Implications of Government Sponsored Mental Health Screenings: Some Important Questions

June 29th, 2004

To the Editor,

The U.S. government is obsessed with mental illness as an explanation for society’s ills. The GAO, an investigative arm of the U.S. government, recently admonished the administration for solely focussing upon “stress” related issues in their research into Gulf War Syndrome. Ignoring irrefutable evidence of systemic damage from exposures to multiple toxicants, tax dollars have been wasted on less productive lines of investigation. These, coincidentally, also serve to reduce governmental/industrial liability for veterans’ ailments and similar symptoms in civilian populations which reflect toxicant induced health problems. This does not bode well for the concept of universal screenings for the population at large in aspects of mental health while huge numbers of children and adults lack for the most basic of health care provisions.

Mental illness is not found upon “screening” but requires prolonged observation by multidisciplinary teams of professionals. Neither are the most appropriate therapeutic interventions likely to be offered for those so identified. Even insured parties are generally denied significant reimbursements for effective behavioral and cognitive therapeutic interventions. It takes knowledge of the individual, extensive assessment to rule out other health conditions and a commitment to at least a trial period of therapies which are non-chemical in nature.

The implications for our children are especially alarming. I am a retired speech-language pathologist, specialized in developmental disabilities and have viewed perhaps a thousand children in educational and clinical settings over a 25 year span. Behavioral therapies along with educational interventions were almost universally successful in shaping appropriate school behaviors with only the most violent of children requiring any pharmaceutical interventions. Early intervention also dictated addressing socio-economic needs of the family via case management so that environmental stressors would be removed as contributing factors. These include poverty induced by parental illness or joblessness; hunger and nutritional deficiencies; homelessness; drug abuse; domestic violence and lack of routine medical care. If the government provided for universal health care, shelters and half-way houses, food pantries; drug rehabilitation centers and quality day care/preschool settings, the incidence of behavioral disturbances in the entire population would likely drop significantly.

Drugs also cannot repair the damage to minds by pollution or the ubiquitous use of pesticides and other toxicants adulterating the air, water and food. These have been proven to retard or impair development and alter emotional states of being. Adult responses to such chemical “stressors”, has been most recently documented by Sklan, et. al. in their examination of anxiety reactions to the paired suppression of the protective enzymes paroxonase and acetylcholinesterase (most commonly induced via pesticide exposures). This is further supported by at least a decade of observations made of UK sheep dippers and the studies of Haley and Abou-Donia into Gulf War Syndrome sufferers. As numerous studies have already demonstrated the presence of pesticide residues in bodily fluids of the vast majority of Americans of all ages, we must be forced to consider that many symptoms of an emotional nature are induced by an absence of appropriate legislation and enforcement of environmental protections.

In lauding the pharmaceutical treatment of symptoms usually attributed to mental illness, we must recall that Americans lose more than 177 billion dollars annually in the costs generated by drug morbidity and mortality (Ernst and Grizzel, 2001), There is no logic in foisting inadequately tested or genetically/biochemically incompatible drugs upon the general population. This is especially true of children still in the stages of central nervous system development. The FDA does not examine all studies (positive and negative) conducted in drug development or perform independent research to confirm claims in the absence of competing interests. There are no requirements for the preliminary testing of patients for genetic compatibility of prescribed drugs known to be inappropriate for large segments of the population.

A cynical, but necessary, examination of the priorities of the Bush administration is required before this wide-ranging proposal, generated in an election year, can be properly evaluated. The US government is currently struggling in the throes of excessive debt and demonstrates conflicts of interests with a wide range of industries including the pharmaceutical houses. We must keep an eye to the many existing, but inadequately funded, programs which already provide for the mental, physical and educational welfare of the general population. Given the clinical complexities of diagnosing mental illness, much less treating it, the addition of cursory “screening” procedures would appear to detract from existing channels already in place for the identification and referral of “at risk” persons.

References:

1. E. H. Sklan, A. Lowenthal, M. Korner, Y. Ritov, D. M. Landers, T. Rankinen, C. Bouchard, A. S. Leon, T. Rice, D. C. Rao, J. H. Wilmore, J. S. Skinner, and H. Soreq “Acetylcholinesterase/paraoxonase genotype and expression predict anxiety scores in Health, Risk Factors, Exercise Training, and Genetics study”, PNAS, April 13, 2004; 101(15): 5512 – 5517.

2. Ernst and Grizzle “Drug Related Morbidity and Mortality, Updating the Cost of Illness Model”, J Am Pharm Assoc, 41 (2), 2001

Competing interests: None declared

–Barbara Rubin,
Retired speech-language pathologist/special educator

Categories: British Med. Journal, Published

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