New Gov’t Task Force Calls For Screening Every Adult, Pregnant Women For Depression

A new recommendation has been released by the U.S. Preventive Services Task Force, a government advisory group that is now recommending all adults be routinely screened for depression as part of their healthcare.

The first part of the recommendation suggests that all adults be screened, but singles out pregnant women and new mothers as a target population. The second part of the recommendation mentions the need to ensure that systems are in place that will allow for the proper diagnosis and treatment of people who are singled out through this screening. The guidelines, which were published in the Journal of the American Medical Association, did not specify how often adults should be screened.

In regards to the implementation of these guidelines, the Task Force states:

The USPSTF recommends that screening be implemented with adequate systems in place. “Adequate systems in place” refers to having systems and clinical staff to ensure that patients are screened and, if they screen positive, are appropriately diagnosed and treated with evidence-based care or referred to a setting that can provide the necessary care. These essential functions can be provided through a wide range of different arrangements of clinician types and settings. In the available evidence, the lowest effective level of support consisted of a designated nurse who advised resident physicians of positive screening results and provided a protocol that facilitated referral to evidence-based behavioral treatment.1 At the highest level, support included screening; staff and clinician training (1- or 2-day workshops); clinician manuals; monthly training lectures; academic detailing; materials for clinicians, staff, and patients; an initial visit with a nurse specialist for assessment, education, and discussion of patient preferences and goals; a visit with a trained nurse specialist for follow-up assessment and ongoing support for medication adherence; a visit with a trained therapist for CBT; and a reduced copayment for patients referred for psychotherapy.2, 3

Multidisciplinary team–based primary care that includes self management support and care coordination has been shown to be effective in management of depression. These components of primary care are detailed in recommendations from the Community Preventive Services Task Force.4 It recommends collaborative care for the treatment of major depression in adults 18 years and older on the basis of strong evidence of effectiveness in improving short-term treatment outcomes. As defined, collaborative care and disease management of depressive disorders include a systematic, multicomponent, and team-based approach that “strengthens and supports self-care, while assuring that effective medical, preventive, and health maintenance interventions take place” to improve the quality and outcome of patient care.4

While attempting to develop a system in which individuals suffering from mental illness and mental disorders including depression are able to receive adequate treatment is a laudable goal in and of itself, there is a very fine line between assisting in an individual’s recovery, prying into their personal business, and violating their rights.

Notice, for instance, that nowhere in the recommendations is there the acknowledgement or discussion about whether or not these individuals suffering from depression have a choice to seek or continue treatment. The discussion centers only around identification and the implementation of a treatment plan.

What about individuals who don’t want to seek counseling, take antidepressants, or otherwise engage in a “treatment policy?” In addition, what about those individuals who are diagnosed as depressed for legitimate reasons or as a natural reaction to a specific event? What about the over-diagnosing of individuals as depressed when that is simply not the case at all?

Read for instance the U.S. News and World Report article by Lauran Neergaard which reads more as a press release than anything else. Neergaard attempts to explain the need for screening in the following way.

She writes:

Depression can go unrecognized, especially if patients don’t seek a diagnosis. Updating 2009 guidelines, the task force reviewed years of research and said Tuesday that screening for depression remains an important part of primary care for adults of all ages. This time around, the guideline separately addresses pregnant and postpartum women, concluding they, too, benefit from screening.

A variety of screening questionnaires are available, such as one that asks how often, over the last two weeks, patients have felt bad about themselves or felt like they’re a failure, had little interest in doing things or experienced problems sleeping, sleeping or concentrating.

Still undetermined, the task force said, is how often to screen, given that a person’s circumstances and risk could change over time.

Those aren’t new recommendations; several other health groups also have long urged depression screening, although there’s no data on how often it’s done. But the task force says one key is that appropriate follow-up be available to accurately diagnose those flagged by screening — and then to choose treatments that best address each person’s symptoms with the fewest possible side effects.

While examining the possibility that a medical issue or symptoms being suffered by a patient can be linked to depression, the idea that catch-all screenings should be in place is not only reminiscent of Brave New World, but is taken directly from the book. So are, I might add, the solutions to it.

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Still, the constant screening of adults without a shred of concern for their own choices and decisions, cannot help but remind us of Scotland’s horrific practice and program called GIRFEC (Getting It Right For Every Child). Based on the idea of “supporting the wellbeing of children,” Scotland is now witnessing an approach in which every child is now given their own caseworker and every action, reaction, behavior and feeling of both the child and the parents is literally scrutinized by government. The result is that children are being ripped from loving homes. In homes where children do reside, parents are often so terrified of having them taken that anything resembling a normal family life brings the fear of a government social worker to the forefront of a parent’s concern.

Notice also how Neergaard describes the screening process and the questionnaires that are available. Some questionnaires ask questions like how often patients have felt bad about themselves or how often they have felt like they are a failure over the last two weeks. Others ask if the patient has little interest in doing things while others want to know if the patient has had trouble sleeping or concentrating. These are legitimate questions, but the answers to these questions, particularly if they are given to a medical doctor, psychiatrist or social worker, whose views of the world are dangerously narrow, could have far reaching and long lasting ramifications for the unsuspecting patient.

Parents may be visited by a child services agent, who generally is more than eager to confiscate their children. Some patients may be visited by a law enforcement agent, demanding they turn over their guns. Others may be forcibly hospitalized. All this because they made the mistake of trusting their physician or answering a question honestly.

Not only that, but look at the nature of the questions. In a country with massive unemployment yet still a notoriously consumerist and money-obsessed society, how could one who spends hours a day staring at a box that reinforces their own inadequacy not feel bad about themselves? And how bad is bad? Is bad feeling like you’re worth absolutely nothing or is bad feeling like the jogging suit you’re wearing makes you look ridiculous in front of people who are better dressed?

How often have you felt like a failure? Try asking this question to an individual who has lost his job because it has been sent to China so big corporations can reap bigger profits. Or perhaps to someone who is in the process of losing their home because they could not pay their mortgage after they lost their job. Or perhaps their wife became ill and, in the freest country in the world, they went bankrupt in order to save her life? Suppose if one asked that question of a man who had recently been released from prison for the hardened crime of possessing a plant, knowing his youth and any ability for his future are now virtually gone. Is it conceivable that these people may feel like failures?

Of course, the recommendations also suggests going after other easy targets such as pregnant women and those who have just given birth. These two population groups are notoriously in flux in terms of their emotions due to the fact that they are carrying a living human being in their bodies or have just given birth to one. Both exhibit a number of blips on the radar screen for any fanatical mental health professional to seize upon if they so desire.

As already mentioned, one of the most concerning aspects of these recommendations is the utter lack of concern or even acknowledgement of the patient’s right to refuse treatment or even refuse to be screened.

Allowing doctors, social workers or any other authority figure to violate rights based upon their conclusion that a person is suffering from a mental disorder is a slippery slope indeed.

In fact, it is such a slippery slope, that it would be best to stay far away from the edge. Scientific and mental health dictatorship has been experimented with in the past – we would be wise not to allow ourselves to repeat it.

Brandon Turbeville 

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