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Offline Dethgurl

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Why Screening Teens for Mental Illness Is a Terrible Idea
« on: September 03, 2011, 11:53:09 PM »
Why Screening Teens for Mental Illness Is a Terrible Idea

By John Horgan | September 2, 2011


http://http://blogs.scientificamerican.com/cross-check/2011/09/02/why-screening-teens-for-mental-illness-is-a-terrible-idea/

Scientific American talks sense! And Robert Whitaker’s work is breaking into the mainstream, finally, where it belongs that we might stop hurting vulnerable people of all ages.

    From Scientific American: Why Screening Teens for Mental Illness Is a Terrible Idea

    Given the recent trend toward prescribing powerful, profitable and potentially harmful psychiatric medications to children in the U.S., I fear that TeenScreen and similar programs may end up hurting more children than they help. Here’s some background information, most of which comes from Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America  (Crown 2010), a book by the journalist Robert Whitaker that I have mentioned previously.
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Offline Ursus

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Why Screening Teens for Mental Illness Is a Terrible Idea
« Reply #1 on: September 04, 2011, 10:26:10 AM »
Here's that piece in full:

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Scientific American
Cross-Check — Critical views of science in the news

Why Screening Teens for Mental Illness Is a Terrible Idea

By John Horgan |  September 2, 2011

Mental illness can afflict children, just as cancer and other diseases do. Many young people quietly struggle with depression and other disorders, which may provoke them to commit suicide, the third most common cause of death among teenagers. So from one perspective, programs like TeenScreen— designed by a group at Columbia University and now operating in schools and community centers in 43 states—make perfect sense. Students fill out a free, computerized form that asks, among other questions: In the past three months, has there been a time when nothing was fun for you and you just weren't interested in anything? Have you had problems with your schoolwork or grades because you felt sad or depressed? And so on. Kids deemed at risk for psychological problemss are referred to a mental-health provider.

"Support for screening teens is increasing along with recognition of the role mental-health checkups can play in improving mental health," Wall Street Journal health columnist Laura Landro remarked in a story on TeenScreen. Although her report is largely positive, Landro does mention that school screening programs "aren't without controversy. Some groups oppose them, arguing that they interfere with issues that should be the domain of the family and lead to over-prescription of psychiatric medications."

Indeed. Given the recent trend toward prescribing powerful, profitable and potentially harmful psychiatric medications to children in the U.S., I fear that TeenScreen and similar programs may end up hurting more children than they help. Here's some background information, most of which comes from Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in American (Crown 2010), a book by the journalist Robert Whitaker that I have mentioned previously.

• Several decades ago, children were rarely diagnosed with mental illness. Today, leading psychiatrists estimate that more than 10 percent of all children suffer from mental illnesses—from attention-deficit disorder to full blown psychosis. In 2008, the General Accounting Office estimated that one in 16 children is "seriously mentally ill." The number of children so mentally disabled that their families are eligible for government assistance has swelled from 16,200 in 1987 to 561,569 in 2007, a 35-fold increase. During this same period, the number of children requiring government assistance for all other ailments—from cancer to retardation—declined from 728,110 to 559,448.

• 3.5 million American children are now taking Ritalin and similar medications for attention-deficit hyperactivity disorder (ADHD), up from only 150,000 or so in the late 1970s. That comes to about one out of every 23 children from four to 17 years old. American children consume three times as many ADHD medications as the rest of the world’s children combined. One study cited by Whitaker, which was funded by the National Institute of Mental Health, concluded that long-term drug treatment of ADHD was associated with increased rather than decreased symptoms.

• Since the selective serotonin reuptake inhibitor (SSRI) Prozac was introduced in the late 1980s, the number of children treated with SSRIs and other antidepressants has soared. One 2002 study estimates that one in 40 children 18 years old or younger takes antidepressants. Whitaker cites numerous studies indicating that antidepressants, while they can provide short-term relief for some children, over the long run are at best ineffective and at worst harmful. Children treated with antidepressants may experience side effects ranging from anxiety and insomnia to full-blown mania and psychosis.

• The most startling trend in pediatric psychiatry is the surge in diagnoses of bipolar disorder, which just a few decades ago was viewed as almost exclusively an adult disease. Since 1995, the number of children diagnosed with bipolar disorder has multiplied more than 40-fold to roughly 800,000. Whitaker presents persuasive evidence that this epidemic may be driven, at least in part, by increased consumption of stimulants (for ADHD) and antidepressants. These medications can trigger bouts of mania followed by sluggishness in children, who are then re-diagnosed with bipolar disorder.

