The Dangers of Psychotropic Medication for Mentally Ill Children: Where is the Child's Voice in Consenting to Medication? An Empirical Study

Abstract

When a child with a mental illness is being prescribed psychotropic medication. who decides whether the child should take the medication -- the parent or the child? What if the child is sixteen years of age? What if the child is in foster care: Should the parent or social service agency decide? Prior to administering psychotropic medication, what specific information should be provided to the person authorized to consent on behalf of the child? Should children be permitted to refuse psychotropic medications? If so, at what age should a child he able to refuse such medication What procedures should be put in place to forcibly medicate a child with psychotropic medication?

There are numerous reports indicating that children in foster care are overmedicated as compared to children not in foster care. What are the reasons for this occurrence? Are there abuses within the foster care system? Should the state mental health agency monitor psychotropic medications for children, require oversight or a second opinion, or monitor abuse? What authority should a state agency have to stop prescribing psychotropic medication to children?

This article will explore the overmedication of children with mental illness, with a specific emphasis on foster care children. Part I will examine the use of psychotropic medication on children, from the viewpoint of psychiatrists, pediatricians, parents, and children. Part II will explore the reasons why foster children receive psychotropic medications at a higher rate than children under their parents' care. Part IIl will provide an explanation of the consent procedures for children, and a critical inquiry into the manner psychiatrists and psychiatric hospitals undertake to address a minor's refusal to take psychotropic medication.

Additionally, Part I will analyze various states' responses to addressing both the overmedicating of children as well as consent and refusal issues that ultimate]y result from the medication of children. It will offer recommendations for a model consent form to be utilized by psychiatrists and in-patient psychiatric hospitals. It will present the rights of children to refuse psychotropic medication as recommended and the procedure for overriding such refusal.

Finally, Part III will analyze a survey of psychiatrists and pediatricians on the use of psychotropic medications to understand the existing consent procedures governing a minor's refusal to take psychotropic medications. The survey's design allows for a better understanding of the reasons behind the overmedication of foster children. The analysis will highlight the best practices and offer recommendations that provide for a state reporting and monitoring system.

Keywords: mentally ill children, psychotropic medication, consent, foster care, social service agncies, right of refusal, forcible medication, oversight, psychiatrists, parents, pediatricians, consent procedures, model consent form, state reporting and monitoring

JEL Classification: I18, I19, K19, K39, K49, L89