Bush's plan to screen for mental health meets opposition in Illinois
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《英国医生杂志》
A comprehensive mental health screening plan developed in concert with President Bush抯 New Freedom Commission (BMJ 2004;328:1458, 19 June) has met with fierce resistance in Illinois, the first state to develop a draft plan to coordinate services for children抯 mental health care.
In April 2003, a report by the Illinois Children抯 Mental Health Task Force, which recommended screening for all pregnant women and all children, triggered fierce controversy. Opponents charged that mandatory screening could subject children to unwanted psychiatric interventions and drugs梔rugs that are under increased scrutiny because of unproven efficacy and high rates of adverse side effects.
Barbara Shaw, chairwoman of the Illinois Children抯 Mental Health Partnership, told the BMJ that there was never any intention to make screening mandatory. "Neither the partnership nor the president抯 New Freedom Commission proposes lining up every child screening." Critics, said Ms Shaw, have "persistently mischaracterised what we are trying to do."
A new draft plan, issued on 30 September, removes the phrases to screen "all pregnant women" and "all Medicaid" recipients and instead inserts the word "voluntary" in a number of instances in relation to screening.
"If it wasn抰 for public pressure, they wouldn抰 have made these changes," said Karen Effrem, a paediatrician and outspoken critic of the screening plan who cautions that definitions of mental illness are subjective and subject to cultural biases. Stefan Kruszewski, a psychiatrist, agrees with Dr Effrem and says that activists will need to continue to monitor the Illinois plan.
Dr Kruszewski, a whistleblower, charged the Pennsylvania Department of Public Welfare Bureau of Program Integrity with widespread abuse and fraud when his efforts to clarify the causes of death in four children and one adult in the state抯 care were blocked. The deaths, he believed, were possibly related to the off-label use of potent atypical antipsychotic medications (BMJ 2004;329:69, 10 July).
Even voluntary screening plans, Dr Kruszewski told the BMJ, could have adverse consequences: "We can manufacture enough diagnostic labels of normal variability of mood and thought that we can continually supply medication to you. The shameful part is that there抯 enough mental illness that requires careful and judicious treatment that we don抰 need to find variants of normal. But when it comes to manufacturing disease, nobody does it like psychiatry."
Ms Shaw, proponent of the partnership proposal said that it was "not a screening plan" but a proposal to develop "best practice" guidelines.
Dr Kruszewski wants to see improved access to quality care for patients who are already seeking help: "If you work on an hourly basis and you have to see four patients in an hour, you抳e got five minutes to ask a patient some questions and then you have to fill out paperwork. We don抰 have the time or the payment vehicles to support talk therapy梥o we make the obvious choice and give a pill."
Until that changes, said Dr Kruszewski, schemes to identify and label more people as mentally ill may result in more stigmatisation and, potentially, more deaths.(New York Jeanne Lenzer)
In April 2003, a report by the Illinois Children抯 Mental Health Task Force, which recommended screening for all pregnant women and all children, triggered fierce controversy. Opponents charged that mandatory screening could subject children to unwanted psychiatric interventions and drugs梔rugs that are under increased scrutiny because of unproven efficacy and high rates of adverse side effects.
Barbara Shaw, chairwoman of the Illinois Children抯 Mental Health Partnership, told the BMJ that there was never any intention to make screening mandatory. "Neither the partnership nor the president抯 New Freedom Commission proposes lining up every child screening." Critics, said Ms Shaw, have "persistently mischaracterised what we are trying to do."
A new draft plan, issued on 30 September, removes the phrases to screen "all pregnant women" and "all Medicaid" recipients and instead inserts the word "voluntary" in a number of instances in relation to screening.
"If it wasn抰 for public pressure, they wouldn抰 have made these changes," said Karen Effrem, a paediatrician and outspoken critic of the screening plan who cautions that definitions of mental illness are subjective and subject to cultural biases. Stefan Kruszewski, a psychiatrist, agrees with Dr Effrem and says that activists will need to continue to monitor the Illinois plan.
Dr Kruszewski, a whistleblower, charged the Pennsylvania Department of Public Welfare Bureau of Program Integrity with widespread abuse and fraud when his efforts to clarify the causes of death in four children and one adult in the state抯 care were blocked. The deaths, he believed, were possibly related to the off-label use of potent atypical antipsychotic medications (BMJ 2004;329:69, 10 July).
Even voluntary screening plans, Dr Kruszewski told the BMJ, could have adverse consequences: "We can manufacture enough diagnostic labels of normal variability of mood and thought that we can continually supply medication to you. The shameful part is that there抯 enough mental illness that requires careful and judicious treatment that we don抰 need to find variants of normal. But when it comes to manufacturing disease, nobody does it like psychiatry."
Ms Shaw, proponent of the partnership proposal said that it was "not a screening plan" but a proposal to develop "best practice" guidelines.
Dr Kruszewski wants to see improved access to quality care for patients who are already seeking help: "If you work on an hourly basis and you have to see four patients in an hour, you抳e got five minutes to ask a patient some questions and then you have to fill out paperwork. We don抰 have the time or the payment vehicles to support talk therapy梥o we make the obvious choice and give a pill."
Until that changes, said Dr Kruszewski, schemes to identify and label more people as mentally ill may result in more stigmatisation and, potentially, more deaths.(New York Jeanne Lenzer)