Bush plans to screen whole US population for mental illness
Jeanne Lenzer, EducationNews.org, June 21, 2004

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New Freedom Initiative

A sweeping mental health initiative will be unveiled by President George W Bush in July. The plan promises to integrate mentally ill patients fully into the community by providing "services in the community, rather than institutions," according to a March 2004 progress report entitled New Freedom Initiative. While some praise the plan's goals, others say it protects the profits of drug companies at the expense of the public.

Bush established the New Freedom Commission on Mental Health in April 2002 to conduct a "comprehensive study of the United States mental health service delivery system." The commission issued its recommendations in July 2003. Bush instructed more than 25 federal agencies to develop an implementation plan based on those recommendations.

The president's commission found that "despite their prevalence, mental disorders often go undiagnosed" and recommended comprehensive mental health screening for "consumers of all ages," including preschool children. According to the commission, "Each year, young children are expelled from preschools and childcare facilities for severely disruptive behaviours and emotional disorders." Schools, wrote the commission, are in a "key position" to screen the 52 million students and 6 million adults who work at the schools.

The commission also recommended "Linkage (of screening) with treatment and supports" including "state-of-the-art treatments" using "specific medications for specific conditions." The commission commended the Texas Medication Algorithm Project (TMAP) as a "model" medication treatment plan that "illustrates an evidence-based practice that results in better consumer outcomes."

Dr Darrel Regier, director of research at the American Psychiatric Association (APA), lauded the president's initiative and the Texas project model saying, "What's nice about TMAP is that this is a logical plan based on efficacy data from clinical trials."

He said the association has called for increased funding for implementation of the overall plan.

But the Texas project, which promotes the use of newer, more expensive antidepressants and antipsychotic drugs, sparked off controversy when Allen Jones, an employee of the Pennsylvania Office of the Inspector General, revealed that key officials with influence over the medication plan in his state received money and perks from drug companies with a stake in the medication algorithm (15 May, p1153). He was sacked this week for speaking to the BMJ and the New York Times.

The Texas project started in 1995 as an alliance of individuals from the pharmaceutical industry, the University of Texas, and the mental health and corrections systems of Texas. The project was funded by a Robert Wood Johnson grant-and by several drug companies.

Mr Jones told the BMJ that the same "political/pharmaceutical alliance" that generated the Texas project was behind the recommendations of the New Freedom Commission, which, according to his whistleblower report, were "poised to consolidate the TMAP effort into a comprehensive national policy to treat mental illness with expensive, patented medications of questionable benefit and deadly side effects, and to force private insurers to pick up more of the tab".

Mr. Jones' Whistleblower Claim

Larry D Sasich, research associate with Public Citizen in Washington, DC, told the BMJ that studies in both the United States and Great Britain suggest that "using the older drugs first makes sense. There's nothing in the labeling of the newer atypical antipsychotic drugs that suggests they are superior in efficacy to haloperidol (an older "typical" antipsychotic). There has to be an enormous amount of unnecessary expenditures for the newer drugs."

Drug companies have contributed three times more to the campaign of George Bush than to that of his rival John Kerry

Olanzapine (trade name Zyprexa), one of the atypical antipsychotic drugs recommended as a first line drug in the Texas algorithm, grossed $4.28bn (£2.35bn; 3.56bn) worldwide in 2003 and is Eli Lilly's top selling drug. A 2003 New York Times article by Gardiner Harris reported that 70% of olanzapine sales are paid for by government agencies, such as Medicare and Medicaid.

Eli Lilly, manufacturer of olanzapine, has multiple ties to the Bush administration. George Bush Sr was a member of Lilly's board of directors and Bush Jr appointed Lilly's chief executive officer, Sidney Taurel, to a seat on the Homeland Security Council. Lilly made $1.6m in political contributions in 2000-82% of which went to Bush and the Republican Party.

Jones points out that the companies that helped to start up the Texas project have been, and still are, big contributors to the election funds of George W Bush. In addition, some members of the New Freedom Commission have served on advisory boards for these same companies, while others have direct ties to the Texas Medication Algorithm Project.

Bush was the governor of Texas during the development of the Texas project, and, during his 2000 presidential campaign, he boasted of his support for the project and the fact that the legislation he passed expanded Medicaid coverage of psychotropic drugs.

