Mr. George W. Bush
President of the United States
August 22, 2006
Dear Mr. President,
It is a great honor to be able to hear you speak today in Minnetonka, Minnesota. As a wife, mother of three children and a pediatrician, I want to thank you for your great concern for the health of the American people, including their mental health. The undersigned groups and I are also appreciative of efforts on the part of your administration to evaluate the effectiveness of programs and eliminate or decrease the funding of those that are ineffective and not wisely using the people’s hard earned funds as was reflected in the budget requests for the Departments of Health and Human Services (HHS) and Education. We want to support and promote those stewardship efforts, especially in relation to programs having to do with mental health screening and intervention, and particularly in relation to programs involving children.
Goal 4 of the New Freedom Commission (NFC) Report declares that, “Early Mental Health Screening, Assessment, and Referral to Services Are Common Practice,” and describes its model programs, such as TeenScreen and the Texas Medication Algorithm Project (TMAP). The Federal Mental Health Action Agenda (FMHAA.) lays out a blueprint for implementation of the NFC recommendations. These documents have resulted in the promotion of a whole series of federal grants and programs to the states for the mental health screening and intervention of children beginning in infancy, despite documented problems with the scientific validity, safety, effectiveness, and cost of both the screening and the associated interventions. In addition, there are grave concerns regarding whether the federal government should be involved in something that has such profound implications for individual autonomy, parental authority, freedom of conscience, and privacy. Here are some examples of programs of concern:
1. State Early Childhood Comprehensive System (ECCS): This program is part of the Maternal Child Health Bureau within Health Resources Services Administration. Minnesota describes the program as a “…federally-funded grant project to coordinate and integrate early childhood screening systems to assure that all children ages birth to five are screened early and continuously for the presence of health, socioemotional or developmental needs. Children and their families should then be linked to mental health services, early care and education, …so that all eligible children … enter school ready to learn.” (Emphasis added.) Problems with this approach include -
• Lack of diagnostic accuracy, consistency and reliability, especially in young children, as admitted by the World Health Organization , the Surgeon General , the National Institute of Mental Health , the National Center for Infant and Early Childhood Health Policy , and major psychiatric texts.
• Overuse of psychiatric drugs in the early childhood age group as indicated by research , ongoing research to test potent antipsychotic drugs in 3-5 year old children when they do not have an actual diagnosis of psychosis , and statements by psychiatric opinion leaders indicating a need for medication for young children who show “genetic susceptibility” to mental illness.
• Lack of scientific validity of the screening instruments and no documented safety or effectiveness of pharmacological or psychosocial treatments in this age group .
2. Foundations for Learning Grants – This mental health program for children ages birth through seven is funded through No Child Left Behind and raises all of the same concerns as the ECCS program just described. We heartily concur with your administration’s suggestion to eliminate this program.
3. Development of Early Childhood Programs: The FMHAA states, “HHS and ED have launched a 5-year research effort to find the best ways to prepare preschool children for later success in school. In the initiative's first year, eight institutions across the country will receive $7.4 million in research grants to test preschool curricula, Internet-based teacher training, and the importance of parental involvement for improving children's readiness to enter school.” Concerns related to this approach include –
• Lack of need. According to the large and well controlled National Center for Education Statistics study America’s Kindergartners, 94% are proficient at recognizing numbers, shapes, and counting to ten; 92% are eager to learn; and 82% have basic pre-literacy skills, such as knowing that print is read from left to right;
• Socioemotional harm of early childhood programs as documented by the 2002 National Institute of Child Health and Human Development study and by researchers at the University of California at Berkley and Stanford University in late 2005
• Federal promotion of extremely controversial and non-academic outcomes that involve mental health, gender, family structure, multiculturalism, and environmental issues through Head Start and in concert with national groups, such as the National Association for the Education of Young Children (NAEYC)
4. Suicide Prevention ($26,730,000), via the Garrett Lee Smith Act enacted in 2004: Among the activities funded are mental health screening programs, particularly TeenScreen. Specific problems associated with TeenScreen include -
• The use of passive consent in violation of Congressional intent
• TeenScreen’s history for teaching program operators how to avoid the Protection of Pupil Rights Amendment (PPRA), despite specific mention of PPRA in this law
• An 84% false positive rate as admitted by the author of TeenScreen
• Lack of effectiveness of screening programs at preventing suicide and reducing suicide mortality
