This letter was published by the Kenosha Parents Union. You can read it on their web site by clicking here.
Kenosha Parents Union is an organization of parents and community members working to Kenosha's strengthen public schools
Letter to Sheboygan Psychologist re TeenScreen
Sheboygan South High School
Attn. Dr. Fred Sutkiewicz
Thank you again for meeting with my psychology interns and myself a few weeks ago. This meeting, combined with the TeenScreen training that I went through with you about a year ago has helped me better understand the overall program. Based upon everything I have learned about the program, I have serious concerns about the program and how it will negatively impact our community and youth.
As you are well aware by now, I am interested in the TeenScreen program due to the overwhelming power it has on the students, parents and our community at large. You personally are in a unique position, given the sheer number of students you come across and the many other individuals you will meet as a result of this program (e.g. parents, caregivers, community groups). I definitely see a need for extending help to those in need and having an active interest in students’ academic and emotional well being; however, the TeenScreen Program is not the best course of action for helping our young community. I hope you carefully review my concerns listed below, do a follow up review of the information I provided, and do your best to track any potential benefits and the negative consequences the program. I must also add that I was pleased to hear that you decided to break from the TeenScreen Manual protocol, which clearly endorses and uses language endorsing referrals to medical practitioners (e.g. psychotropic drugs), and use your best judgment with regards to providing appropriate referrals.
Due to the multiple other concerns regarding the program, I am forwarding this letter to the School Board for review as well. If, after reviewing the information below, you or the school Board would like to conduct a more point-by-point discussion about the program or choose not to continuing endorsing the program (e.g. as did several other school districts such as the Pinellas County School District in Pinellas, FL, Fresno Unified School District in Fresno, CA- where I did my graduate work and helped stop the TeenScreen Program from starting) 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.
Since the field of psychology and psychiatry is unlike all other branches of health and medicine, (e.g. not adhering to the same rigorous objective standards for diagnosing and instead being quite subjective in nature, not having even one biological test for any psychiatric disorder, having poor agreement between mental health professionals not only for diagnosing, but also for the cause for all the disorders-often called “illnesses”, and having even poorer agreement from mental health professionals as to the best coarse of treatment), I was concerned to learn 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 do (e.g. 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 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 to (e.g. psychiatrist or other medical doctor for drugs, family treatment or individual counseling).
Since I still have not heard where the children are being sent to, and since I inquired at the training numerous times about the referral process but was told you 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. 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 the treatment referrals and recommendations that I make. It appeared much more appropriate when I heard that the “interviewers” by the volunteer therapists were able to have some discussion and follow up questioning when a student was marked as having a “mental illness” or problem. Unfortunately, Teen Screen does not allow for the one who has all the information to make the referral, but rather the one individual who was trained by Teen Screen, who may not have any in depth psychological training.
Your referral process, debriefing discussion and verbal discussions with parents will ultimately direct their understanding of any potential problem, and will also ultimately direct their care (e.g. family therapist, individuals therapy, Priest, Minister, Rabi, psychiatrist, neurologist, pediatrician, etc...). Given this, I am sure you understand the significant and considerable difference between seeing a individual therapist specializing in child-adolescent therapy, obtaining skill-based education, and obtaining a average fifteen minute medical consult where by the data states that 90% of them 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 studies 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 agreed that any approach is superior to one or another, I can only hope you personally decide not to follow other Teen Screen programs that predominantly and/or only states you will refer to physicians who in turn prescribes 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 also 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; however, this letter does not account for the possibility that a parent sought out another opinion or even 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 referral recommendation. Again, this places the TeenScreen recommendation in a very influential and powerful position. To this extent, I really am interested in your “training program” for making these recommendations, and I request to see what the TeenScreen Manual recommends, especially since my son and daughter could be potential South High School TeenScreen statistic.