Bush is the clear front runner when it comes to drug company contributions. According to the Center for Responsive Politics (CRP), manufacturers of drugs and health products have contributed $764 274 to the 2004 Bush campaign through their political action committees and employees-far outstripping the $149 400 given to his chief rival, John Kerry, by 26 April.

Drug companies have fared exceedingly well under the Bush administration, according to the centre's spokesperson, Steven Weiss.

The commission's recommendation for increased screening has also been questioned. Robert Whitaker, journalist and author of Mad in America, says that while increased screening "may seem defensible," it could also be seen as "fishing for customers," and that exorbitant spending on new drugs "robs from other forms of care such as job training and shelter programmes."

But Dr Graham Emslie, who helped develop the Texas project, defends screening: "There are good data showing that if you identify kids at an earlier age who are aggressive, you can intervene... and change their trajectory."

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EducationNews.org
The President's New Freedom Initiative for People with Disabilities
The 2004 Progress Report

Executive Summary

Introduction

Announced in February 2001, the New Freedom Initiative is President George W. Bush's bold plan to tear down the remaining barriers to full integration into American life that many of this Nation's 54 million citizens with disabilities still face. This Progress Report highlights accomplishments under the New Freedom Initiative since the issuance of the May 2002 Progress Report.

Increasing Access Through Technology

Assistive and universally designed technology offers people with disabilities better access than ever before to education, the workplace, and community life. To promote the development and dissemination of technology for individuals with disabilities, the President has:

Secured $120 million over three fiscal years (FY 2002 through FY 2004) to promote the development of assistive and universally designed technology and to fund alternative financing programs, such as low-interest, long-term loans to put technology into the hands of more people with disabilities; created a working group of Federal agencies that developed strategies for improving access to assistive technology mobility devices (i.e., wheelchairs and scooters); established DisabilityInfo.gov, a web portal providing information about the array of Federal programs that affect people with disabilities; and promoted full implementation of Section 508 of the Rehabilitation Act, which requires that electronic and information technology purchased, maintained, and used by the Federal government be readily accessible to and usable by individuals with disabilities.

Inspired by the vision of the New Freedom Initiative, agencies did the following to further promote access to technology for people with disabilities:

Secretary of Commerce Donald Evans announced an eight-point plan to promote the development of assistive and universally designed technology nationally and internationally. The Department of Defense significantly expanded its Computer/Electronic Accommodations Program (CAP), which now provides assistive technology for employees with disabilities in 58 agencies.

Expanding Educational Opportunities for Youth with Disabilities

A quality education is critical to ensure that individuals with disabilities can work and fully participate in their communities. The President has done the following to ensure that no child with a disability is left behind by our Nation's education system:

Secured more than $3.7 billion in additional annual funding for the Individuals with Disabilities Education Act Part B State Grants program since FY 2001 (for a total of nearly $10.1 billion in FY 2004), and proposed an increase of $1 billion in FY 2005; and established the President's Commission on Excellence in Special Education, which issued a report in July 2002 emphasizing, among other things, the importance of accountability under the No Child Left Behind Act for the educational outcomes of students with disabilities.

Additionally, agencies are advancing the New Freedom Initiative's goal of ensuring a quality education for youth with disabilities.(What does this mean? - parentadvocates asks).

The Department of Education, alone and in collaboration with other agencies, has recently funded a number of grants and studies to determine what strategies best enable students with disabilities to access the general education curriculum and what kinds of early interventions promote the best results for students with disabilities.

Several agencies have supported activities that reach out to youth with disabilities who are making the transition from high school education to other life goals, including post-secondary education and work.
Integrating Americans with Disabilities Into the Workforce

More than a decade after passage of the Americans with Disabilities Act, the unemployment rate of people with severe disabilities remains stubbornly high. To bring more people with disabilities into the workplace, the President has:

Secured $20 million for a fund to help individuals with disabilities purchase technology needed to telework; continued to support a proposal that would exclude from an employee's taxable income the value of computers, software, and other equipment provided for telecommuting; ensured implementation of the landmark "Ticket to Work" program, so that Social Security and Supplemental Security Income (SSI) disability beneficiaries who want to work can choose their own employment related services; promoted vigorous enforcement of the ADA and challenged Federal agencies to do innovative outreach to employers, particularly small businesses; and secured funding for a number of demonstration projects aimed at removing disincentives to work that currently exist in the Social Security and SSI disability benefit system.