• The promotion of further overuse of dangerous and ineffective psychiatric medication
• The financial burden that paying for these medications cause already overburdened public programs like Medicaid and foster care
5. State Incentive Grants for Transformation: Despite public statements to the contrary from the Substance Abuse and Mental Health Services Administration (SAMHSA) and Members of Congress, according to documentation from SAMHSA, the purpose of these grants is to “enable States to begin implementing the Commission’s findings,” which include mental health screening and psychotropic drug treatment when study after study is proving these drugs dangerous and ineffective, especially for children. In addition, part of the transformation process is to fund technical assistance grants to the National Association of State Mental Health Program Directors and six non-governmental organizations as subcontractors to assist States “in the development of activities and plans to implement the New Freedom Commission recommendations.” All of these organizations have a vested financial and or professional interest in expansion of mental health screening and intervention programs and have been uncritical supporters of these programs without acknowledging any of the problems mentioned in this letter. We appreciate that the budget request held funding level, but believe that given the dangers and ineffectiveness of the model programs, such as TeenScreen and TMAP, that these grants should be cut altogether.
6. Violence Prevention Programs: The majority of funding goes for the Safe Schools, Healthy Students (SSHS) grants under SAMHSA. These involve infant mental health and TeenScreen suicide screening with all of their already mentioned problems. In addition, another program funded under these grants is the Early Warning, Timely response program developed jointly via the Departments of Education, Justice and HHS. This program lists several supposed warning signs for potential mental health and violence problems that include “intolerance for differences and prejudicial attitudes.” The description of this warning sign says, “All children have likes and dislikes. However, an intense prejudice toward others based on racial, ethnic, religious, language, gender, sexual orientation, ability, and physical appearance when coupled with other factors may lead to violent assaults against those who are perceived to be different.” All of us are very concerned about federal government involvement in labeling children as potentially mentally ill or violent based on these kinds of subjective and politically motivated criteria. We strongly agreed with the budget request to not fund any new SSHS grants and would hope that even more would be cut. We also strongly commend and support the budget request to eliminate the Safe and Drug Free Schools state activities that fund many similar programs.
7. Mental Health Integration in the Schools: This program, funded through No Child Left Behind, is yet another vehicle for mental health screening, with all of its attendant problems to be implemented in the schools. We heartily agree with your administration’s budget request to eliminate this program.
In direct contradistinction to many other groups, I and the undersigned groups are not asking for more funding and more federal involvement in child mental health issues and programs, but much less or none. Given the many problems with these programs, as outlined above, in these times of many competing budgetary priorities, we are asking you to urge Congress in the strongest possible terms to support your budget requests regarding these programs and to go even farther to reduce or eliminate these programs that are of questionable medical, as well as constitutional, safety and effectiveness.
Thank you again for the opportunity to hear you speak and for your attention to these important issues. Please do not hesitate to contact me or any of the groups listed for further detail on the issues and programs.
Best Regards,
Karen R. Effrem, MD
305 Brockton Lane North
Plymouth, MN 55447
763-458-7119
kreffrem@pro-ns.net
Groups in Support:
EdWatch
www.edwatch.org
Alliance for Human Research Protection
www.ahrp.org
National Physicians Center
www.protecthealth.org
International Center for the Study of Psychiatry and Psychology
www.icspp.org
Concerned Women for America
www.cwfa.org
Eagle Forum
www.eagleforum.org
Association of American Physicians and Surgeons
www.aapsonline.org
The Liberty Coalition
www.libertycoalition.net
Law Project for Psychiatric Rights
www.psychrights.org
MindFreedom International
www.mindfreedom.org
Republican Liberty Caucus
www.rlc.org
Citizens Health Alliance for Truth
www.chatdc.org
US Bill of Rights Foundation
President of the United States
August 22, 2006
Dear Mr. President,
It is a great honor to be able to hear you speak today in Minnetonka, Minnesota. As a wife, mother of three children and a pediatrician, I want to thank you for your great concern for the health of the American people, including their mental health. The undersigned groups and I are also appreciative of efforts on the part of your administration to evaluate the effectiveness of programs and eliminate or decrease the funding of those that are ineffective and not wisely using the people’s hard earned funds as was reflected in the budget requests for the Departments of Health and Human Services (HHS) and Education. We want to support and promote those stewardship efforts, especially in relation to programs having to do with mental health screening and intervention, and particularly in relation to programs involving children.
