Iris Hoffman knows firsthand about psychotropic drug overuse in the state’s foster care system.
“I spent the majority of my adolescence in out-of-home placements: juvenile halls, treatment centers, group home-like situations,” Hoffman said. “And unfortunately, I spent most of those years on different psychotropic medications, as well.”
Hoffman, now 18 and out of foster care, is off those medications. She said psychotropic medications are routinely prescribed to young people in foster care — including powerful antipsychotic drugs such as Seroquel, Abilify and Risperdal — as a standard treatment.
The numbers back up her assertion.
Nearly one in four children in California foster care are on psychotropic medications, said Sen. Jim Beall (D-San Jose), chair of the Senate Select Committee on Mental Health. In group homes, the percentage skyrockets to 56% — more than half of all youth in group homes across the state are receiving those drugs, he said.
“We cannot use psychotropic drugs as a crutch to control behavior,” Beall said. “We must provide alternative options and services to kids, so they can get well without the use of these drugs.”
Beall authored two bills this session to address the issue, and is co-author of a third one to push state agencies to provide more data about psychotropic drug use in the foster care system:
- SB 319, by Beall, would establish a system for public health nurses to monitor and oversee anyone in foster care prescribed psychotropic medications;
- SB 484, by Beall, would establish treatment protocols and state oversight of psychotropic drugs in group-home settings; and
- SB 238, by Sen. Holly Mitchell (D-Los Angeles), would require the state to provide more data on the numbers of children in foster care who are prescribed psychotropic drugs along with other medications that might cause harmful drug interactions.
Hoffman said she remembers being one of those numbers.
“I remember lining up with more than half of the girls I was in group home settings with, to receive our meds. Then [we] proceed to class and sleep through our first few classes, dozing off, this is more than half of us!” she said.
“You’re getting medications from a psychiatrist who sees you one hour a month, administered by staff [members] who are getting minimum wage, with minimal education. It’s scary,” Hoffman said. “It’s scary for me, and I know it’s scary for those who are still in the system.”
Lawmakers Gather for Change
Sen. Mike McGuire (D-Healdsburg), chair of the Senate Committee on Human Services, convened a hearing last month to specifically address the over-prescription of psychotropic drugs among foster youth. He said foster children are nine times more likely than others on Medi-Cal to receive those medications. Medi-Cal is California’s Medicaid program.
“Sometimes there’s good reason [for foster youth] to be sad and angry. And drugs have become the first response in this state,” McGuire said. “The mental health needs of foster kids in our state system must include signs of trauma and a continuum of services.”
McGuire said the high school dropout rate of 40% and the high numbers of foster youth who are incarcerated within five years of leaving foster care shows a level of disregard for foster kids that is echoed by the state’s rate of psychotropic drug prescriptions.
“It’s time for the state to be a better parent,” he said.
Long-term use of psychotropic medications can lead to obesity, diabetes, heart disease “and in some cases, death,” Beall said. “We must provide alternative therapies to kids, and we need an alert system to notify us of potential abuse,” Beall added.
“We’ve seen organ failure, chronic diseases, we’ve seen boys who develop breasts,” said Anna Johnson, policy advocate at the National Center for Youth Law. “We’ve seen rapid weight gain, kids develop obesity and diabetes, or get these irreversible tics and tremors.”
Sometimes foster youth are given adult doses of medications, or they receive them at a young age, Johnson said. The drugs themselves may do some kids a world of good, she said, but they’re not for everyone.
“These are pills that can change their lives forever,” Johnson said.
According to George Stewart, a child psychiatrist in Berkeley working with the Seneca Family of Agencies, there are three take-home messages about changing the over-prescription of psychotropic medications for young people.
“The research base for the safety and efficacy of psychotropic medication use in children is inadequate,” Stewart said. “And child psychiatrists and pediatricians are put in untenable positions in their work with traumatized youth, leading to the over-prescription of medications. And the third point is, traumatized children are healed through supportive, loving relationships — medications merely suppress symptoms.”
Getting children off medications they don’t need starts with a physician tapering the administration of the drug over time.
“Legally that’s true,” said Jennifer Rodriguez, executive director at the Youth Law Center, a public interest law firm based in San Francisco. “But practically speaking, a lot of this goes back to the caregiver [and not the prescribing physician].”
Rodriguez said foster children are punished by group home caregivers for non-compliance if they say they want to come off the drugs.
“The practical reality is the caregiver has full control. Visitation rights, the right to use the phone, being able to go outside,” she said. “So it’s difficult to get a second opinion. It’s important to be monitoring group homes where we have a high percentage of psychotropic drugs and that we audit them to make sure they’re providing proper mental health services.”
According to Will Lightbourne, director of the state Department of Social Services, the state is aware of the problem and has been taking steps to address it.
“Our goal is only having meds used when all other systems have been used [first],” Lightbourne said.
He pointed out that two advisory panels have studied the problems of group homes and have been crafting guidelines for homes with fewer numbers of foster children. But group homes have been an important piece of the foster care system, he said, and changing to a better system takes time.
“It will be a long road,” he said. “We can’t simply wish away the congregate care facilities.”
McGuire said he will convene a follow-up hearing in the fall to assess the state’s progress.