Bush launches controversial mental health plan

[Guest guest]

http://bmj.bmjjournals.com/cgi/content/full/329/7462/367-a

 

British Medical Journal

 

 

BMJ 2004;329:367 (14 August),

doi:10.1136/bmj.329.7462.367-a

 

Bush launches controversial mental health plan

Jeanne Lenzer

 

New York

 

President Bush announced on 26 July that his

administration has begun implementing the

recommendations of the New Freedom Commission on

Mental Health to " improve mental health services and

support for people of all ages with mental illness "

through comprehensive screening.

 

The plan states that schools are in a " key position "

to screen the " 52 million students and six million

adults who work at the schools " and includes

recommendations for screening preschool children (19

June, p 1458).

 

Mr Bush's announcement comes after new reports showing

that increasing numbers of toddlers and children are

being prescribed amphetamines, anti-depressants, and

antipsychotic drugs. Concern that widespread screening

will only increase the number of young people taking

drugs has triggered criticism of the plan.

 

Dr Daniel Fisher, one of the 22 commissioners

responsible for writing the final report for the

president, said that widespread screening—at a time

when medical education was " geared to the biomedical

model and teachers want to get kids fixed " —could

result in greater numbers of children being given " a

label, a diagnosis, and a medication. "

 

" What troubles me a little bit, " said Dr Fisher, " is

that mental health will continue to be used as a

substitute for addressing the social, cultural, and

economic needs of children. "

 

Addressing those needs and heeding the recommendation

of the plan to transform the system to one based on

fostering recovery and resilience could, he said,

" solve many behavioural problems. " But, he added,

widespread screening before systems are transformed

could undermine some very positive elements of the

plan, including its focus on care that is driven by

patients and on housing support, educational rights,

and employment.

 

Concerns about the increasing number of children

taking psychotropic drugs were heightened by a study

published in this month's issue of the Archives of

Pediatric and Adolescent Medicine ( 2004;158:

753-9)[Abstract/Free Full Text]. The study, by Dr

William Cooper and colleagues at Vanderbilt

University, Tennessee, found that in 2001 nearly one

in every 100 adolescents enrolled in TennCare, a

programme for families in Tennessee on low to moderate

incomes, became new users of antipsychotic drugs. The

six year study followed the 313 454 children enrolled

in TennCare in 1996, just under 30% of all children in

Tennessee.

 

Dr Cooper said that he and his colleagues are

currently studying nationwide data on the use of

antipsychotic drugs among children covered by private

insurance. He said that they expect they'll see

similar findings nationally, given preliminary results

from current research at Vanderbilt and reports from

doctors at other institutions.

 

The Tennessee study found that a minority of children

who were prescribed antipsychotic drugs were

psychotic. The two main reasons for new prescriptions

of antipsychotic drugs were attention deficit

hyperactivity disorder (23% of prescriptions) and

conduct disorder (20%). Most of the prescriptions were

for the newer " atypical " antipsychotics.

 

" We don't know if these drugs are helpful in

conditions like attention deficit hyperactivity

disorder, " said Dr Cooper. Although the atypical

antipsychotics reportedly cause fewer dyskinaesias

than the older antipsychotic drugs, they are

associated with serious problems, including weight

gain (one study showed that 11% of children taking the

drugs gained 10% of their body weight in six months),

diabetes, fatal ketoacidosis, and potentially lethal

cardiac dysrhythmias. " You're just trading one set of

side effects for another, " said Dr Cooper. " We don't

know if the benefits of these drugs outweigh their

risks. "

 

President Bush's proclamation on the anniversary of

the Americans with Disabilities Act is at

www.whitehouse.gov

 

 

Other related articles in BMJ:

 

News

Bush plans to screen whole US population for mental

illness.

Jeanne Lenzer

BMJ 2004 328: 1458. [Full text]

 

Rapid Responses:

 

Read all Rapid Responses

 

Where’s the Evidence for Screening, Are Systems in

Place for Positive Screens? Laura Newman bmj.com, 13

Aug 2004 [Full text]

Number crunching Joan McClusky bmj.com, 16 Aug 2004

[Full text]