AMERICA’S YOUTH MENTAL HEALTH CRISIS: The American Academy of Pediatrics (AAP), the American Academy of Child and Adolescent Psychiatry (AACAP), and the Children’s Hospital Association (CHA) recently joined together to declare a “national state of emergency in child mental health.” The U.S. Assistant Secretary for Mental Health and Substance Abuse recently declared, “America’s youth deserve appropriate, well-informed and effective behavioral health crisis services. All too often, children and youth experiencing a behavioral health crisis face hospitalization or justice system involvement.”

WHEREAS the mental health establishment’s sweeping adoption (since the 1990s) of a medical framework for understanding distress and dysfunction often renders normal variations in emotion, cognition, and temperament as signs of mental illness. Today, parents and young people are expected to seek mental health through medicine. Consequently, there has been a steady rise in the overuse of drugs to treat common childhood problems. Nationally, since 2015, over 44% of Americans 12 and older have been prescribed one or more psychotropic drugs. These prescriptions include stimulants, antidepressants, anti-anxiety pills, mood stabilizers, and antipsychotics.

WHEREAS the mental health status of American youth has been deteriorating for decades despite a parallel increase in the use of psychotropic drugs.

WHEREAS all psychoactive drugs, including opioids, have the potential to cause  physical dependence (when prescribed for more than a few weeks) and other adverse effects. These substances “work” by changing the brain and body, thereby inducing physiological/physical dependence. When people attempt to stop taking these drugs, their withdrawal symptoms can be worse than the original problem(s) for which they were first prescribed. Adverse drug effects and withdrawal symptoms can lead to additional and increasingly serious diagnoses and prescriptions. This often includes untested polypharmacy drug regimens (two or more concurrently prescribed drugs). This is called a “prescribing cascade,” a well-documented and risky phenomenon. Such drug effects contribute to a significant portion of psychiatric emergencies.

WHEREAS the number of children and adolescents seen in U.S. hospital emergency departments nearly doubled between 2011 and 2022. According to an emergency medicine physician in southeastern Virginia, most children seen for a psychiatric emergency have already been prescribed psychotropics. This typically involves polypharmacy drug regimens – none of which have been tested for their safety or effectiveness.

WHEREAS an understandable response to this rise in psychiatric emergencies has been a call for more mental health specialists and psychiatric hospitals for children. Few are paying attention to the fact that use of psychotropic drugs can worsen mental health symptoms. As we’ve learned through the opioid crisis, increasing access to prescribing clinicians generally leads to more harm. The No. 1 predictor of a geographic region’s rate of opioid prescriptions is the number of available opioid prescribers. The same is expected for psychotropic prescriptions. Likewise, communities that increase their access to psychiatric services will likely worsen youth mental health outcomes if they over-rely on drug treatment.

WHEREAS Children’s Hospital of The King’s Daughters (CHKD) has responded to the youth mental health crisis in southeastern Virginia by building a 14-story psychiatric hospital and increasing the number of child psychiatrists from 1 to 19. The hospital also conducts clinical drug trials. In 2020 alone, the hospital participated in 241 industry-funded clinical drug trials, including testing psychotropics in children. It is well-established that participation in drugs trials leads clinicians to prescribe more of the drugs they test, a potentially harmful conflict of interest.

WHEREAS timely, transparent, and public reporting of medical errors has proven to be a powerful force for improving the quality and safety of acute hospital care, the same should be required for psychiatric care. Transparency should be imperative among communities with child psychiatric hospitals or organizations conducting psychotropic and/or opioid drug trials on pediatric patients. We must examine the impact that child psychiatric hospitals have on a region’s use of psychoactive drugs.

WHEREAS our nation’s hospitals and large healthcare systems have adopted the use of electronic health records (EHRs). Through these records it is now possible to generate de-identified reports of psychiatric diagnoses and prescriptions without violating patient privacy or confidentiality.

WHEREAS over 700 people recently attended a Medicating Normal event to address psychotropic overprescription in southeastern Virginia. Ninety-eight percent of exit surveys showed an overwhelming interest in tracking and publicly reporting on local psychotropic trends.

THEREFORE, WE, THE UNDERSIGNED, PETITION CHKD and other hospitals and major healthcare systems in southeastern Virginia to support the development of a community-based task force to create a process and mechanism to track, interpret, and report on local rates of psychotropic and opioid prescriptions. This process must be collaborative, involving all community stakeholders. The process must be overseen by an independent organization and free of conflicts of interest. Likewise, we petition for the development of such mechanisms in every major U.S. community. Such access to local prescription data would enable communities to develop effective public health interventions to protect and preserve child mental health.

SPONSORS: The International Society for Ethical Psychiatry and Psychology (ISEPP), The Richard Fee Foundation, RxIsk, Periscope Foundation, and PharmedOut at Georgetown University Medical Center. 

AUTHORS: David O. Antonuccio, Ph.D., Clinical Psychology, Professor Emeritus, University of Nevada, Reno; Lynn Cunningham, Co-Director/Producer of the documentary Medicating Normal; David Healy, M.D., Psychiatrist, scientist, psychopharmacologist, and author; Sue Parry, Parent Advocate; and Gretchen LeFever Watson, Ph.D., a clinical psychologist.

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