I received a call from Rep. Andy Welti last week, after my Thursday item lamenting  the brevity of a bill that would require the state to develop mental health education curriculum. The bill, I wrote, was 62 words long, and in my view, it opened the door for drug industry-funded advocacy groups to influence content made available for teachers of middle and high school students. (The bill does not mandate that mental health coursework be taught, only that it be made available for interested health teachers.) 

The Plainview DFLer notified me that the version I described was actually an early draft and that the full bill was fleshed out with clarifying language, and he encouraged me to listen to testimony available in an audio clip taken during the bill's Feb. 17 hearing before the K-12 Education Policy and Oversight Committee. The bill is now indeed longer than 32 words -- it is 124 words -- and to its credit, does contain language intending a systematic approach to the development of mental health curriculum.

Coursework would "address mental health components of [the CDC’s] National Health Education Standards," it explains, as well as reflect "best practices in mental health eduction," language that presumably would support evidence based treatments and screening information. It also requires materials be age-appropriate and aligned with local health and physical education standards. It still requires the commissioner to create the new content "in consultation with mental health organizations." 

Welti echoed the belief that there is a stigma surrounding mental illness, one which can be reduced through greater education, and describes the bill as a good-faith effort to raise awareness about mental illness among students, in the belief that more information is a good thing. At the hearing, two students and one educator spoke in favor of the bill, as well as a representative from NAMI, the National Alliance for Mental Illness. The educator, a health instructor from Red Wing named Lisa Hansen, spoke about having received supplementary training on mental health curriculum made available through Johns Hopkins University in  Baltimore, and how that training opened her eyes to the importance of curriculum that has been tested for efficacy. 

"If you don't have the right curriculum, you do more harm than good," Hansen said. In the past, Hansen explained, students might have been ushered into the auditorium for an ominous presentation about suicide, then "released into math class without any sort of debriefing."  She also argued for a comprehensive message that extended beyond merely describing the symptoms of illnesses. "We need to destigmatize depression and stigmatize suicide," she said. Hansen expressed her anguish at the prospect of teens unable to recognize the signs of depression in themselves or others, and the risk of depression leading to suicide.

But as Karen Effrem later testified, "there is a huge amount of discussion and conflict in the professional medical community about the diagnosis and treatment of mental illness in children."  Effrem is a pediatrician representing Edwatch. During the period of supportive testimony for the bill, the biological brain disease model of depression had careened around the room with nary a whither of question. At one point in the discussion, NAMI's Sue Abderholden had stated that too many people "don't understand the biological basis" of mental illness, and at another point, Hansen argued "[we need to tell students] it's an illness just like diabetes. If you don't take your medication for your diabetes, you're going to die, and if you don't take your medication for your depression and do talk therapy, the consequence could be death." 

"Medications were frequently referenced during testimony," cautioned Effrem. "Yet antidepressants are under an FDA black box warning for children ages 15-24, and that wasn't even referenced in these discussions. They are banned for use altogether except for Prozac in children under 18 in England." After describing ongoing conflicts within the academy over the DSM [Diagnostic and Statistical Manual of Mental Disorders], she asked "if there is that much conflict among professionals, how are we going to resolve this in a teacher student relationship?" But it was right about then that committee chair Carlos Mariani asked her to wrap it up.  Which, I can't say he did to anyone testifying in support of the bill. 

Edwatch comes at the bill from a social conservative perspective, but other parties who have argued against a disease model for depression, for instance, are anything but reactionary, and a disease model invariably leads to a medication solution. From a research perspective, there seems little doubt that antidepressants function as placebos for all but the very severely depressed. Research on drug actions raise questions over the idea that depression is a brain disease. And the notion that depression arises from a chemical imbalance in the brain has been definitively set aside for years now, although this admittedly is not well known outside of the academy. Even the notion that propagating a biological model of brain diseases reduces stigma is subject to question (PDF).

These are all admittedly minority positions. The prevailing consensus, if drug sales, medical and popular opinion are any guide, is that mental illnesses are brain diseases and medications and therapy correct those conditions.

Welti asserts his bill "has nothing to do with the issue of medication," saying "that would be settled between somebody and their doctor." He believes any ongoing concerns over how to present disputed material about mental illness will be resolved through consensus. That may seem optimistic to ask of the school system, if the research academy is at odds on so many fundamental questions, but he sees it as an effort worth making.  "If you're going to say there's no perfect agreement about mental illness, what does that mean? That you do nothing?"

Freelancer Paul Scott of Rochester writes frequently about health and fitness for various media. Susan Perry will return Monday.