Legislator seeking accounting of kids’ meds

More children are on psychiatric medications than ever, according to state and national data, and Arizona taxpayers last year paid more than $26 million for these drugs to treat kids in publicly funded health programs.

Citing concerns about overmedicated foster children, a Mesa legislator wants to require state health officials to report annually on the amount of psychotropic drugs prescribed to kids in the Arizona Health Care Cost Containment System and rein in their use.

Mental health advocates, physicians and parents worry the bill is a misguided effort to slash desperately needed care for the most vulnerable children and adolescents while furthering the stigma of mental illness.

While it may produce some numbers, they say the figures will be meaningless — and misused — without a deeper understanding of the children, their circumstances and their nondrug therapies.

And they contend this measure and others like it around the country are pushed by the lobbying arm of the Church of Scientology, which opposes mainstream psychiatry, including psychotropic medications.

Sen. Karen Johnson, R-Mesa, who sits on the advisory board of the church’s Citizens Commission on Human Rights, said she believes psychotropic medications are sometimes appropriate, even for children. But she also says that some youngsters, particularly in foster care, are put on drugs to make them easier to handle.

“If you drug them and get them to be zombie-like, then they’re less of a problem,” she said.

“It’s a large amount of money that would appear to not be necessary in our opinion,” Johnson said. “That would be one place to cut.”

Nationwide, an estimated 50 percent of kids in the child welfare system have significant mental health problems, according to the Child Welfare League.

Debate has been raging for years as more children, both in and out of foster care, are being diagnosed with mental illnesses and prescribed powerful drugs typically tested only on adults. Once a drug has been approved for use by the Food and Drug Administration, doctors can prescribe it “off label” to children.

In the U.S., the number of children prescribed antipsychotic drugs increased five-fold from 1995 to 2002, to an estimated 2.5 million. Almost one-third of those prescriptions were written by pediatricians or family practice doctors, according to a 2006 study.

And according to the federal Centers for Disease Control and Prevention, an estimated 3.5 million children are taking stimulants to treat attention-deficit hyperactivity disorder.

At the same time, there are huge gaps in treatment and even bigger holes in the scientific research into whether psychotropic drugs are effective in children and what their long-term side-effects may be.

There’s no one answer as to why the numbers are going up, though theories include everything from heredity to better education and treatment to mass marketing and society’s demand for a quick fix.

“We’re not making stuff up. The families we work with are all families with significant challenges,” said Vicki Johnson, executive director of MIKID, a local support and advocacy organization for families with mentally ill children.

“If you’re going to look at how much money you’re spending on medication, then you have to look at how much otherwise might be spent because they couldn’t be managed in the community,” she said.

Treating mentally ill children is tricky. Mostly, parents say, it’s trial and error.

Teri Hollaway’s son, Roger, spent three months in detention, a month at St. Luke’s Behavioral Health Center and six more months in residential treatment. It took years for the 15-year-old, diagnosed with bipolar disorder, ADHD and post-traumatic stress, to find a medication that works.

“I didn’t want to put him on meds. It was very frightening for me,” said the Mesa mother of five.

“It’s not an exact science. But the reality is that these kids have the right to be on medications if that helps them, and they don’t need to have the government in their lives.”

The time and money spent on crunching AHCCCS numbers would be better spent on early intervention, prevention and treatment, Hollaway said.

“There’s something kind of creepy about it if you ask me,” she said of Johnson’s bill.

A 2006 review of AHCCCS data showed the number of children diagnosed with a mental illness increased 185 percent between 2002 and 2005.

Data released to Johnson from AHCCCS showed that during fiscal 2005-06, there were 22,297 children and young adults under 21 receiving $26.1 million worth of psychiatric medication. That included nearly 500 kids under 6 years old, and at least one as young as a year old.

Children on AHCCCS, the state’s version of Medicaid, include those in the juvenile justice and child welfare systems, as well as low-income kids.

“We treat children with a little bit more severe problems and complex needs than the general population,” said Eddy Broadway, deputy director for behavioral health with the state Department of Health Services, which oversees the mental health system.

Broadway said the AHCCCS data doesn’t take into account therapies and other services kids receive. He said it would be difficult to provide the aggregate numbers Johnson wants in an understandable, meaningful way.

“This data doesn’t necessarily let you know the child’s situation,” he said. “It just tells you a budget and a number and an age group. It doesn’t tell you a whole lot.”

Though Broadway said prescribing practices already are being monitored, a longtime child-welfare consultant who’s worked extensively in Arizona said it’s not being done well enough.

Paul Vincent, director of the Child Welfare Policy and Practice Group, has trained mental health workers here and reviewed the state system.

“I share the opinion of a lot of folks in the field that these drugs tend to be overused, and they’re often not prescribed by psychiatrists,” he said

Vincent said few states track data of medicated kids to recognize trends and follow children’s progress. That’s particularly important now, he said, as the off-label use of drugs increases.

Several states are scrutinizing similar data for kids in foster care, including Texas, California and Florida.

In Tennessee, a class-action lawsuit forced health officials to create new standards for prescribing psychotropic drugs to foster children.

AHCCCS opposed Johnson’s bill last year and it failed in the Senate Health Committee. Committee Chairwoman Sen. Carolyn Allen, R-Scottsdale, said she’ll give the measure another hearing.

“We just think that things should be out in the open,” Johnson said. “If this stuff is so good for kids, let’s take a look at it.”

Statistics don’t really matter to kids like 8-year-old Jimmy Gillian of Gilbert.

Jimmy was born to a 15-year-old bipolar mother while she was in foster care. He has bipolar, fetal alcohol, attention-deficit and attachment disorders. He’s tried to hang himself and routinely threatened his adoptive parents and five siblings.

Karen and Michael Gillian tried weaning him off drugs, brought him to a naturopath and put him on 20 different dietary supplements. The Gilbert couple strictly monitored his diet for food allergies and took him to Colorado for a brain scan.

Medications, even at adult doses, have only sporadically controlled his rages. In November, his parents reluctantly checked him into a Scottsdale treatment facility.

“We lived with it for seven years. We just couldn’t do it anymore,” Karen Gillian said. “We don’t want to give up on him. Deep down inside, we know there’s a good kid in there.”