Thursday, January 03, 2008

Mandatory Mental Health Screening for Massachusetts Medicaid Kids

As reported initially by the Boston Globe, then covered by the AHRP Blog and Furious Seasons, Massachusetts has implemented a mental health screening process for its children on Medicaid. It would make sense that if mental health is to be examined, one would look for symptoms of mental illness. To assist in the process, one of eight questionnaires is to be used by doctors to identify mental health issues. Here are some of the issues mentioned on one of the mental health screenings:
  • Complains of aches and pains
  • Is less interested in school
  • Is absent from school
  • Refuses to share
  • Blames others for his or her troubles
  • Teases others
  • Does not understand other people's feelings
  • Does not show feelings
  • Gets hurt frequently
  • Wants to be with you [the parent] more than before
There are a few others that seem iffy, but I think the above are the worst offenders. So what? Apparently, it may be a sign of some yet to be defined mental illness that a child would want to be with mommy more often, refuse to share toys with a sibling, and not show interest in school. 'Cuz kids should show little interest in their mothers, school is pretty exciting, and most kids love letting their brother share their coolest toy.

Yes, I understand that any of the above could possibly be linked to a mental health issue. If I counted right, there were 35 of these issues listed on the questionnaire. Who is going to spend time going over each of these 35 issues? Nobody. It would seem that if we are going to screen kids for mental health problems, we might want to stick with the more important issues rather than a kid who does not like to share toys.

It is certainly a good idea for doctors to pay attention to the mental health of their patients. However, I'm not sure that this sort of overly inclusive checklist of potential issues is going help much.

Mental Health Problems: An Epidemic? There is the black undercurrent of labeling developmentally relatively normal behavior as indicative of a mental disorder and sticking the kids on all sorts of psychotropic meds that (in many cases) have little data to support their use.

But there is more to it than drugs. It's our culture. We've come to accept that there is an epidemic of autism, depression, anxiety, ADHD, bipolar disorder, and who knows what's next in our kids. While the drug industry certainly played a role in these developments, it says something about our culture that we are readily willing to buy into the idea that mental illness has spread like a plague throughout American society. Have we bought into these disorders hook, line, and sinker because:
  • It abdicates parents of any responsibility for their children's behavior
  • It lets kids off the hook for their behavior (I couldn't help it -- I have ADHD)
  • It adds yet more drama to the teen years (Gina is, like, so moody. I bet she is, like, bipolar)
  • It seems so scientific. We uncover yet more diagnoses with each edition of the DSM and we then think that we have a better understanding of human behavior.
I'm not claiming that these are especially deep thoughts, but there is something about the interaction of science, marketing, and American culture that seems to have gone awry here.


Anonymous said...

There is a psychiatric / pharmaceutical plan to "suicide screen" every
child in the United States before they graduate from high school.
Evidence exists that shows massive pharmaceutical backing that will
result in even more overdrugging of kids with psychiatric drugs .

Can you take a moment to view this very short video? Click here:

And then sign and forward this petition to your associates
and everyone you know? It already has over 24,000 signatures.

It's simply a race to inform enough parents so something can be done
about this.

olddockeller said...

I wish that you would look a the literature on the PSC (the instrument that you picked in your comment on our efforts to screen for mental health issues in Massachusetts). The purpose is not diagnosis; we shouldn't use the questionnaire to identify issues with each of those 35 questions. the PSC only works when one looks at the questions in aggregate. Works pretty well, actually.
If anyone wants to see how it it actually used, check out

David Keller MD
A pediatrician in Massachusetts

CL Psych said...

Dr. Keller,

I'll give it a look. Thanks for the link.

shrink on the couch said...

In the same vein as parental abdication of responsibility, many parents accept these diagnoses and medications because they lack the time, patience, energy and/or will required to address their kids' behavior the old fashioned way: with appropriate discipline tools and the new fasioned way: behavior mgmt techniques. With many health insurance plans, its cheaper to medicate than it is to see a child behavior specialist.

Thanks for a great blog! Greatly needed & appreciated.