Goal 4 of the New Freedom Commission (NFC) Report declares that, “Early Mental Health Screening, Assessment, and Referral to Services Are Common Practice,” and describes its model programs, such as TeenScreen and the Texas Medication Algorithm Project (TMAP). The Federal Mental Health Action Agenda (FMHAA.) lays out a blueprint for implementation of the NFC recommendations. These documents have resulted in the promotion of a whole series of federal grants and programs to the states for the mental health screening and intervention of children beginning in infancy, despite documented problems with the scientific validity, safety, effectiveness, and cost of both the screening and the associated interventions. In addition, there are grave concerns regarding whether the federal government should be involved in something that has such profound implications for individual autonomy, parental authority, freedom of conscience, and privacy. Here are some examples of programs of concern:
1. State Early Childhood Comprehensive System (ECCS): This program is part of the Maternal Child Health Bureau within Health Resources Services Administration. Minnesota describes the program as a “…federally-funded grant project to coordinate and integrate early childhood screening systems to assure that all children ages birth to five are screened early and continuously for the presence of health, socioemotional or developmental needs. Children and their families should then be linked to mental health services, early care and education, …so that all eligible children … enter school ready to learn.” (Emphasis added.) Problems with this approach include -
• Lack of diagnostic accuracy, consistency and reliability, especially in young children, as admitted by the World Health Organization , the Surgeon General , the National Institute of Mental Health , the National Center for Infant and Early Childhood Health Policy , and major psychiatric texts.
• Overuse of psychiatric drugs in the early childhood age group as indicated by research , ongoing research to test potent antipsychotic drugs in 3-5 year old children when they do not have an actual diagnosis of psychosis , and statements by psychiatric opinion leaders indicating a need for medication for young children who show “genetic susceptibility” to mental illness.
• Lack of scientific validity of the screening instruments and no documented safety or effectiveness of pharmacological or psychosocial treatments in this age group .
2. Foundations for Learning Grants – This mental health program for children ages birth through seven is funded through No Child Left Behind and raises all of the same concerns as the ECCS program just described. We heartily concur with your administration’s suggestion to eliminate this program.
3. Development of Early Childhood Programs: The FMHAA states, “HHS and ED have launched a 5-year research effort to find the best ways to prepare preschool children for later success in school. In the initiative's first year, eight institutions across the country will receive $7.4 million in research grants to test preschool curricula, Internet-based teacher training, and the importance of parental involvement for improving children's readiness to enter school.” Concerns related to this approach include –
• Lack of need. According to the large and well controlled National Center for Education Statistics study America’s Kindergartners, 94% are proficient at recognizing numbers, shapes, and counting to ten; 92% are eager to learn; and 82% have basic pre-literacy skills, such as knowing that print is read from left to right;
• Socioemotional harm of early childhood programs as documented by the 2002 National Institute of Child Health and Human Development study and by researchers at the University of California at Berkley and Stanford University in late 2005
• Federal promotion of extremely controversial and non-academic outcomes that involve mental health, gender, family structure, multiculturalism, and environmental issues through Head Start and in concert with national groups, such as the National Association for the Education of Young Children (NAEYC)
4. Suicide Prevention ($26,730,000), via the Garrett Lee Smith Act enacted in 2004: Among the activities funded are mental health screening programs, particularly TeenScreen. Specific problems associated with TeenScreen include -
• The use of passive consent in violation of Congressional intent
• TeenScreen’s history for teaching program operators how to avoid the Protection of Pupil Rights Amendment (PPRA), despite specific mention of PPRA in this law
• An 84% false positive rate as admitted by the author of TeenScreen
• Lack of effectiveness of screening programs at preventing suicide and reducing suicide mortality
