“I’m not bipolar. I’m just naughty.”
In the past few days, we have all had the honor of getting to know a remarkable young man from Texas named Ke’onte Cook. He has appeared on ABC’s 20/20, testified before Congress, and for many of us, his face is the face we now see when we think about the impact of overuse of psychotropic medications on foster youth.
It’s remarkable to see Ke’onte now—a happy, bright, well-spoken young man—and imagine that he would need anything other than a loving family in order to thrive. Yet he received no less than 12 different medications while in foster care—up to 5 medications at the same time. He received medications used to treat seizures, which he never had. He received medication used to treat bipolar disorder, a condition for which he has never been diagnosed. I am not a doctor, but it is difficult for me to imagine any valid medical reason for those many drugs being prescribed to someone so young.
The new report on psychotropic medication use among foster youth, which was released by the Government Accountability Office this week, is shocking. There is no other word for it. Shocking to imagine that a young person in foster care is 4.5 times more likely to be medicated as youth not in foster care. Shocking to think that in some states, nearly 40% of all foster children are receiving psychotropic medications. Shocking to imagine that these vulnerable youth are being given multiple medications, and often in doses higher than recommended for either children or adults!
Yet, as shocking as these statistics are, it is not news that foster youth are medicated more often than those not in care. In 2010, the Tufts Clinical and Translational Institute (CTSI) reported an increase of psychotropic medications among youth in foster care, including more medications prescribed for young children; increased frequency of use of more than one medication at a time; and increased “blanket authorizations” of prescriptions in residential facilities.
During one of our conversations for the ABC program 20/20, Diane Sawyer asked me why foster children were medicated so frequently. Wasn’t it a fact that foster youth were more troubled than the general population? I answered truthfully—of course they are more troubled. Think about any child in their circumstances: imagine being the victim of abuse or neglect, then removed from the only home you ever knew, and then shifted from one foster home to another to another. Of course these children are troubled.
But we can address the real stresses in their lives without resorting to altering their brain chemistry. Look at Ke’onte today. Thanks to the dedication of a CASA volunteer, Ke’onte is now living with a loving adoptive family. And thanks to that family and the help of an attachment therapist, he is no longer taking any of these psychotropic medications. He didn’t need them then, and he doesn’t need them now.
Of course, I do not believe that psychotropic medications are never warranted. There are youth in foster care facing serious mental health challenges for whom medication can be a great benefit. But these prescriptions must be driven by true need, careful and thoughtful diagnosis and conscientious ongoing monitoring. If, instead, they are driven by money, expediency or simple frustration with an inadequate system of care, then their use is inconsistent with a child’s right to receive proper medical care and to live without the numbing or dangerous side effects of psychotropic drugs.
Is this a turning point? It’s too soon to know. But it’s gratifying to see the national debate beginning. For too long, these children—victims already of abuse and neglect—were victimized again by a system that failed to treat their mental health with the respect it deserves. It’s time for this tragedy to end. It’s time that we stop treating our foster youth like second-class citizens. They deserve better.
To learn more about this issue, listen to the National CASA podcast from January 2011, “The Diagnosis and the Drug: Use of Psychotropic Medication in the Foster Care System.” In this podcast, Stephen McCrea, CASA Supervisor with CASA for Children in Portland, OR, talks about the history of mental health treatment of foster youth including the introduction of psychotropic medications, their use now and what a CASA/GAL volunteer should know when working with medicated youth. Before working with the CASA program, McCrea was a crisis counselor and a residential counselor for youth.