• Children diagnosed as bipolar are treated with drugs—notably antipsychotics normally prescribed for adult schizophrenics—that have severe physiological as well as mental side effects, including obesity, diabetes and involuntary tremors. More than half a million children—including infants less than two years old!—are now ingesting antipsychotics. This trend, The New York Times reported last year, has been aggressively promoted by manufacturers of antipsychotics, which have become the most lucrative class of drugs in the world.

The promoters of TeenScreen, you will surely not be surprised to learn, have ties to the pharmaceutical industry. The program was designed by David Shaffer, a professor of child psychiatry at Columbia who according to one watchdog group (which is not, I should add, affiliated with Scientology) has served as a paid consultant for GlaxoSmithKline and other manufacturers of psychiatric drugs. The executive director of TeenScreen, Laurie Flynn, previously headed the National Alliance on Mental Illness, a group that lobbies for improved care for mental illness. Both under Flynn's leadership and since she left, NAMI has been criticized for its close ties to manufacturers of psychiatric drugs. According to a 2009 investigation by The New York Times, NAMI receives about three quarters of its donations from drug companies.

TeenScreen is subtle compared to other psychiatric-intervention programs. Some psychiatrists have advocated medicating young people who are deemed to be "at risk" of schizophrenia—because they exhibit signs of mental instability and/or have schizophrenic relatives. Several trials of this "early intervention" approach have produced inconclusive results, and a proposed trial in Australia was canceled recently after critics complained that the risks far outweighed any potential benefits.

The Australian plan, for an estimated  cost of $400 million, would have treated adolescents with the antipsychotic drug Seroquel, according to an Australian newspaper. The drug's manufacturer, AstraZeneca, recently paid $647 million to settle a U.S. lawsuit that claimed the firm failed to properly disclose evidence linking Seroquel to diabetes. Previous studies have shown that the false positive rate of predicting schizophrenia exceeds 80 percent. I hope that the cancellation of the Australian program portends a backlash against the over-medication of young people worldwide.

Mental illness is devastating for children as well as adults, and medication, when used wisely and sparingly, can help. But clearly our current approach to treating disturbed young people is broken. Let me give Whitaker the last word: "Twenty years ago, our society began regularly prescribing psychiatric drugs to children and adolescents, and now one out of every fifteen Americans enters adulthood with a 'serious mental illness.' That is proof of the most tragic sort that our drug-based paradigm of care is doing a great deal more harm than good."


About the Author: Every week, John Horgan takes a puckish, provocative look at breaking science. A former staff writer at Scientific American, he is the author of several books—most notably, The End of Science: Facing the Limits of Knowledge in the Twilight of the Scientific Age.

The views expressed are those of the author and are not necessarily those of Scientific American.



© 2011 Scientific American, a Division of Nature America, Inc.
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Offline Ursus

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Comments: Why Screening Teens for Mental Illness Is a...
« Reply #2 on: September 05, 2011, 07:38:29 PM »
There's some pretty powerful discussion going on 'bout this issue.

Comments left for the above piece, "Why Screening Teens for Mental Illness Is a Terrible Idea" (by John Horgan; Sept. 2, 2011; Scientific American), #s 1-20:


