Suicide and TeenScreen
Suicide is a horrific and traumatic event for everyone connected to it. The victims most likely suffer months or even years of emotional anguish, perhaps in silence and perhaps not taken seriously by those closest to them. Family members are thrown into a desperate world of blame, guilt, regret and simply not understanding what happened. It affects friends, teachers, counselors, psychologists and psychiatrists. My host father in Germany committed suicide, something that seems completely contrary to his whimsical good-nature. But a lot happened in the years after I left Germany, and apparently more than he could bear. In the little village where his ex-wife and children moved, another man committed suicide. A man I never met, but he did it in front of his children, and they were visibly traumatized by the event, even years later. As a support worker for foster families, I sat and listened to desperate children recount to me why their lives were no longer worth living. These events left me with a deep sense of helplessness, and at times a vague sense of hopelessness. I reacted physically as well as emotionally, and afterwards would not be able to sleep, would become highly distractable and at times rather irritable. It is no wonder that a significant number of our social workers live with a sort of vicarious post-traumatic stress disorder.

The feeling that something (anything) must be done to identify and treat depression in young people is understandable. But that doesn't make everything done in the name of suicide prevention advisable.

December 28th, 2006, the New England Journal of Medicine published a report on TeenScreen, a controversial mental health screening program developed by Columbia University and administered in schools in 42 states. The article gives some statistics related to suicide among adolescents and states,
These grim statistics argue strongly for early detection and intervention and provide a rationale for mental health screening among teenagers. The premise is that the primary risk factors for suicide--mood disorder, a previous suicide attempt, and alcohol or substance abuse--can be identified and treated.
Note that it is the suicide rate, not the effectiveness of TeenScreen, which provides the basis for the testing. The conclusion is a little more disconcerting.
I believe that voluntary mental health screening should be universal. But we need to go beyond school-based screening if we are optimally to reach young people who are at risk for psychiatric illness and suicide. Pediatric clinicians are in an ideal position to detect mental illness in young people, and they should be better trained to probe for and recognize the signs and symptoms of major psychiatric disorders.
The traumatic effects of suicide alone are not justification for any particular course of action, and particularly not for the universal screening of adolescents. There are a number of concerns which come immediately to mind:

Does screening, in fact, have any impact on suicide attempts? (Short answer, no.)

Exactly how prevalent is suicide? (It ranks third among children...right after unintentional injuries and homicide. In real numbers, we are talking about 0.01% of children.)

Who is paying for it? And why? (Just as a side note, I'm not one to jump on businesses for trying to make a profit, and the very existence of "BigPharma" is more of an effect of ill-planned attempts at controlling it, in my opinion. Off topic, but this article outlines my reasoning, if taken from the example of "Ma Bell.")

There are a number of interesting sites out there regarding TeenScreen, and I shan't bore you with rehashing all the arguments against this program. Tomorrow, I'll take up my concern. In the meantime, here is a summary of sites worth the time, if you are so inclined to read a little more:

TeenScreen--The Last Straw
TeenScreen Truth
The Heritage Foundation

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