Psychotheraputic State
By Stephen M. Lilienthal and Michael D. Ostrolenk

What should be the role of the Federal Government in promoting mental health? This topic will be debated increasingly within the coming year. The presidentially appointed New Freedoms Commission on Mental Health issued a report in July 2003 urging enactment of widespread screening for children to identify and treat mental illnesses. Defenders of constitutional liberties have good reason to be very skeptical of at least one objective.

The report in Recommendation 4.2 states: "The key to improving academic achievement is to identify mental health problems early and, when needed, provide appropriate services or links to services. The extent, severity, and far-reaching consequences make it imperative that our Nation adopt a comprehensive, systematic approach to improving the mental health status of children."

Later, the Commission's report in Recommendation 4.3 states its backing of "systematic screening procedures to identify mental health and substance use problems and treatment needs in all setting in which children [and] youth...are at high risk for mental illnesses or in settings in which a high occurrence of co-occurring mental and substance use disorders exists. In addition to specialty mental health and substance abuse treatment settings, screening for co-occurring disorders should be implemented when an individual enters the juvenile or criminal justice systems, child welfare system, homeless shelters, hospitals..."

Bit by bit, bureaucrats at HHS could take such language and slowly but surely push its boundaries, continually expanding its reach. Unless institutional checks are put in place to prohibit unwarranted expansion, eventually your child could visit the hospital to have his tonsils removed and also receive a free mental health checkup, too, courtesy of Uncle Sam. If your child is full of energy, as many children are, his rambunctiousness could be grounds for receiving a prescription for Ritalin.

The report in Recommendation 4.2 includes a section on a "Model Program: Screening Program for Youth" that promotes the Columbia University TeenScreen® Program clearly states that one of its goals should be "To ensure that all youth are offered a mental health check-up before graduating from high school."

Rep. Ron Paul (R-TX), who is a physician, is concerned that the recommendations of this report threaten to take on a life of their own. That "comprehensive" and "widespread" could easily become "universal." He wrote in his commentary Mental Health Screening for Kids: Part II: "It's not hard to imagine a time 20 or 30 years from now when government psychiatrists stigmatize children whose religious, social, or political values do not comport with those of the politically correct, secular state."

Rep. Grace Napolitano (D-CA) introduced House Concurrent Resolution 292 on October 2, 2003, which expresses "the sense of Congress that Congress should adopt and implement the goals and recommendations provided by the President's New Freedom Commission on Mental Health through legislation or other appropriate action to help ensure affordable, accessible, and high quality mental health care for all Americans."

House Concurrent Resolution 292 states in part:

Whereas the Commission has recommended that to implement its fourth goal of making early screening, assessment, and treatment of mental illness a common practice, Congress should help promote children's mental health by improving and expanding school mental health programs, encouraging screenings for mental disorders (including co-occurring substance use disorders) in primary health care, and supporting appropriate referral to treatment and integrated treatment strategies...

The fact that House Concurrent Resolution 292 has been introduced by a member of the minority party and that its 33 co-sponsors are primarily litmus-test liberals, such as Howard Berman (D-CA), Carolyn McCarthy (D-NY), Patrick Kennedy (D-RI), Jim McDermott (D-WA) and Fortney "Pete" Stark (D-CA), should be of little comfort to defenders of constitutional liberties. Experienced legislators such as Berman and Stark realize that it may take years to enact this legislation but the way to do so is to be relentless in advocating its passage.

Fortunately, there are defenders of constitutional liberties who realize the threat that this legislation represents to parental rights and Federalism.

First and foremost is Representative Paul, who contends this legislation represents one more step to remove power from parents and place it in the hands of bureaucrats. He also worries that important lobbies -- namely, those associated with the pharmaceutical industry -- could very well become active in promoting this legislation because it would help them to more effectively market their wares to children.

Earlier this fall, when the House was considering the Labor, Health & Human Services, and Education Appropriations Bill, Rep. Paul, acting as "a medical doctor, as a civil libertarian, and a strict [constitutionalist]," offered an amendment to deny funding to implement the kind of "universal mental health screening" system recommended by the Commission. No money in the Appropriations Bill was designated to initiate a "universal mental health screening program" but he argued that the Commission's goals could be accomplished by regulation. The amendment represented a precautionary measure to make clear the House's opposition to universal mental health screening. "[T]he whole point was to prevent the proposal from being implemented in the first place," Paul explained after the vote.

Rep. Ralph Regula (R-OH), a member, like Rep. Paul, of the majority party, took offense to the introduction of the amendment, suggesting it would lead to denial of mental health screening and treatment for cases in which it was clearly warranted.

Paul countered that Regula had "misconstrued" the purpose of the amendment in that "it would not deny medical care. What it does is it denies the authority to the administration to have universal screening of all children in public school. It does not deny care to any individual that may qualify." Furthermore, in his commentary, Mental Health Screening for Kids, Part II, Paul disputed the notion advanced by his amendment's opponents that no money has been appropriated to institute mental health screening. The Labor/HHS/Education Appropriations Bill included $20 million for state programs that Paul considers to be the "precursors" to the Commission's recommendations for a significant expansion of mental health screening.

"Anyone who understands bureaucracies knows they assume more and more power incrementally," Paul wrote in his commentary. Today's model program at the local level can become tomorrow's model federal program, and then become a universal one.

Eagle Forum advised its members to contact their U.S. Representative to "Stop school-based mental health screening." The Association of American Physicians & Surgeons issued a similar appeal to its members. Paul's amendment to shut off funding for a universal mental health screening program fell to defeat, receiving 95 votes in support to 315 opposed. Conservative constitutionalists such as Roscoe Bartlett (R-MD, John Shadegg (R-AZ), Jeff Flake ((R-AZ), C.L. "Butch" Otter (R-ID) lined up with Paul. So did respected moderate Tom Petri (R-WI). Pro-family stalwarts Joe Pitts (R-PA), Mark Souder (R-IN), Trent Franks (R-AZ), Marilyn Musgrave (R-CO) and John Hostettler (R-IN) voted for it too. So did House Majority Leader Tom DeLay (R-TX). The only member of the minority party to offer support was Gene Taylor (D-MS).

Paul cautioned that the debate comes at a time when there is great concern that American children are being overmedicated by drugs, such as Ritalin, to treat hyperactivity. The problem of energetic school children is compounded in this era when television watching has become a substitute for real play and when many schools do not permit enough time for recess to allow children to work off energy.

Paul is intent on continuing his crusade, planning to introduce legislation late this year to cut off funding for universal screening before such a program can get started. Paul makes clear that the natural result of the Commission's call for widespread mental health screening for children and teenagers will be to force parents to surrender one more of their responsibilities to the state. Big Government Bureaucracy will move further and further into the realm of decision-making once reserved for parents and private physicians. Defenders of constitutional liberties, Libertarians and social conservatives alike need to realize that the best way to stop the cancerous idea of universal mental health screening from taking hold is very simple yet no doubt effective: an ounce of prevention is the best cure. In this case, it would be cutting off funding for universal mental health screening before such a program is even instituted.

Stephen M. Lilienthal is the Director of the Center for Privacy & Technology Policy ofthe Free Congress Foundation.

Michael D. Ostrolenk is the Director of Government Affairs of the Association of American Physicians & Surgeons.

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