 1. rgcorrgk 5:33 am 09/3/2011
    Follow the money.
2. JustinShariat 11:02 am 09/3/2011
    Thanks for writing this article. This disturbing trend really needs more coverage.
3. ralph234 11:22 am 09/3/2011
    You argue persuasively for caution in treating children with psychotropic medications, however, the argument seems unrelated to the benefit of screening children for mental health problems and completely ignores the social, behavioral and psychological inteventions available to help children who may die because we fail to address their mental health problem.
4. PeterWalsh 2:18 pm 09/3/2011
    I agree with your article a 100 percent. I am among those children diagnosed with ADD. I have been taking Adderall/Strattera ever since i was in elementary school. These drugs completely change my personality and make me extremely antisocial. It was only during my junior year of high school i questioned the benefits of the drug and stopped taking it. In fact i am still prescribed the meds right now and i am a sophomore in college. I have been hiding this from my parents for 3 years. A questionnaire that asks children if they actually do not take there medication but say they do will most likely be very high. Because when my parents find out i have not been taking meds get angry and dont understand my reasoning. I firmly believe that there is no reason children need to ingest any kind of medication daily we've lived for thousands of years without giving children meds why do we need to start now so badly? People rely on there drugs way too much.
5. mhilm 3:30 pm 09/3/2011
    "In the past three months, has there been a time when nothing was fun for you and you just weren’t interested in anything? Have you had problems with your schoolwork or grades because you felt sad or depressed?"
    I realize these are only two example questions from a (hopefully) much larger and more subtle survey. But replace school work and grades with work and social life, and how many adults would answer yes?
    Occasional angst is the norm for adolescence.
    Everyone has times when the world seems gloomy. Catch someone when they're ill, or just tired, or in one of those gloomy patches, and, if this is the sort of question they are asked, they will almost certainly be diagnosed with mental health issues.
    At the very least such questionnaires should be given several times over a period of months before any conclusions are based off them. Someone who seems at risk can be monitored, not drugged, until an assessment over time provides a more accurate picture of the person's mental state.
6. jfk104 4:45 pm 09/3/2011
    I had a terrible experience with prescribed ADD and antidepressant drugs. In my junior year of high school I had a tough time with depression. I went to a psychotherapist and eventually a psychiatrist. This psychiatrist seemed like a glorified drug dealer. I was given a checklist for ADD symptoms and was asked to answer true or false questions like "Do you have trouble concentrating on schoolwork." That's all it took for me to be subscribed Vyvanse. I was also given an antidepressant (Lexapro, I believe) and Lamictal for bipolar disorder. I thought maybe these would help me take things down a bit, but all it really did was suppress everything that I was. After a few months I couldn't avoid the fact that this person was completely unprofessional and I stopped taking prescription drugs. I think that our teenage years are much too volatile to make any accurate diagnosis for some mental illnesses.

    I personally believe that the trend of online social networking stifles our ability to connect at a personal level, which in turn harms our mental development. I didn't feel comfortable until college, where I am now able to see my friends more frequently in person than online. Text-based conversations do not allow us to appropriately convey our emotions.
7. JustinShariat 8:01 pm 09/3/2011
    ralph234, your argument makes no sense. How is discussion on the gross over-prescribing of psychoactive drugs to children, encouraged by the drug companies themselves, at all ignoring the issue of childhood mental health? Nowhere in this article does it say that there isn't a small percentage of kids that can benefit from certain medications; it only says that this number is small, and much more caution should go into giving any child medicine.

    It seems to me you're not aware of how drastically these medicines impact a child's development. I suggest reading about the drugs that are being given to these children... It's truly unbelievable.
8. Jumanji 2:42 am 09/4/2011
    Interesting article, thanks John. Please note though from an Australian reader that at the date of writing this comment the Australian government have not cancelled this $400 million program. The research trial only has been cancelled.   McGorry's EPPIC early psychosis programs and the $400 million dollar drop-in-centre headspace services both to be run by the private health company, Orygen Youth Health (of which McGorry is Executive Director) are proceeding with complicit government backing. The ethical and scientific concerns raised by the Cochrane Collaboration review, international peers and Australians, in addition to Australians who are concerned about the loss of alternate services funds have  been diverted away from, to fund this dangerous public health experiment have gone unheeded. McGorry and the Australian government are going ahead full steam ahead with a minor blip of trial cancellation and scant media attention to any of these concerns.
9. Dan45 10:04 am 09/4/2011
http://www.opednews.com/articles/The-Me ... 25-27.html[/list]
10. SK1973 11:16 am 09/4/2011
    I have a 17 year old child who has a serious mental health issue, without medications he would be a danger to himself, he falls into the 1% of Americans who have a schizophrenic condition typically these conditions arise between the ages of 15 and mid 20's, he was diagnosed at 16 after being symptomatic of psychosis for a full year. I believe that pre-screening for youths could be helpful if it were to give them empowering information on how to help protect their minds, especially concerning the importance of Omega 3's and avoiding street drugs and why it is different for people with a predisposition to these types of conditions and the general population. Increasing pleasurable activities, stress reduction techniques, cognitive behavioral therapy techniques, dbt, etc. My son is in a program for persons experiencing their first year of psychosis and to be accepted into the program the psychosis did have to be full blown. Medications are not mandated but encouraged and we are fully aware of the risks, but also the risks of not taking the medication. It's tricky, and complicated and a decision for the family to make and I think this would be great if it weren't driven by Pharma and handled in a sensitive way, but once you get corporations and government involved I would be concerned about scare tactics... it's a complex issue.
11. ralph234 11:47 am 09/4/2011
    JustinShariat did you read my comment?

