Excerpted from Interview of Joanna Moncrieff, MD
Interviewer: Claudia Hammond
January 3, 2007
Audio can be found here: http://www.youtube.com/watch?v=vBfA2OBirBI
“All in the Mind” reports from the U.S.A. on the increasing controversial mental health screening programs for school children. Now, here’s Claudia Hammond with “All in the Mind”
Claudia Hammond: The biggest screening program is TeenScreen; it’s a quick questionnaire designed for 9-18 year olds. And the idea is to highlight anyone who might have symptoms of a psychiatric problem.
But not everyone is happy with the idea. Everyday teenage behaviour might be pathologized as illness and that the more children who are screened the more children will end up on psychiatric medication. And some parents are unhappy that their children were given the test at all.
Claudia Hammond: Joanna, in Chelsea’s case, the issue of consent did seem to be a big problem. But if in principal, if parental consent is obtained and it’s all voluntary, I mean it sounds like a kind of laudable aim to try and screen individuals.
Joanna Moncrieff: Well firstly on the issue of consent, in order for it to be informed consent, parents really ought to be told that there is no evidence that screening is actually going to prevent suicide, which is one of the main reasons it was introduced and also that the evidence about standard psychiatric treatment; such as drug treatments in children is questionable.
For example the trials on the use of antidepressants in children are inconsistent and many of them show that antidepressants do not have good effects in children. So parental consent needs to be properly informed consent. And I’m not at all convinced that the parents are getting the full facts when they’re being asked about whether to submit their children to this screening program.
I think problem with screening is it, it’s already suggesting way before you get into a clinical interview that it’s already starting to reframe peoples’ problems in medical terms and so even if the people who do this screening test don’t actually say explicitly to the children that they’ve got a psychiatric disorder called “this”. The children will take away from the experience of screening that they have a psychiatric problem and that they’re psychiatrically ill and in today’s’ climate many people will assume that that means that they need drug treatment. One test of the screening instrument that happened in Colorado diagnosed 50% of children as having evidence of possibly having some psychiatric disorder.
Claudia Hammond: 50%? That really is quite high isn’t it?
Joanna Moncrieff: It is indeed. And although not all of those people would probably have a confirmed diagnoses after a clinical interview, you’ve already started to suggest to them and their families that there’s something’s wrong and that what is wrong is a medical or psychiatric problem.
Claudia Hammond: So Joanna, if it’s all voluntary like that and it’s framed in such a way that the children themselves and their parents know exactly what it is they’re filling in and what this test can do and can’t do; isn’t that sort of reasonable to sort of highlight things if you can do it in a very sensitive way?
Joanna Moncrieff: Well first of all, as you know it hasn’t always been done in a voluntary way; often the screening has been implemented when parents haven’t objected to it rather then actually parents actively agreeing to their children to be screened. But secondly I think although many children will attend a clinical interview and won’t necessarily go on to be diagnosed and put on drug treatment. Actually even the experience of going to see a psychiatrist may be very frightening and very stigmatizing for some people, especially some young people. I think as psychiatrists we get immune to that and loose sight of how perturbing it is to be told that even might have a psychiatric problem. And of course some children will end up on drug treatment and we know that more and more children are being put on drug treatment. And I think that there is not enough concern about that at the moment.
Claudia Hammond: Joanna , what do you think will happen here? Will we see this coming across the Atlantic and being introduced in schools in the U.K. do you think?
Joanna Moncrieff: I don’t know whether we’ll actually get the full screening, with use of screening instruments. But we already see evidence in the U.K. of the sort of attitudes that inspired screening in the U.S.
For example, many more childhood behavioural problems are being labelled as psychiatric disorders, are being given diagnostic labels and the use of a range of psychiatric drugs such as Ritalin and stimulants, antidepressants and antipsychotics; their uses all increasing in line with trends in the United States albeit not as dramatically.
Interviewer: Claudia Hammond
January 3, 2007
Audio can be found here: http://www.youtube.com/watch?v=vBfA2OBirBI
“All in the Mind” reports from the U.S.A. on the increasing controversial mental health screening programs for school children. Now, here’s Claudia Hammond with “All in the Mind”
Claudia Hammond: The biggest screening program is TeenScreen; it’s a quick questionnaire designed for 9-18 year olds. And the idea is to highlight anyone who might have symptoms of a psychiatric problem.
