Teen Screen (coming soon to a cinema near you)

BBC Radio's "All in the Mind" recently reported from the U.S.A. on the increasing controversial mental health screening programs for school children. An excerpt of Claudia Hammond interviewing Joanna Moncrieff, MD can be found here. In the interview, Dr Moncrieff highlights the issues of informed consent, misdiagnosis and attendant (self-)stigmatisation, and the inevitability of drug treatment of those identified as 'positive.' She doesn't speculate about financial links between the instigators of Teen Screen and pharmaceutical companies, but plenty of others have done so, as will be apparent from the web link.

So what is Teen Screen screening for, exactly? From a research paper on the official TeenScreen (a.k.a. Columbia Suicide Screen) website:

"Students were identified as screen positive if they endorsed any of the following on the CSS:

(1) suicidal ideation in the past 3 months, or
(2) a prior suicide attempt at any time, or
(3) three of the five emotional items (unhappy, withdrawal, irritability, anxiety, or substance abuse) rated as a bad or very bad problem, or
(4) indication of a youth's desire to speak to a professional about any of five emotional symptom items."

So, here's my screening of Teen Screen:

(1) One wonders how the concept of 'suicidal ideation' was communicated, given that it is a broadly defined term encompassing everything from fleeting fantasies born of temporary frustrations to well-planned, fully intentional but unsuccessful attempts. Not to mention the "To be or not to be" to-and-froing de rigueur in English classes and the cultivation of a quasi-existentialist weltanschuuang - which often persists well into adulthood!

(2) This seems a reasonably straight-to-the-point question to ask, but I'd also want to know how 'suicide attempt' was defined. Would non-suicidal self-injury (e.g. superficial scratches to the wrists) be reported under this category? Would kids be encourage to include incidents of risk-taking behaviour of the boys-will-be-boys variety?

(3) Is 'bad' merely not 'good' or 'neutral'? Will there be some attempt made at establishing why the teenager is unhappy, withdrawn, anxious etc before a prescription is written? Will they take into account the fact that minors live out a somewhat totalitarian existence, and are not as free as adults to change or escape from whatever it is that is contributing to their emotional turmoil?

(4) The study was conducted in New York. (OK, cheap shot.) But people will consult shrinks for plenty of things that fall well within the realm of everyday stresses and strains: relationship problems, career counselling, study techniques... (It seems to me that many psychiatrists in private practice seem to specialise in the Bridget Joneses of this world: "OMG, I'm nearly thirty, still don't know what to do with my life, still haven't met the man of my dreams, how depressing!" etc. And not just in New York!)

It turned out that 84% of positives were false-positives. But if we only save one life... etc... yes, that's a valid point. I'm not so much averse to having kids take the test itself (setting aside for a moment the issues of informed consent and Big Pharma involvement) but to the consequences for the kids who return a positive result, even those in the other 16% . Psychiatry is a mental health hazard to teenagers, conceptualising annoying but temporary and situationally-based adolescent behaviour as ingrained personality disorders, and indoctrinating them into a culture that, to paraphrase Freud, encourages them to make hysterical misery out of common unhappiness. And maybe, just maybe, that's the kind of thing that leads to suicide.