    I agreed the article made a good point regarding problems of giving osychotropic medications for chiildren.

    I said the article did not address how other non-medication interventions ("social, behavioral and psychological inteventions available")could be used to help children after a sceeening for mental health problems, therefore it did not answer the original question posed in the article.

    The question posed at the begining of the article was not how deterimental psychotropic medications are for children, rather it asked whether or not mental health screening is beneficial.
12. mighty_archemedes 12:36 pm 09/4/2011
    As a teacher and neuroscientist, I have to disagree with your analysis entirely.

    It's true that more teens are being diagnosed with depression, bipolar disorder, and schizophrenia today than fifteen years ago; but there are numerous factors in that that you have failed to mention. The first is the monumental change in our society over that time period–a financial collapse, an ongoing war overseas, the rise of social networking; all of these things and more have had documented and significant effects on mental health at home. I see no reason why it would not extend to the comparatively fragile mind of teenagers and the younger. Additionally, our understanding of your mentioned mental illnesses has grown exponentially in the last ten years, particularly schizophrenia, and we are simply more capable of determining these things.
    Now, if one were to compare the number of cancer drugs being administered today to the number administered in the 1960s, one could make the shortsighted argument that the cancer drugs are causing the cancer. But correlation is not causation, and diagnosis is definitively not cause. Why should we prevent students from having access to potentially much needed health care?
    I am well aware of the number of children that are taking Ritalin today, along with a plethora of other drugs for diseases of cognitive fatigue and other mental incapacities. This doesn't prove anything, nor does it even prove, though I am inclined to agree with you on this, that it is being overprescribed. I have also, in my entire career and education, never seen the 80 percent misdiagnosis rate studies for schizophrenia that you mentioned, and would like it if you would state your source so I could further educate myself on this or send the team a challenge to its results. Schizophrenia is, as it is, a diversified and general label-illness, much like lupus, or arthritis. It says little of its cause, and the only hardened objective diagnosis techniques I know of can only be done on a corpse. Even they can't definitively disprove it.

    I'm assuming that Scientific American would never publish an unverified witch-burning article, but your editorial strays dangerously close to it.
13. rosabw 5:12 pm 09/4/2011
    Whatever y'all think is best for my child....When did psychiatrists become the turn-to for raising children? Talk about Dr. Spock screwing up out generation, how about Novartis for our children? It's just cold...

    Yeah, yeah...my son took Vitamin R for 8 years, but then we started homeschooling him and he didn't seem to need it. He won't go back now. He must have really hated it, but he had no choice.

    PETER WALSH….YOU ROCK!!!!
14. Bops 5:53 pm 09/4/2011
    We all know people who say they won't even take a asprin for any reason.
    If someone enjoys pain...fine...don't take anything.

    Most people are helped by Prozac, SSRIs and other antidepressants deal with cronic pain and other problems.

    A family member, likes the high he gets so much that he won't get help. It's not uncommon. He loves all the "6 feet from the edge music"...and the life style that goes with it.

    It all started about age 12, now he's 30 with friends just like himself. He says that he likes his freedom...diagnosed with depression, bipolar disorder, and schizophrenia. (like his mom)

    That's a lot of money for one program...maybe there's a better way. It's a complex issue.
15. Byteryder 12:48 am 09/5/2011
    "Folllow the money" as another poster said. First make it profitable by making it a run-away crisis. This is done by broadening the symptomatology until it is inclusive of sufficient numbers be alarming.

    Then, offer a solution. Like White Rabbit (Jefferson Airplane) the answer to everything is in a pill. A pill, small, quick, and in the case of psychoactive meds, the only trail left behind is qualitative, subjective at best, not quantifiable, objective.

    Create the mountain out of the mole-hill. Then sell rides to the top for outlandish fares.
16. zstansfi 3:23 am 09/5/2011
    Archemedes, while I think that it is clear the concluding statements of this article are ridiculously flawed, I don't think that the general point of this article is particularly offensive. It is quite apparent that there has been a radical increase in the rate of diagnosis of mental illness in western society over the past few decades. Now, there is certainly a strong possibility that over-diagnosis plays a part. And, I think a major part of the criticism of medicating young children is that it frankly is very difficult to accurate diagnose people in this age group with any sort of disorder, which makes our current use of medications seem simply bizarre.