But not everyone is happy with the idea. Everyday teenage behaviour might be pathologized as illness and that the more children who are screened the more children will end up on psychiatric medication. And some parents are unhappy that their children were given the test at all.
Claudia Hammond: Joanna, in Chelsea’s case, the issue of consent did seem to be a big problem. But if in principal, if parental consent is obtained and it’s all voluntary, I mean it sounds like a kind of laudable aim to try and screen individuals.
Joanna Moncrieff: Well firstly on the issue of consent, in order for it to be informed consent, parents really ought to be told that there is no evidence that screening is actually going to prevent suicide, which is one of the main reasons it was introduced and also that the evidence about standard psychiatric treatment; such as drug treatments in children is questionable.
For example the trials on the use of antidepressants in children are inconsistent and many of them show that antidepressants do not have good effects in children. So parental consent needs to be properly informed consent. And I’m not at all convinced that the parents are getting the full facts when they’re being asked about whether to submit their children to this screening program.
I think problem with screening is it, it’s already suggesting way before you get into a clinical interview that it’s already starting to reframe peoples’ problems in medical terms and so even if the people who do this screening test don’t actually say explicitly to the children that they’ve got a psychiatric disorder called “this”. The children will take away from the experience of screening that they have a psychiatric problem and that they’re psychiatrically ill and in today’s’ climate many people will assume that that means that they need drug treatment. One test of the screening instrument that happened in Colorado diagnosed 50% of children as having evidence of possibly having some psychiatric disorder.
Claudia Hammond: 50%? That really is quite high isn’t it?
Joanna Moncrieff: It is indeed. And although not all of those people would probably have a confirmed diagnoses after a clinical interview, you’ve already started to suggest to them and their families that there’s something’s wrong and that what is wrong is a medical or psychiatric problem.
Claudia Hammond: So Joanna, if it’s all voluntary like that and it’s framed in such a way that the children themselves and their parents know exactly what it is they’re filling in and what this test can do and can’t do; isn’t that sort of reasonable to sort of highlight things if you can do it in a very sensitive way?
Joanna Moncrieff: Well first of all, as you know it hasn’t always been done in a voluntary way; often the screening has been implemented when parents haven’t objected to it rather then actually parents actively agreeing to their children to be screened. But secondly I think although many children will attend a clinical interview and won’t necessarily go on to be diagnosed and put on drug treatment. Actually even the experience of going to see a psychiatrist may be very frightening and very stigmatizing for some people, especially some young people. I think as psychiatrists we get immune to that and loose sight of how perturbing it is to be told that even might have a psychiatric problem. And of course some children will end up on drug treatment and we know that more and more children are being put on drug treatment. And I think that there is not enough concern about that at the moment.
Claudia Hammond: Joanna , what do you think will happen here? Will we see this coming across the Atlantic and being introduced in schools in the U.K. do you think?
Joanna Moncrieff: I don’t know whether we’ll actually get the full screening, with use of screening instruments. But we already see evidence in the U.K. of the sort of attitudes that inspired screening in the U.S.
For example, many more childhood behavioural problems are being labelled as psychiatric disorders, are being given diagnostic labels and the use of a range of psychiatric drugs such as Ritalin and stimulants, antidepressants and antipsychotics; their uses all increasing in line with trends in the United States albeit not as dramatically.
Claudia Hammond: If screening programs do start to appear over here we’ll keep you up to date on “All in the Mind” But in the meantime do let us know what you think about the idea of screening teenagers in schools. You can email us at allinthemind@bbc.co.uk
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Joanna is a Senior Lecturer in Psychiatry at University College London, department of Psychiatry and Behavioural Science. She has published several critical reviews of psychiatric drug treatments, as well as papers on the history of psychiatry. She is the founding member and co chair person of the Critical Psychiatry Network (web site: www.critpsynet.freeuk.com). This is a network of psychiatrists in the UK who challenge some of the orthodox thinking in psychiatry, especially the emphasis on the medical model of psychiatric disorder, and the link between psychiatry and coercion.
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