Long before the COVID-19 lockdown, young people in psychological distress began to flood emergency departments. A popular refrain: We need more pediatric mental health care providers to meet treatment demands. As part of its campaign to improve pediatric mental health, the King’s Daughters Children’s Hospital is building one of the first pediatric psychiatric hospitals in the country and recently increased the number of child psychiatrists from 1 to 19. But the Increased access to psychiatric services can aggravate youth mental health crisis if services rely too heavily on pills for illnesses.
Hampton Roads has the highest documented rates of psychiatric addiction treatment for young people, which often begins with stimulants for Attention Deficit/Hyperactivity Disorder (ADHD). In 2000, 17% of elementary school students in the area had been diagnosed with ADHD. Almost all were medicated, with 28% receiving two types of medication (usually a stimulant and an antidepressant) and 8% receiving three types (often including an antipsychotic or sleeping pill). Outcomes associated with this heavy reliance on psychiatric drug treatment were poor. In 2003, we wrote an early warning in Scientific Review of Mental Health Practice. He called for the judicious use of psychiatric medications and the establishment of mechanisms for tracking and reporting psychiatric diagnoses and prescriptions.
By then, Hampton Roads had responded by implementing innovative, non-drug interventions to address common pediatric emotional and behavioral issues. The region’s intensive response, funded by CHKD, has resulted in improved educational outcomes and psychiatric deprescribing, as evidenced by a 32% reduction in ADHD diagnosis and treatment. This community initiative could have served as a national model for improving mental health care, except that people with ties to the pharmaceutical industry were successful in having it abolished, as documented in “Shooting the Messenger: The Case of ADHD “.
Mechanisms for reporting regional psychiatric tendencies have never been developed. Meanwhile, psychiatric polypharmacy among young Americans has been on the rise, according to recent reports from the Journal of the American Medical Association.
A critical factor omitted from most public discussion is the mental health establishment’s massive adoption of a medical framework for understanding distress and dysfunction. This paradigm shift has made individual differences in emotion, cognition, and temperament signs of mental illness. Young people are now seeking mental health through medicine.
Consequently, the country is experiencing an epidemic over-prescription of psychoactive drugs. “A lot of young people today don’t mind taking Adderall (a stimulant) in the morning to get started, Viocodin (an opioid) in the afternoon to treat a sports injury, marijuana” medicine “in the evening to relax and Xanax (a benzodiazepine) at night to fall asleep,” according to psychiatrist Anna Lembke, chief of addiction medicine at Stanford University School of Medicine.
Every psychiatric prescription has the potential to cause an adverse reaction. But when used for more than a few weeks, these substances often induce physical dependence. When stopped, the withdrawal symptoms may be worse than the condition for which the pills were originally prescribed. This often leads to patients receiving additional and increasingly serious diagnoses, medications, and drug combinations. Prescribing drugs to treat the side effects of other drugs is called “the prescribing cascade,” a well-documented risk phenomenon that accounts for a portion of people requiring emergency psychiatric services.
The #1 predictor of a geographic region’s opioid prescription rate is the number of physicians available, regardless of the rate of injuries, surgeries, or other conditions requiring pain treatment. The same is true for psychiatric prescriptions.
CHKD should use a significant portion of its “Lighting the Way” campaign funds to reinvest in a non-medical mental health paradigm, deprescribing protocols, and conflict-free strategies to monitor prescribing and psychiatric outcomes in the region. Then, once again, the community might be ready to steer the nation toward effective solutions with minimal medical risk while reducing overreliance on psychiatric labels and drugs.
Drs. Gretchen Watson and David Antonucio (retired) are clinical psychologists. As medical school professors in Norfolk, Virginia, and Reno, Nevada, respectively, they conducted research and co-authored scientific papers on psychiatric drug overuse.
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