    On the other hand, I won't deny that much of the increase in mental illness could be accounted for in terms of changes in how our society operates. But does this not suggest that we ought to make changes to our social structure, rather than over-medicating young people?

    Horgan may display the subtlety of a farm animal, but I don't think he's wrong on this point. It seems to me that the children who truly are having the most trouble are probably already being referred for treatment. So then what is the use of enhanced screening procedures if our physicians are so trigger-happy with their prescription pads? I think that it is perfectly conceivable that the potentially massive increase in false positive diagnoses might not be worth the small potential for increased numbers of correct detections.
17. JamesDavis 8:36 am 09/5/2011
    When I attended the School Of Natural Healing in Utah in the late 70s and early 80s, ADD, ADDHD, and make believe illnesses like, phantom pain, was just starting to skyrocket into a costly run away train. We found that ADD and ADDHD could be reversed and eliminated with the elimination of certain foods in the child's diet like processed sugars, as in sodas, and dairy products, as in candies, and replaced with green leafy vegetables and tropical fruits. We also found that ADD and ADDHD was not a disease, but a disorder that these sugars and dairy products caused, and should never be treated by a chemical medication; the chemical medication actually made the condition worse and created some very distasteful side effects that was actually worse than the condition.

    We also found that children suffering from allergies and chronic pain brought on by sugars and dairy products was caused by an imbalance in their immune system and when treated with echinacea and goldenseal, coupled with bee pollen, the immune system increased and the allergies went away in about six months and the breathing problems went away with some simple acupressure on certain pressure points in front of the arm pit and on the back shoulder blade.

    Children have an incredible ability to heal themselves of most inflictions when they have a healthy diet and healthy friends, and chemical medications are seldom needed.
18. mighty_archemedes 11:40 am 09/5/2011
    Zstansfi, it's the associations set forth in the article that I find burning. So suppose we are overdiagnosing, which is not to say that I'm confident that we are, but we'll hold it as an axiom for now. If that's the case, then should we work on our standards and practice in diagnosis to reduce false positives, or should we simply make an effort to diagnose fewer people? The first method will reduce the error and lead to better results and happier people as a whole. The second, what this man is proposing, will simply leave people behind and leave the net error alone entirely. It's naïve. Problems like that are solved through diligence and hard work, not running from the issue.
    Second, I would like to point out that more often than not, psychiatric disorders simply lead to counseling. Not everyone that has a mental illness has a magic pill to look to, though believe me, nearly every one of them wishes they did. This program is not about jamming pills down the throats of our children, it's about getting them legitimate help when they need it. Some of them will be on medication, but it's not like it's legally mandatory.
    The way that this editorial is written almost leads me to believe that it's politically biased. I just can’t figure out for whom yet.
19. JustinShariat 2:49 pm 09/5/2011
    All of you rationalizing this as fine seem to have skimmed over the parts about pharma controlling the diagnostic criteria.
20. zstansfi 2:55 pm 09/5/2011
    Well, I wouldn't argue that screening for mental illness is a flawed concept, in fact, I think that it's a great idea. And this is because I am not as concerned with over-diagnosis so much as over-treatment. However, the argument of Horgan's which really resonants with me is that we probably aren't doing a very good job of discriminating between individuals who need medication and those who do not. Currently, the first and second lines of defense against mental illness in the medical profession are GPs and psychiatrists. While admittedly anecdotal, my experience has been that these individuals are usually pretty quick to write prescriptions for minor ailments. And this is supported by pretty widely available statistics on the increasing rate of drug prescriptions in the US. This certainly makes me question whether the average physician is making an informed decision about who gets medications and who gets therapy.

    You've claimed that people diagnosed with mental disorders are more likely to receive therapy than medication–however, this simply seems infeasible to me. Can you provide a citation that supports this? Also, I think we need to be clear that there is a difference between therapy and medication in that it is very easy to stay on medication for a year or a decade, but long-term therapy is a much more difficult undertaking. So it's possible that a high proportion of individuals might might receive some therapy, but also a lot of medications.

    Now, I would say that it is pretty irresponsible for Horgan to imply that pharmaceuticals are causing mental illness. To the best of my knowledge, there is absolutely no evidence for this contention. On the other hand, it would be false to claim that we actually have a good understanding of what these drugs do to rapidly developing brains. We don't. And I think it is a reasonable question to ask whether we might be medicating too many children.