• The promotion of further overuse of dangerous and ineffective psychiatric medication
• The financial burden that paying for these medications cause already overburdened public programs like Medicaid and foster care
5. State Incentive Grants for Transformation: Despite public statements to the contrary from the Substance Abuse and Mental Health Services Administration (SAMHSA) and Members of Congress, according to documentation from SAMHSA, the purpose of these grants is to “enable States to begin implementing the Commission’s findings,” which include mental health screening and psychotropic drug treatment when study after study is proving these drugs dangerous and ineffective, especially for children. In addition, part of the transformation process is to fund technical assistance grants to the National Association of State Mental Health Program Directors and six non-governmental organizations as subcontractors to assist States “in the development of activities and plans to implement the New Freedom Commission recommendations.” All of these organizations have a vested financial and or professional interest in expansion of mental health screening and intervention programs and have been uncritical supporters of these programs without acknowledging any of the problems mentioned in this letter. We appreciate that the budget request held funding level, but believe that given the dangers and ineffectiveness of the model programs, such as TeenScreen and TMAP, that these grants should be cut altogether.
6. Violence Prevention Programs: The majority of funding goes for the Safe Schools, Healthy Students (SSHS) grants under SAMHSA. These involve infant mental health and TeenScreen suicide screening with all of their already mentioned problems. In addition, another program funded under these grants is the Early Warning, Timely response program developed jointly via the Departments of Education, Justice and HHS. This program lists several supposed warning signs for potential mental health and violence problems that include “intolerance for differences and prejudicial attitudes.” The description of this warning sign says, “All children have likes and dislikes. However, an intense prejudice toward others based on racial, ethnic, religious, language, gender, sexual orientation, ability, and physical appearance when coupled with other factors may lead to violent assaults against those who are perceived to be different.” All of us are very concerned about federal government involvement in labeling children as potentially mentally ill or violent based on these kinds of subjective and politically motivated criteria. We strongly agreed with the budget request to not fund any new SSHS grants and would hope that even more would be cut. We also strongly commend and support the budget request to eliminate the Safe and Drug Free Schools state activities that fund many similar programs.
7. Mental Health Integration in the Schools: This program, funded through No Child Left Behind, is yet another vehicle for mental health screening, with all of its attendant problems to be implemented in the schools. We heartily agree with your administration’s budget request to eliminate this program.
In direct contradistinction to many other groups, I and the undersigned groups are not asking for more funding and more federal involvement in child mental health issues and programs, but much less or none. Given the many problems with these programs, as outlined above, in these times of many competing budgetary priorities, we are asking you to urge Congress in the strongest possible terms to support your budget requests regarding these programs and to go even farther to reduce or eliminate these programs that are of questionable medical, as well as constitutional, safety and effectiveness.
Thank you again for the opportunity to hear you speak and for your attention to these important issues. Please do not hesitate to contact me or any of the groups listed for further detail on the issues and programs.
Best Regards,
Karen R. Effrem, MD
305 Brockton Lane North
Plymouth, MN 55447
763-458-7119
kreffrem@pro-ns.net
Groups in Support:
EdWatch
www.edwatch.org
Alliance for Human Research Protection
www.ahrp.org
National Physicians Center
www.protecthealth.org
International Center for the Study of Psychiatry and Psychology
www.icspp.org
Concerned Women for America
www.cwfa.org
Eagle Forum
www.eagleforum.org
Association of American Physicians and Surgeons
www.aapsonline.org
The Liberty Coalition
www.libertycoalition.net
Law Project for Psychiatric Rights
www.psychrights.org
MindFreedom International
www.mindfreedom.org
Republican Liberty Caucus
www.rlc.org
Citizens Health Alliance for Truth
www.chatdc.org
US Bill of Rights Foundation
