Behind the closed doors of the 19th-century asylums, the brutal “treatments” administered to patients can oftentimes be recognized with a single emblem: the straitjacket. In spite of being originally intended to protect patients from bringing harm to themselves [1], their inhumane use can now be seen to reflect society’s ignorance of the patients. The modern-day straitjacket takes on a different form but captures this same notion. The modified term includes the word, “chemical,” applying their historical use of violently restraining patients to the overprescription of psychotropic medication [2]. This has become a greater problem over recent decades, especially as we have realized that some parts of our society are more susceptible to overprescription than others. In the case of children, the focus should be placed on the already more vulnerable population in foster care.
The general issue of overprescription remains a pervasive concern in the United States. For instance, the use of psychotropic medications have increased 22% in the last decade, with 1 in 5 adults currently consuming at least one psychotropic medication [3]. The issue started when the Food and Drug Administration (FDA) approved the prescription of Prozac—an antidepressant advertised to have minimal side effects—in 1987 [3]. While effective, its prescription has quadrupled in the United States since being released, making antidepressants the second most commonly prescribed drug [3]. This surge applauds the nation’s technological advancements, yet raises the concern that patients may be prescribed medications more often than needed without being prompted to carefully consider other evidence-based non-pharmaceutical treatments. In addition, as many psychotropic medications are accompanied with an array of side effects, patients can be seen to further seek out additional medications, leading to a dangerous prescription cascade.
Overprescription becomes an even greater issue when considering the susceptibility of children in foster care. 1 in 4 children in foster care is currently taking at least one psychotropic medication, which is a rate that is four times higher than that for all children in the United States [4]. The medication records of children in foster care also show higher doses than other children, despite research demonstrating that higher doses can result in serious long-term side effects especially when administered during developmental phases [4]. The explanation behind this difference lies within the structure of the foster care system as an institution. The system fails to provide sufficient informed consent and monitoring as part of their responsibility in providing care for the children [5]. For instance, several states were found not to require practitioners to follow the guidelines from the American Academy of Child and Adolescent Psychiatry when releasing prescriptions for children in foster care [5]. This questions whether children in foster care are receiving even the basic levels of care when it comes to issues that directly affect their long-term health.
The inadequacies of the foster care system in providing proper medical care should be further evaluated in context of the greater mental health needs demonstrated by these children. Even before entering the system, many of the children have experienced traumatic events. Instead of fulfilling these needs, the system reacts with administering psychotropic medications as a form of first-line intervention despite numerous research advising against such use. This models the use of psychotropic medications as chemical straitjackets; foster care children receive medication after medication to keep them from “acting out.” This can be seen in the first class action lawsuit in 2017 during which one of the plaintiffs stated that he had been prescribed more than six psychotropic medications when in foster care, being heavily medicated at all times without awareness about other treatment options [5]. The failure of the system to provide proper education continues to the foster care parents, who are rarely given any information nor directions about the medications consumed by the children in their care [3]. This makes it extremely difficult for these guardians to provide sufficient oversight to the children, continuing the problem even outside the legal system itself.
Observing this lack within the foster care system, we are faced with a question that should not have to be asked: Do foster care children not deserve the same level of care as any other children in our nation? Despite the obvious answer, our nation’s actions have illustrated that the very systems built to protect these children have failed. The combined ignorance that has perpetuated this issue for decades further emphasizes that even ignorance is oftentimes a crime. Seeing these children in chemical straitjackets, we as a nation must reconsider whether we are truly making decisions for the well-being of the children, or for the convenience of the system.
Reviewed by Zachary Deutsch
References:
[1] Science + Media Museum. (2022, December 15). From asylums to anarchy: The straitjacket and popular culture. https://www.scienceandmediamuseum.org.uk/objects-and-stories/straitjacket-and-popular-culture
[2] United States House Committee on Ways & Means. (2014, May). Reichert opening statement: Caring for our kids: Are we overmedicating children in foster care? https://waysandmeans.house.gov/2014/05/29/reichert-opening-statement-caring-for-our-kids-are-we-overmedicating-children-in-foster-care/
[3] Smith, B. L. (2012, June). Inappropriate prescribing. American Psychological Association. https://www.apa.org/monitor/2012/06/prescribing
[4] Edelman, M. W. (n.d.) Overmedicating children in foster care. Children’s Defense Fund. https://www.childrensdefense.org/overmedicating-children-in-foster-care/
[5] LaFortune, K. A., & Fields, S. (January). Mismanagement of psychotropics in the foster care system. American Psychological Association Judicial Notebook, 52(1), 19. https://www.apa.org/monitor/2021/01/jn
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