Federal agencies have also undertaken the following activities to promote increased employment opportunities for people with disabilities:

The Department of Labor and other agencies have worked to improve the capacity of community One-Stop Career Centers to provide employment-related services to people with disabilities. The Department of Labor and the Equal Employment Opportunity Commission are each working to promote employer best practices for the hiring and retention of qualified individuals with disabilities. The Office of Personnel Management and other Federal agencies have worked to promote the Federal government as a model employer of people with disabilities. Several agencies have complemented outreach efforts to employers with outreach to people with disabilities, educating them about their rights and responsibilities under the ADA as future employees. (Could you be more specific? - parentadvocates asks)

Promoting Full Access to Community Life

The Supreme Court's decision in Olmstead v. L.C., 527 U.S. 581 (1999), said that, wherever possible, people with disabilities should be provided services in the community, rather than in institutions. For the promise of full integration into the community to become a reality, people with disabilities need safe and affordable housing, access to transportation, access to the political process, and the right to enjoy whatever services, programs, and activities are offered to all members of the community at both public and private facilities. The President has done the following to promote full integration of individuals with disabilities into the community:

Issued an Executive Order calling for swift implementation of Olmstead, which resulted in a report identifying barriers to full integration that exist in Federal programs and proposing more than 400 solutions for removal of these barriers; proposed a budget increase of $2.2 billion over the next five years for the Department of Health and Human Services to fund demonstration projects that promote community-based services for people with disabilities; proposed $918 million over six years to remove transportation barriers still faced by individuals with disabilities; established the New Freedom Commission on Mental Health, which issued a report recommending ways to improve America's mental health care delivery system; and secured $15 million under the Help America Vote Act to improve access to voting for people with disabilities.

Agencies have also done or are doing the following to advance the goal of full integration of people with disabilities into the community:

Implementation of Olmstead

Health and Human Services Secretary Tommy Thompson established the Office on Disability to coordinate disability programs across HHS agencies. The Department of Health and Human Services has awarded nearly $160 million in Real Systems Change Grants since 2001 to support community-based services for people with disabilities. In FY 2003, the Department of Health and Human Services' Centers for Medicare and Medicaid Services funded a $6 million demonstration grant that enables state and community-based providers to test new strategies for recruiting, training, and retaining direct service workers.

The Departments of Justice and Health and Human Services have entered into an agreement under which HHS refers Olmstead-related complaints to DOJ's ADA mediation program. To date, several complaints have been successfully mediated.

Housing

Thirty percent of the families participating in the Department of Housing and Urban Development's home ownership voucher program include family members with disabilities. During FY 2003, the Department of Housing and Urban Development trained more than 1,500 housing professionals under its Fair Housing Accessibility FIRST initiative, which helps architects and builders to design and construct apartments and condominiums with legally required accessibility features. The Department of Housing and Urban Development has funded grants to enable older individuals and individuals with disabilities to remain in their homes and live independently in their communities.

The Department of Justice has vigorously enforced the Fair Housing Act, filing fifteen lawsuits during the past two years against developers, architects, and civil engineers who designed inaccessible multi-family housing, and resolving another fifteen cases through consent decrees.

Transportation

The Department of Transportation's Bureau of Transportation Statistics issued a report, entitled "Freedom to Travel," based on the first national survey of the views of people with disabilities about transportation.
The National Highway Traffic Safety Administration (NHTSA) recently issued a Final Rule regulating platform lifts and their installation in new motor vehicles. Since the inception of its Job Access and Reverse Commute Program, the Department of Transportation has funded over 200 state and local grantees in 44 states to provide new employment transportation services for low-income persons, including persons with disabilities. The Departments of Transportation, Education, Labor, and Health and Human Services are sponsoring "United We Ride," a five-part initiative to assist states and communities in coordinating human service transportation.

Improving Access

The Solicitor General intervened in the Supreme Court case of Tennessee v. Lane to defend the constitutionality of Title II of the Americans with Disabilities Act as applied to state governments.
The Department of Justice has reached 36 agreements with towns and cities under "Project Civic Access," an effort to ensure that towns and cities across America are fully accessible to people with disabilities.
In 2003, the Department of Justice has achieved favorable action for persons with disabilities in well over 350 matters.

See The New Freedom Initiative for more information.