NCYL Challenges Lack Of Proper Oversight Of Psychotropic Medications Given To Youth In Government Custody

Rather than being provided therapeutic counseling and mental health support, children in government care — including those in immigration custody and foster home settings — are routinely prescribed powerful psychotropic medications to control their behavior, without proper safeguards and oversight in place. The National Center for Youth Law, through policy development and litigation, is a leader in the fight to end these unsafe and unhealthy practices.

NCYL has deployed advocacy efforts in California and Missouri, and has also filed landmark legal challenges charging the state of Missouri and the federal government with failing to oversee and closely monitor the use of these powerful drugs, exposing the children in their care to possible serious and permanent injury

Here is a closer look at NCYL’s efforts to protect children against these dangerous practices:

Missouri

NCYL — along with Children’s Rights, Inc., Saint Louis University Legal Clinic and Morgan Lewis — represented children in Missouri foster care custody in a class-action lawsuit that led to significant reform in the state.

The 2017 lawsuit charged the state with exposing youth to unreasonable risk of serious physical and psychological harm by failing to maintain an adequate oversight system to ensure that psychotropic drugs are administered safely and only when necessary.

Among the suit’s allegations: children were placed on psychotropic drugs without the benefit of an adequate medical history, without a rigorous informed consent process, and with no second-opinion mechanism to review extreme cases.

The case was settled in 2019 after the state agreed to implement reforms, including comprehensive medical record and medication monitoring, implementation of a more robust informed consent policy, required secondary reviews for certain medications, and rigorous training for staff. The settlement also calls for the establishment of a statewide expert committee to further inform policies.

California

Foster children in California had routinely, into the 2010s, been prescribed psychotropic medications that were used as chemical restraints, rather than for medically accepted purposes. This is particularly troubling, as over-medicated children face serious, life-long damage to their health, including morbid obesity, diabetes, and cardiovascular damage.

In response to this, NCYL launched a statewide campaign that seeks to ensure that children in California’s care receive trauma-informed mental health services rather than unnecessary and harmful drugs.

NCYL developed legislation and led advocacy efforts that resulted in laws being adopted, collectively aimed at ensuring California foster youth are only prescribed psychotropic medications when absolutely necessary, and that they are offered mental health services that include non-drug treatments.

California has passed five NCYL-sponsored bills that deal with psychotropic medication policy since 2015. These include:

• Senate Bill 484 (2015): Requiring California to identify the group homes most over-reliant on psychotropic medication and requiring these homes to develop alternative treatments. 
• Senate Bill 319 (2015): Requiring public health nurses to improve their monitoring of foster children prescribed psychotropic medications. 
• Senate Bill 238 (2015): Requiring a variety of stakeholder groups to receive training on the appropriate uses of psychotropic medications. 
• Senate Bill 1174 (2016): Subjecting prescribing physicians to heightened scrutiny by enabling the Medical Board of California to conduct investigations of physicians who frequently prescribe outside recognized safety parameters for children.
• Senate Bill 1291 (2016): Requiring the State to monitor counties to ensure they offer mental health services for children in foster care that include non-drug treatments.

NCYL continues working to ensure California’s public agencies have the guidance, data sharing, resources, and training to implement these laws effectively.

Federal government

NCYL represents five classes of detained unaccompanied immigrant children in a federal lawsuit — Lucas R. v. Azar — that charges the government with numerous violations of their rights in the U.S. Constitution, federal statutes, and the Flores Settlement Agreement. 

The complaint specifically charges the government with regularly placing unaccompanied immigrant children in detention facilities where they are administered powerful psychotropic medications for weeks, months, or years, without procedural safeguards and without providing notice to or obtaining the informed consent of their parents, even when those parents are present in the U.S. and readily available to grant or withhold consent.

While the court has ruled largely in the Plaintiffs’ favor on three of the claims alleged in Lucas R., the claim regarding  psychotropic medication is still in litigation.

The lawsuit, with its remaining claims scheduled for trial in November 2022, has the potential to create critical due process protections for current and future unaccompanied immigrant children in federal custody.