Reply #30: Finally...

[HuckleB]

Regarding assessments, yes, your concern about a shortage of pediatric mental health professionals is valid, by any current measure. However, this is a screening program, not a program intended to offer full assessment for every child. Screening in schools can be done via RNs, LCSWs and others, with referrals made to more highly trained mental health professionals for those children who present with serious symptomalogy. This is no different than screening for vision or scoliosis. We don't send opthalmologists and surgeons to do the screenings in schools for those matters. Still, I certainly acknowledge your concern about the shortage of pediatric mental health professionals. This is part of the problem in regard to assessment for diagnoses such as ADHD and depression in children today. Full and competent assessment is not provided in far too many cases.

Your concern regarding funding, leading to shortcuts is, of course, also valid. This is probably my biggest concern for such a program, though it doesn't make such a program inherently evil, in and of itself. Follow-up must be available to make such a program worthy of itself. Currently, it's not available in many parts of the country, and not just for mental health matters.

As for your opinion of the "American people" and the quick fix. I agree that this is an issue for some. I don't see it as widespread in the general population as you do, however. Further, I see increased mental health care parity as one of the few ways to begin to educate the public and general practitioners of the need for more complete, competent and ongoing assessments, in addition to more robust treatment for those with an actual, viable diagnosis, including therapy, medication when truly warranted, with consideration of environmental issues, including the family and school. Further, we've all had teachers send children for assessment where it was clearly not warranted. That's a problem of education and professionalism on one end. Of course, if a physician or mental health care professional concurs without truly doing full assessment, with an ongoing component, and merely feeds the child medicine, that, too, is a failure of education and professionalism. It has been my experience that both sides of that coin are working harder to address matters more holistically as time goes on. Of course, no human system is perfect, and, in the end, the balance of risk versus benefit is always tenuous.

Again, I don't see evidence that sadness is being diagnosed as depression on any widespread scale. Yes, there are some general practitioners prescribing SSRIs without a full and ongoing assessment. This, too, is something that is changing, as more and more GPs do not choose to prescribe psychotropics, at least without full consultation with a mental health professional. Yes, most health care diagnoses end up being subjective, to some extent. The reality is that health care is still very much an art, regardless of the science involved. Still, those who use the DSM for diagnosis, and who were taught at reputable schools, understand that diagnosis cannot be made for mere sadness, for example. Further, they know that the diagnosis cannot be made without the client facing serious deficits in function.

Also, I am wondering if you have ever seen an assessment where anyone gave the diagnosis of caffeine addiction?

Oh, what social ills do you see as underlying ADHD, depression, etc... and how do those ills affect the genetic component of these diagnoses?

I guess you hear about it every day. I don't. That's interesting.

I do wonder about your last statement regarding who is doing the treatment. Yes, it's true that LCSW's and masters level therapists now abound on treatment teams everywhere. And it's true that they did not receive the same level of education and training in assessment as psychologists do. However, your earlier concern about the quick fix via medication doesn't connect to this concern about masters level therapists, in my opinion. These folks can't prescribe, and neither can psychologists except in New Mexico, and it's not my experience that these folks are stuck in a quick fix mode, or are the folks jumping to a conclusion about an ADHD diagnosis (which must be made only after excluding all differential diagnoses, in addition to meeting the rest of the criteria across environments with serious functional deficits involved -- and, yeah, I know that doesn't always happen).

As for me, I don't think such a program should be mandatory, but I see no inherent evil in such a program. Early intervention can actually keep many children off medications, and could provide for more even growth and development curve. However, I don't see such a program as anything but window dressing unless it coincides with programs intended to increase the number of pediatric mental health professionals who can do ongoing care, increase the education of teachers on mental health and development, and increase the available health care funding to pay for more holistic treatment.

Again, thanks for your thoughtful response.