I am additionally concerned that during the training session you made reference to the support of the TeenScreen Program, but failed to mention anything about the drawbacks and limitations of the program and of the mental health professionals who admittedly oppose it. As a researcher, it is difficult to weight the pros and cons of a program when the program discussion only focuses upon how beneficial it might be, but yet fails to produce peer reviewed evidence demonstrating the benefits and failures of the program. Most importantly, there is no data to suggest that the TeenScreen Program actually lowers suicides. This program has been running for quite some time now, and I have not seen any peer reviewed data showing that the TeenScreen actually lowers suicide. Instead, TeenScreen’s own 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, “TeenScreen assesses mental health of high school students.”) Additionally, the TeenScreen program 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 phenomenon?
Researchers and psychiatrists alike are even 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 2005, 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 Teen Screen 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..., it 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).
I am also 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, noting that the one remaining SSRI drug, Prozac, although they could not be certain it caused people to commit suicide or become suicidal, “only worked in 1 of our 10 cases”. The drug companies are not able 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 quite dangerous and proven to be deadly at worst.
Likewise, there is no data proving that screening will prevent suicides, the whole reason this screening program came about to begin with. 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. “
I will address the reason the FDA and the TeenScreen program did not follow Great Britain’s actions later, but for now, I believe the SASD and you personally need to consider the following. If the Sheboygan Area School District (SASD) and its counselors who adopt the Teen Screen approach 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 student 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, but yet there are thousands and thousands of cases in which children are harmed by these drugs, doctors and school system referrals. I found no less than 4 specific cases recently going through the court system whereby a children 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.
So where did Teen Screen come from? 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 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 companies (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 Teen Screen Program is Ms. Laurie Flynn. Ms. Flynn and the Teen Screen 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 Teen Screen 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 Teen Screen Advisory Board. Hogan is also part of the New Freedom Commission on Mental Health, created by President Bush Sr.. 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 Teen Screen 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 the Teen Screen Program, 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 perqs 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 Times. 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 specifically to Teen Screen, 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 corner of their Internet site 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?
I hope this raises your suspicion as to the “true” agenda to the Teen Screen Program, and has demonstrated sufficiently how the program fails to produce desirable results. The Teen Screen 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 returns?
There are 47.7 million (47,700,000) public school students.
There are 5 million (5,000,000) private school students.
17% of the kids screened by TeenScreen accept counseling (8,959,000). Seventeen percent (17%) may be a low percentage, but I am only taking numbers supplied by TeenScreen.
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 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 neuroprocessing, and it is no wonder why drug companies are tripping over themselves to sponsor screening of everyone in the United States (e.g. It is mandated 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 study over 350 youths were suicide screened using TeenScreen’s survey. They found that over 50% were at risk of suicide and 71% screened positive for psychiatric disorders at a youth homeless shelter. That’s not science, that’s a dream come true for drug companies.
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 in our children. I think it is noteworthy to acknowledge that just recently yet another study comparing cognitive psychotherapy to antidepressant medication (Paxil) was just 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 (i.e. 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 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.
I would respectfully request that the following data and information be given to all parents prior to any screening, as I believe the real issue here is parental rights related to what they deem appropriate for their children. I do not believe the government should interfere and have any legitimate authority to direct a families intimate health matters. I believe there is a right to know about hidden agendas and what could occur if they disagree with the recommendations of the School Counselor. I also ask that the SASD offer an opinion regarding if they are willing to report parents to the Department of Family Services if the parents choose not to medicate their children or agree with the screening device that states their child has a mental disease (i.e. 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.) Other examples include the nightmare that Aliah Gleason went through when she was taken from her home, not allowed parental contact for five months while she was placed in foster care, and ultimately forced to take drugs due to the incorrect screening outcomes and misinformed school district. These are tough questions that have not been answered as of yet, and I believe they need to be addressed before child is torn between a well-intentioned school district, school counselor, profit driven program and parent.
Dr. Toby Watson, Psy.D.
Clinical Depth Psychologist
Clinical and Doctoral Training Director
International Center for the Study of Psychiatry and Psychology Board Member