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Mental Parity_Temp 11/24/09 6:54 PM Page 17 Mood Disorders at Lutheran Hospital. "We can say that about 1 in 4 patients didn't have the correct diagnosis, which is quite a big number" , study author Dr. Akhil Sethi told Medscape Psychiatry. To further blunt the process, the vast majority of those conducting these evaluations, almost entirely primary care doctors and teachers, have neither any specialty in mental illness nor the time to explore the special circumstances comprising an individual's life. Studies show primary care doctors address the mental health concerns in 80 percent of children and adolescents, and of those referred to a psychiatrist, another study showed that 90 percent of young people receive a prescription. Despite the widely acknowledged flaws, the DSM guidelines have become ubiquitous, stretching beyond their original purpose of diagnosis to be applied in epidemiological studies of which the most expansive have declared that more than half the population suffers from some form of mental disorder. These huge numbers, vastly inflated as they may be, justify devoting more resources to preventing mental illnesses. Thus, identifying the "walking wounded," has become public policy in the form of even more simplified—and inaccurate—screening tests. "This is a not a question of bad or good, but do w e need to know more before we undertake such a massive intervention in our children's lives?" says Wakefield. "I think that with the false positives so high, this is not a good idea." If mass screenings are not very accurate and may actually cause more harm than good, then why the push to broaden them? Over the past few decades, pharmaceutical companies have played a large role in expanding screening programs across the country: Eli Lilly has given almost $4 million, on top of another $ 1 million from other drug makers, in support of Screening for Mental Health, Inc., according to the organization's tax returns dating back to 1996. TeenScreen, while accepting no direct industry money, was originally marketed by Rabin Strategic Partners, a public relations firm representing Jansen Pharmaceutica, Johnson & Johnson, OrthoMcNeil, and Pfizer among other pharmaceutical companies. Before becoming director of TeenScreen, Laurie Flynn was the executive director of the National Alliance on Mental Illness, which for the three years leading up to her departure, accepted $11.72 million from 18 different drug companies, according to lawsuits and public records. Pfizer paid for the creation of PRIME-MD (Primary Care Evaluation of Mental Disorders), one of the first popular screening tests used in primary care settings. Many other pharmaceutical firms have created their own questionnaires, often with their names printed in the letterhead. Wakefield is quick to emphasize that the screenings are well-intentioned by medical providers. "People are trying to do things with integrity," he says. "The pharmaceutical companies are only exploiting what's already there." What's already there is a medical model that has grown increasingly popular and rooted in the mental health system despite r egularly critical media reports of the pharmaceutical industry. Yet many continue see the current system as a therapeutic endgame in which the exploratory process stops with diagnosis. They worry about the patients who fall within the gray areas, the ones with symptoms more complicated or subtle than what can be check-marked in a box. The OCTOBER 2009 ones who simply need to talk to someone on a regular basis, even just as a reminder to keep up their medication regimen. Over the 25 years Barbara Williams worked on psychiatric wards, she says she has noticed a subtle shift in goals, from wellness to behavior control. The field turned its focus to symptoms and in turn, to controlling those symptoms. Health clinics became behavioral clinics, the focus on the external habits rather than in the internal world. "You can get people out of the hospital a lot quicker if you can stabilize them with drugs," she says. "Never mind that they're going to come back when they stop taking their meds." n Matt Isaacs is a fellow at the UC Berkeley Investigative Reporting Program. A CLOSER LOOK (continued from page 9) Minimal expansion of consumer choice: 1) The much-debated House version of the public plan option would be open only to about 2 percent of people under age 65, mostly those now not covered who buy insurance on their own (it may or may not be expanded in 2015). 2) No additional plan options for those in the many markets dominated by one or two private plans, and no additional choice of doctor or hospital within existing plans. It's not universal. Several million, especially the undocumented, remain left out of the system. The new limits on abortion extended to poor women. Ultimately, the combination of the mandate to buy insur ance, federal subsidies to low-income families to purchase private plans, failure to adequately control insurance prices or crack down on the abuse of insurance denials make the House bill—and its Senate counterpart—look a lot lik a massive bailout for the prie vate insurance industry. Don't be misled by howling from the insurance industry which has been spending some $1.4 million a day to steer the direction of legislation. They would prefer the status quo, but will be more than happy to count the increased revenues coming their way. While access to insurance will increase for many of the uninsured, the final accounting will be an even firmer private insurance grip on our healthcar e system, with the U nited States remaining the only industrialized nation which barters our health for private profit. Months ago, the Obama administration and Congress predetermined this outcome by ruling out the most comprehensive, most cost effective, most humane reform, single-payer, or an expanded and improved Medicare for all. Yet, through grassroots pressure, single-payer advocates forced consideration by the House of an improved Medicare for all until the very end. Nurses and other single-payer proponents who have heroically fought for this reform for years will continue the campaign, next in the Senate, where Sen. Bernie Sanders is sponsoring single-payer amendments; monitor our website, www.calnurses.org for updates. The scene will also shift to state capitals, where vibrant singlepayer movements remain active and will escalate. Proponents of comprehensive reform will never be silent, and never stop working for the real change we most desperately need. n Rose Ann DeMoro is executive director of CNA/NNOC. W W W. C A L N U R S E S . O R G REGISTERED NURSE 17