 3-7 years, with [sic] frank symptoms of BP disorder.” NIMH

36. TEAM (Treatment of Early Age Mania)“no child left behind”

37. Voodoo-Psychiatry • TMAP panelist Dr. Barbara Geller & Dr. Joan Luby promote “bioplar” diagnosis in children: • “An extreme example… involved a manic preschooler who believed that she made the sun rise and set."

38. NIMH Clinical Trials attempt to Justify Illegitimate Drug Rx • “Pediatric BPD…can be precipitated by antidepressant treatment.”(Harvard Rev Psych, 1995) • “Many of these young BPD patients have been treated with stimulants or antidepressants and few have been treated with mood stabilizing agents. Therefore, it is necessary to provide controlled studies of psychotropics in this younger bipolar population to provide clinical practice with an appropriate evidence-base.” NIMH

39. Brandon & the Bipolar Bear

46. Diabolical Pathologizing

47. Who will bear responsibility? • …for the harms likely to follow from mental health screening when children are wrongly labeled as having a mental illness? • …for depriving children of a normal childhood? • …for exposing 91% (9 out of 10) children referred for mental health services to psychoactive drugs? • Who will restore children’s drug damaged brains?

48. Who will restore the wondrous magical world of childhood?