That Poor Antipsychotic
As the health care reform debate rages on, I often wonder how mental health treatment will change. Poor children are among the most vulnerable in our society. Yesterday, the New York Times published an article citing that children on Medicaid were found to be prescribed anti-psychotic drugs, at a rate of four to one when compared to their middle-class counterpart. Now, I can get on a soapbox rant, but I think it's more constructive to ask, why is it that convenience and the employment of cost-cutting measures trump appropriate mental health treatment?
Why is this happening?
Is it that poor families do not know or do not care to advocate for their children? Is it that the doctors just want to minimize paperwork and medicate a problem to oblivion? Can you imagine if the reverse were true? The fanfare and protest would be never ending!
According to the New York Times, these children are less likely to receive family counseling or psychotherapy since Medicaid pays more for medication than for counseling session and poor families are time-challenged with attending counseling or therapy sessions, if that service is available. However, I think it's more than that. I think it comes back to the stigma of mental illness and a lack of understanding of how talk therapy can help.
The data shows that these antipsychotics are given even when these children don't need them. But you have to realize that this is a rational choice for a poor and probably poorly educated family. We live in a society that allows for commercials to run non-stop to fix your CLPD (what ever that is), your arthritis, your asthma, your left nut on lockdown, your flaccid penis and your left twitching eye. In this insane world then, it makes perfect sense to correct rebellious behavior with a small blue or red pill. In a family constantly on the perilous edge of survival it is the easy way out. It makes sense.
Even the article admits that "it is often a pediatrician or family doctor who prescribes an antipsychotic to a Medicaid patient — whether because the parent wants it or the doctor believes there are few other options." Granted, the drugs are typically cheaper than long-term therapy. Who really wants to dig deep into the abandonment, alcoholism, abuse, oppression, molestation, or other dysfunctional etc. remnants these families are recycling? It's so much easier to have Medicaid pay $7.9 billion than attend years of dynamic therapy or 20 sessions of directed cognitive behavioral therapy. Even the experts agree "that some characteristics of the Medicaid population may contribute to psychological problems or psychiatric disorders."
Oh, really??
According to the article, "studies have found that children in low-income families may have a higher rate of mental health problems — perhaps two to one — compared with children in better-off families. But that still does not explain the four-to-one disparity in prescribing antipsychotics." Now, I have a bone to pick with that finding. Based on my empirical experience, better-off families are just as screwed up. They just learn to hide it better. A child's perceived abandonment by a parent is still real whether it's because of absence that came about through overwork or through disappearance.
Isn't it criminal?
"The data also indicates that poorer children are more likely to receive antipsychotics for less serious conditions than would typically prompt a prescription for a middle-class child." While the experts do not have clear evidence to form an opinion on whether or not children on Medicaid were being overtreated, where the hell is the Food and Drug Administration on this issue? To me there is something seriously wrong with this picture. "Medicaid children were more likely than those with private insurance to be given the drugs for off-label uses like A.D.H.D. and conduct disorders. The privately insured children, in turn, were more likely than their Medicaid counterparts to receive the drugs for F.D.A.-approved uses like bipolar disorder."
Again, this is about properly educating poor families about what it means to have a mental illness, what do you have to do to manage it, and what an FDA-approval means. In an over-drugged society, where a pill is supposed to fix everything, how can we expect a poor, lowly educated parent with minimal resources make what to her (given that it's probably a single-female headed household) may seem to be a rational choice in the best interest of her child?
The Afterw@rd
