Does poverty make kids mentally ill?

Federal health regulators are investigating why so many doctors are prescribing antipsychotic drugs to Medicaid-eligible children. The number of poor kids on the powerful medication tripled between 1999 and 2008, and the program now spends more money on antipsychotics than any other drugs.

The Department of Health and Human Services (HHS) has been investigating the phenomenon for several months, according to a Monday story in The Wall Street Journal. The study focuses on drugs like Abilify, part of the newest class of antipsychotics called “atypicals.” Though Abilify is the no. 1 drug in the country, drugs like it are prescribed to the poor in highly disproportionate numbers.

Stephen Crystal, a health policy professor at Rutgers University, found that children on Medicaid are four times more likely to be on antipsychotics than privately insured children. And while 1.4 percent of Medicaid-eligible children are prescribed the drugs, doctors order them for 12.4 percent of foster children.

Dr. Stephen Cha, a chief medical officer at the Centers for Medicare and Medicaid Services, said doctors should consider other options, including therapy for psychological baggage that ultimately may be at the root of misbehavior. The government, he told the WSJ, wants to reduce "the unnecessarily high utilization of antipsychotics."

It’s true that foster children, often subjected to some form of abuse, can have emotional impairments. Mistreatment by caregivers in the earliest years can damage emotional development. With Reactive Attachment Disorder, for example, disastrous, often violent tendencies can emerge and progress even after a child moves to a loving home.

The sheer number of kids on medication, though, casts doubt on whether they’re being treated for genuine mental issues. Some doctors say medication is too often the first resort. But for Dr. Fernando Siles in Dallas, it isn’t that simple. Medicating a child with serious behavioral problems is preferable to seeing him kicked out of another foster home, making the situation worse, he told the WSJ.

The problem isn’t isolated to children, though, or even the United States. HHS Inspector General Daniel Levinson conducted a similar investigation two years ago into nursing homes and Medicare. That study found 22 percent of claims for these same drugs violated current standards regarding unnecessary drug use in nursing homes. Canada has seen its number of children on antipsychotics nearly quadruple.

For now, all we know is that the pharmaceutical industry is raking in money, at taxpayers’ expense. Whether the inspector general will find a problem with that—and effectively do something about it—remains to be seen.