In 2009, Gabriel Myers, a seven-year-old foster child in Florida, hanged himself in the bathroom of his home due to the side effects of psychiatric drugs. Gabriel was taking multiple psychiatric medications, and his foster father stated that the doctor would spend about five minutes with Gabriel before sending him off to the pharmacy with a new prescription. Another victim of overprescription in the foster care system was Ke’onte Cook, who was treated with dozens of medications over four years for seizures, bipolar disorder, and ADHD, conditions he was never officially diagnosed with. Sadly, these are just two examples out of many children who are neglected in a system by people who are supposed to be taking care of them, including their doctors.
Foster care children take psychiatric medications at a rate four times higher than the rate for all children. They also take them in higher doses, and often their prescriptions are not accompanied by proper treatment planning or monitoring. It appears that at times these prescriptions are given more to keep the children complacent rather than to heal any problems.
Children in the foster system are more prone to experiencing mental health problems due to their past life events, thus putting them in a position where they are likely to take medication to manage those problems. A 2018 study by the US Department of Health and Human Services found that up to 80 percent of children in the system have significant mental health needs. They may have faced previous trauma, which can include neglectful parents, and sexual, physical, and emotional abuse. Foster care children are two times more likely to have learning disabilities and developmental delays, five times more likely to experience anxiety, six times more likely to have behavioral issues, and seven times more likely to suffer from depression. Hence, some take psychotropic medications more frequently than others to manage their conditions. However, these drugs have the power to do just as much harm as good, and their overprescription often targets the most vulnerable populations.
The crisis created by the overprescription of these medications originated with the rise of the psychopharmacology industry in the 1950s. With the development of the spectrophotofluorimeter (which measures the spectrum of fluorescent light reflected from a substance), scientists were able to detect biochemical changes involved in behavior, leading to the creation of drugs that can alter human behavior and treat mental health conditions. These pills carried the promise of resolving disorders ranging from depression to schizophrenia.
While these drugs were effective and sometimes applicable solutions, not much has changed in the psychopharmacology field since the 1950s in terms of developing drugs that target novel neurotransmitters. The medical community considers newer drugs safer, but they are not better at treating the condition. For instance, drug therapies for depression result in remission or improvement for less than one third of patients. Despite these statistics, psychotropic medications are widely accepted as part of the standard mental health treatment process of both children and adults, while alternative or additional therapies are not always included in this standard.
Managing the multiple mental health issues of foster children requires increased medical attention that both caregivers and the healthcare system cannot always provide. One in three foster children who take medication do not receive treatment planning or monitoring. Without proper oversight, foster children become victims of overprescription as they receive incorrect diagnoses and could experience a multitude of harmful side effects from the medications.
Foster children may need additional referrals to other specialists and more diagnostic testing, but the US healthcare system makes this difficult to accomplish. Most foster children are covered by Medicaid, which doesn’t appropriately compensate physicians, nor does it accommodate children’s needs for referrals to other specialists. Psychiatrists, for example, have one of the lowest rates of Medicaid acceptance. Foster parents need a flexible schedule to successfully juggle taking care of the household and children in addition to taking them to their appointments. Time constraints and numerous responsibilities make quick fixes more appealing than a series of lengthy appointments. This puts foster children with behavioral or emotional issues in a position where it is easier to find ways to control them than it is to provide them with proper care and attention.
Beyond getting foster children proper medical attention, the side effects of psychiatric medications – which include nightmares, hallucinations, suicidal thoughts, and death – must be considered. In children, the full side effects of psychiatric medications are not known due to a lack of research, and their common use in children is not FDA approved. In adults, we know that psychiatric medications can cause metabolic, neurologic, physiologic, and cognitive issues, and adults who take these pills often end up with diabetes or heart disease. We do not know if children will experience the same long-term effects of these medications because kids are still developing. Their brains and bodies are still growing and maturing, whereas in adults the same processes no longer apply. No long-term studies exist on children to monitor the effects of psychiatric medications on metabolism, neurological function, and other bodily systems. Short-term side effects overlap between children and adults, but they are much more severe in children.
In 2015, the Administration for Children, Youth, and Families (ACF) proposed measures to fix the lack of monitoring in prescribing psychiatric medications. Many child welfare agencies cannot properly address the mental health issues of foster care children because they do not have access to nonpharmacological treatments. The ACF sought to increase trauma-informed interventions that can accommodate the mental health needs of foster care children and reduce the dependency on drugs as treatment. Congress needed to give the ACF $250 million so that they can create a system that enacts trauma-informed practices, uses appropriate screening and assessments, has better data collection, and improves coordination between welfare and Medicaid services. Additionally, the ACF also needed $500 million to incentivize states to decrease the overuse of psychiatric medications, increase access to trauma-informed therapy interventions, and promote child wellness in the welfare system. At the state level, many welfare agencies are behind in executing this plan.
Careless prescription of psychiatric medication cannot continue. Children in the foster care system already face multiple challenges and inadequate healthcare should not be one of them. When these children do not have adults in a parental role that can advocate for them, they need their healthcare providers to do better. However, improving this situation goes beyond just the decisions of medical professionals and relies on implementing policy changes to address the current limitations of the system. Perhaps the loss of young lives like Gabriel’s could have been prevented with the much-needed changes.