How America’s Overmedicating Low-Income and Foster Kids

More kids in the U.S., especially low-income and foster-care children, are on antipsychotics than in any other country. States are just starting to intervene.

By Chris Kardish

 Stefan Boekels/Corbis

Stefan Boekels/Corbis

Allen Brenzel, a child psychiatrist in Lexington, Ky., can point to the moment he knew his state had a drug problem. A few years ago, Brenzel was working as a consultant for a residential treatment facility for kids under state custody. During his time there, he became acutely aware that many of the children in the program were on prescriptions for psychotropic medications — and lots of them. “It was not uncommon for me to see children as young as 10 or 12 on three or four psych meds,” Brenzel says. “That became more the norm than the exception.” But it was seeing a little boy no older than 5 who was on four different psychotropic drugs that still stands out today in the psychiatrist’s mind. “I remembered thinking you shouldn’t be on more medications than your age.”

Brenzel says he knows that sounds glib, but it drives home a crucial point. Children in the United States are on drugs for longer and more often than kids in any other country. And for children on Medicaid or in foster care, the numbers are far higher. In Kentucky, for example, a child in the Medicaid program is nearly three times as likely to be prescribed a mind-altering psychotropic medication as a kid under private insurance. For a Kentucky foster child, the likelihood is nearly nine times the norm.

Kentucky is hardly alone in overprescribing psychotropics, a class of drugs that ranges from stimulants to antidepressants and antipsychotics. Between 1997 and 2006, American prescriptions for antipsychotics increased somewhere between sevenfold and twelvefold, according to a report by the University of Maryland. And just as in Kentucky, the nationwide numbers for children in foster systems or on Medicaid are startlingly higher than for other children. An average of 4.8 percent of privately insured children are prescribed these drugs every year; among kids on Medicaid, the number is 7.3 percent, according to the most recent study, which looked across 10 states. For children in foster care, it’s a whopping 26.6 percent.

For many physicians and psychiatrists, it’s a situation that’s gotten out of control. “We’ve reached the limits of medicalization,” says Julie Zito, a professor of pharmacy and psychiatry at the University of Maryland. “We’re medicating poverty.”

States have begun to act. Spurred by a series of federal probes and a 2011 directive to begin reporting on the steps they’re taking to reduce prescription rates, state health officials have tried a variety of approaches to address the problem. What they’ve found is that it’s an enormously hard battle to fight. Some places, like Kentucky, are just getting started; others are finding that the efforts they have taken aren’t enough. And it’s not simply about monitoring prescriptions. To make real inroads, states must focus on providing greater access to drug alternatives and on fixing a fragmented system of care. “We know what works,” says Sheila Pires, founder of the Human Service Collaborative, a group specializing in child and family service systems. She points to things like individually tailored pyschiatric therapy programs and family support groups, all connected through people who coordinate the full range of a child’s needs. “The challenge has been getting sufficient service capacity and care coordination across the systems — behavioral health, Medicaid and child welfare.”

Read more at Governing

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Categories: Human rights, Medicine, Opinion/Editorial, Politics, Psychology, Public Health, Science, Self-determination, Social policy

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3 replies

  1. And it isn’t just children who are being abused by a failed health care system. The homeless and the elderly, who tend to place absolute trust in the decisions of medical professionals, are being exploited by a corrupt, self-serving and impotent mental health care system.

    Like

    • Yep, and I’ve seen it first hand. Physicians that have no knowledge of manufactured recommendations or are just simply too busy to read up on what the psych md’s prescribe at (in some cases) a 15 minute exam.

      Ophthalmologists (and many MD”s) that didn’t know that Ritalin was counter indicated in children under 14 because it causes muscle spasms and the eye’s are…controlled by muscles. duh!

      Here in KY, some are beginning to be more careful of what they prescribe but there are still those that are more interested in getting the billing for the 15 minute exam and caseworkers that are only interested in not having any ‘issue’s’ from foster children.

      When I did fostering, I also found out that there was a lack of accurately reporting what was going on with the foster child. If the psych md doesn’t have accurate reporting, they sure can’t make an accurate diagnosis and if necessary prescribe any meds.

      But the use of prescription drugs to turn a child into a compliant robot, is the epitome of adult abuse and neglect of a child. The one aspect that assists in this is the lack of transparency of Juvenile Court. They answer to no one but the few there and too many of them have little or no understanding of the abuse of prescription writing.

      Liked by 1 person

  2. Updating this one…I told my niece in law to find out if two of her boys had been tested for lead poisoning ever since she’s been told one has ODD and the other ADHD. Both might have started with lead poisoning and there is no pill in the world that’s gonna fix it.

    Liked by 1 person

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