Overmedicating Wards of the State

A number of articles in recent months have discussed the extremely high use of psychiatric medications among foster children. Many of these medications are very harsh antipsychotics with a laundry list of severe side effects like liver and kidney damage as well as extrapyramidal symptoms like tremors. These medications are serious business and there should be some equally serious concerns about their use in young children, especially since in some cases, there’s limited information available on their safety in pediatric patients.

The increase in the use of antipsychotics among foster children isn’t evidence of an epidemic of mental illness. It’s a sign of deep social issues that aren’t being addressed, and need to be, for the safety of foster children and their communities. Within the context of the deeply broken and dysfunctional foster system, the aggressive use of psychiatric medications should be a red flag and a warning bell, but it doesn’t seem to be receiving very much attention.

When examining the foster care system, you have to look at who is most likely to end up in foster care, to explore the population of children affected by the policies of the system. Unsurprisingly, the distribution within the system is heavily slanted toward low-income children, particularly children of colour and nonwhite children. People of low income are less likely to be able to defend themselves in court or to have measures in place to keep their children out of the foster care system. And white people are more likely to be able to keep their children in cases where social services are involved due to systemic racism and better access to resources.

Disabled children and children of disabled parents are also more likely to fall into the foster system, which means there may be a slight statistical increase in mental illness among children in foster care. For severely mentally ill children, a very small percentage of the overall population, sometimes the only measure parents can take is to give their children into the custody of the state because there are no services and support available. Parents who cannot care for mentally ill children on their own are in fact specifically advised to do this; instead of providing respite care and other support services, the state simply takes over. And often provides terrible ‘care’ in the process.

Disabled parents are also targeted as unfit, which means they are frequent targets for investigation. Even if they are in fact perfectly fit parents who would meet every standard set by social services, their children are seized because they are disabled.

A perfect storm of circumstances mixing racism, classism, and ableism comes into play to create a large population of foster children who bounce through the system. Supposed oversight is often short on the ground because of cuts to social services and a complete inability to keep up with all assigned cases; even good social workers are not superheroes, and they cannot possibly keep up with huge caseloads. Consequently, children tend to ‘fall through the cracks,’ which is a polite way of saying they go into a black hole from which they may never emerge. That black hole can lead right to psychiatric medications.

Foster children sometimes have behavioural problems, unsurprisingly linked to constant upheaval, distress about their circumstances, and other factors. These are sometimes associated with disabilities, but not necessarily. Unfortunately, they’re often assumed to be disability-related and in a system which focuses on bottom lines and fast outcomes, the recommendation is often to simply medicate these issues away. Thus, children end up being placed on aggressive and very dangerous drugs when they ‘act out,’ and when those drugs make zombies of them, foster parents, and the system, think they’ve solved the problem.

There’s an inescapable racial element, though, to who ends up labeled with behavioural problems. A long history of pathologising people of colour and nonwhite people comes into play for children as well; numerous studies have shown that the same behaviour in children of different races is treated differently. A white child is playful or exuberant, for example, while a Black child is ‘acting out’ and ‘causing disruptions.’ The Black child is referred for evaluation, while the white child is not, and there’s a high chance that medications are going to be recommended after evaluation; even if the child isn’t actually having behavioural problems at all, and is just doing what kids do.

There’s a creepy element of control going on here too, where childhood behaviours are suppressed by harsh medications because they are considered undesirable. Extinguishing curiosity, adventurousness, and other traits of childhood is its own form of punishment and social control. Foster children growing up heavily overmedicated on dangerous drugs are going to experience a difficult battle when it comes to establishing lives for themselves, going to college, and pursuing opportunities.

Some of the side effects from antipsychotic drugs are permanent. These medications are leaving lasting legacies on children who grew up in foster care, like tardive dyskinesia that will never go away. There’s also a strong correlation between antipsychotics and weight gain, and it’s notable that discussions about the ‘childhood obesity crisis’ don’t specifically examine the role of antipsychotics in that ‘crisis.’ If the state cares about weight gain in childhood, as it claims, it might want to take a look at the medications it is giving its wards.

It’s not that psychiatric medication is a bad thing, but that it can be dangerous when it is not used responsibly. For children with severe mental illness, antipsychotics can make a huge difference in quality of life, especially when paired with therapy, a stable living environment, and support. For children who don’t need these medications, the risks are considerable, and there’s no discernible benefit. Unless, of course, you think like the state and believe that silencing children is a benefit.