    I suspect part of your objection to this article is that it really says nothing about the TeenScreen program, something which I think another commenter pointed out. In fact, I'm not entirely sure why it was mentioned at all. I suspect it simply provided a convenient excuse to write a screed against the pharmaceutical industry.


© 2011 Scientific American, a Division of Nature America, Inc.
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Offline DD Form 214

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Re: Why Screening Teens for Mental Illness Is a Terrible Ide
« Reply #3 on: September 05, 2011, 07:56:28 PM »
Screening teens for mental illnesses is a great idea!  The drug companies will be able to come up with good medicine.  lol
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Offline Ursus

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Re: Why Screening Teens for Mental Illness Is a Terrible Ide
« Reply #4 on: September 05, 2011, 09:51:57 PM »
Quote from: "DD Form 214"
Screening teens for mental illnesses is a great idea!  The drug companies will be able to come up with good medicine.  lol
Ya might wanna peruse the comments above for some ideas as to why "screening teens for mental illnesses is a great idea." Thus far, your argument lacks substance of any significance.
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Offline Xelebes

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Re: Why Screening Teens for Mental Illness Is a Terrible Ide
« Reply #5 on: September 06, 2011, 12:18:58 AM »
What I often hear happening in the United States is that a lot of doctor's hands are tied up in terms of what therapies they can offer.  Often times there are pressures to reduce pain before attacking the illness - like one case where a man without insurance is prescribed painkillers alongside the antibiotic to treat an abscessed tooth.  Together they would have been fine, but when the guy can only afford one or the other.  The doctor should be made aware of this.  Giving the patient both prescriptions forces the patient to choose and oftentimes they make the wrong decision.  The wrong decision in this case is to go for the painkillers.  Alternatively, a treatment of antibiotics and dental surgery would have been optimal.

I hear a lot from fellow autistics in the US that they are given as much as six or seven different prescriptions to treat things that should not be concerned too much about - OCD symptoms, depressive symptoms, psychosis symptoms and so on and so forth.  What often makes it cheaper is to give them a stable place where they can work on their life skills - that is the most important thing they should be working on.  It significantly reduces the stress and reduces the need to medicate.
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Offline Froderik

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Re: Why Screening Teens for Mental Illness Is a Terrible Ide
« Reply #6 on: September 06, 2011, 09:47:56 AM »
Quote
What often makes it cheaper is to give them a stable place where they can work on their life skills - that is the most important thing they should be working on. It significantly reduces the stress and reduces the need to medicate.

 :tup:
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Offline DD Form 214

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Re: Why Screening Teens for Mental Illness Is a Terrible Ide
« Reply #7 on: September 06, 2011, 09:57:27 AM »
Quote from: "Froderik"
Quote
What often makes it cheaper is to give them a stable place where they can work on their life skills - that is the most important thing they should be working on. It significantly reduces the stress and reduces the need to medicate.

 :tup:

A stable place "program" would be great!  Thanks Froderik I knew you would pull through.  lol
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Offline Ursus

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Re: Why Screening Teens for Mental Illness Is a Terrible Ide
« Reply #8 on: September 06, 2011, 12:00:46 PM »
Quote from: "Xelebes"
What I often hear happening in the United States is that a lot of doctor's hands are tied up in terms of what therapies they can offer.  Often times there are pressures to reduce pain before attacking the illness - like one case where a man without insurance is prescribed painkillers alongside the antibiotic to treat an abscessed tooth.  Together they would have been fine, but when the guy can only afford one or the other.  The doctor should be made aware of this.  Giving the patient both prescriptions forces the patient to choose and oftentimes they make the wrong decision.  The wrong decision in this case is to go for the painkillers.  Alternatively, a treatment of antibiotics and dental surgery would have been optimal.

I hear a lot from fellow autistics in the US that they are given as much as six or seven different prescriptions to treat things that should not be concerned too much about - OCD symptoms, depressive symptoms, psychosis symptoms and so on and so forth.  What often makes it cheaper is to give them a stable place where they can work on their life skills - that is the most important thing they should be working on.  It significantly reduces the stress and reduces the need to medicate.
Well, increasing one's life skills would certainly be the common sense approach, eh? Assisting and supporting someone in the direction of them being able to help themselves is always the better way.

But this would entail more personal attention, where the support is custom tailored to the needs of the individual. A practitioner's skill and ability to establish a respectful and caring rapport would be essential. It's far easier to rely on a prescription pad to make the objectionable symptoms go away.
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