BMJ  2004;329:292 (31 July), doi:10.1136/bmj.329.7460.292-b

Letter

Bush plans to screen whole US population for mental illness

Is road of initiative paved with good intentions?

EDITOR—The grandiose scale of George W Bush's mental health initiative makes it difficult to comment on the "road" he wishes to take, or to relate this American proposal to the recent British report on mental health and social exclusion.^{1 2} The devil is in the detail. Because of the longstanding mutual interests of the pharmaceutical industry and this presidency, the remorseless pressure of Big Pharma on doctors and patients spreads far beyond the United States to policy and planning across the world's health economies.^{3 4}

None the less, the United Kingdom can learn from the American population perspective that schools "are in a `key position' to screen the 52 million students."¹ Big Pharma has an interest in screening to label more mental illness that can introduce millions of new child "consumers" to maintenance psychotropic treatment. But schools can also provide promising opportunities for promoting mental health across the entire school age population.⁵

That really could "change their trajectory" to the benefit of a whole society.¹ In Britain there are several educational trials aiming to help children develop self awareness, motivation, and empathy and deal with feelings and social situations.² These do not aim to make more children into long term consumers of drugs. One critical step is missing in the United Kingdom. To tackle the huge inequalities present in public mental health, the government must first amend this: "There is no requirement for schools to include learning about mental health" (p 29).²

Department of Public and Family Health, APU, Chelmsford, Essex CM1 1SQ a.w.caan{at}apu.ac.uk

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Competing interests: WK is past chair of the School Health Research Group and current member of the mental health promotion forum for London.

References

1. Lenzer J. Bush plans to screen whole US population for mental illness. BMJ 2004;328: 1458. (19 June.)[Free Full Text]
2. Social Exclusion Unit. Mental health and social exclusion. London: Office of the Deputy Prime Minister, 2004. [With foreword by Tony Blair.]
3. Terpenning MS. Campaign to revitalise academic medicine. BMJ 2004;328: 1377. (5 June.)[Free Full Text]
4. Caan W. Dubious company. Health Serv J 2004;17 June: 18.
5. Carlisle D. Emotional rescue. Health Development Today 2004;February/March: 12-14.

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