FARMINGTON — As May, which is Mental Health Awareness Month, comes to an end, families, mental health providers and advocates across the country have been highlighting the importance and difficulties of maintaining children’s access to quality mental health treatment during rough economic times.

Using this campaign to preserve and improve access to effective services that protect the health, safety and welfare of our kids is important.

Proper safeguards also need to be highlighted and put into place, however, to protect kids from unnecessary and costly care which could jeopardize both mental and physical health over one’s lifetime.

The idea of putting a child in need of treatment at greater risk is something most reasonable people would avoid.

So why then are we prescribing children certain antipsychotic drugs for which there is little data demonstrating effectiveness, and which are associated with serious health risks including metabolic disorders, weight gain, diabetes and serious cardiac problems?

A recent study in the Journal of the American Medical Association confirms earlier reports that prescribing rates of antipsychotics to kids continue to increase despite lack of evidence as to their effectiveness.

Antipsychotics were top sellers in the United States in 2008, with sales reaching more than $14 billion.

The drugs are frequently prescribed “off label,” for purposes not approved by the Food and Drug Administration. The study indicates physicians don’t always take appropriate precautions to reduce health risks.

It’s worth mentioning that one of these drugs was the focus of a recent multimillion-dollar drug company settlement with the U.S. Department of Justice, in which it was alleged the drug’s manufacturer inappropriately marketed the medicine for off-label use in children and elderly patients.

While the FDA recently approved a few antipsychotic drugs for use with older kids, the advisory panel recommendations on which the approval was made were lukewarm at best. One of the drugs, Ziprasidone, received only eight votes in favor for acceptable safety; nine panel members abstained from voting, and one voted that it was not safe.

Concerns about cardiovascular risks, including sudden death, were raised, as were concerns about substantial weight gain and metabolic problems, including higher blood lipids and glucose (diabetes).

Clearly, the current system to regulate how these drugs are prescribed isn’t doing enough to safeguard kids.

Some states are working to preserve access to these drugs, while at the same time taking steps to protect young kids from inappropriate or unnecessary prescribing.

New Hampshire and Maine, for example, have proposed policies asking providers to justify why they are prescribing certain antipsychotics to kids under age 5.

Florida initiated such a proposal in 2008 and prescribing decreased by nearly 75 percent. There was no public outcry and few doctors complained. It’s clear, though, more needs to be done to protect older kids.

Children who can benefit from these drugs should have access. Benefits, however, need to be quantified and weighed against several factors.

Is the drug effective for the illness for which it’s prescribed? Are appropriate steps being taken to make sure a child is monitored regarding health risks? Do caregivers have understandable information about side effects? Do they know when to call their child’s doctor if something isn’t right?

Finally, given cuts being made to mental health and social services across the country, policymakers and insurers should be asking these same questions and thinking about better ways to spend limited resources that may be more effective and safer in treating mental illness.

As communities rally to raise awareness about children’s mental health this month, we hope the momentum will continue to promote safe, effective and evidence-based treatment options kids in need deserve.


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