by John-Michael Dumais, Childrens Health Defense:
Critics called for an outright ban on chemical restraints in mental health facilities after a study showed a steep rise in the number of children being subjected to them. They cited the lack of informed consent and a culture of medicalization that leads to labeling, misdiagnosis and over-prescribing of drugs that can cause suicidal and homicidal ideation.
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More children are being subjected to drug restraints because more children are being admitted to mental health facilities, a new American Academy of Pediatrics (AAP) study found. Pharmacological restraints tend to be used with greater frequency on autistic children, low-income children and children of color.
Although the average rate for the use of drug restraints among all children ages 5-17 years old with any diagnosis remained relatively steady during the 2016-2021 study period, the analysis found a 141% increase in the use of restraint drugs overall, alongside lengthening inpatient stays.
This means more children are being hospitalized for mental health conditions and more are being subjected to drug restraints — antipsychotics used to sedate — and in ways that disproportionately disadvantage some youth.
In November, the Citizens Commission on Human Rights International (CCHR) called for a ban on all psychiatric and physical restraints, citing a similar World Health Organization (WHO) statement and an October Los Angeles Times exposé on the coercive use of restraints in psychiatric facilities.
Experts who spoke with The Defender argued reliance on chemical restraints reflects the failure of a treatment model dominated by biological psychiatry rather than offering real or lasting solutions.
Given the lack of safety data on psychotropic drugs, especially for children (for antipsychotics, attention deficit/hyperactivity disorder (ADHD) medications, and antidepressants), and the alleged lack of scientific basis for mental health diagnoses, experts emphasized the need for informed consent and refusal rights as a means to combat the reflexive overmedication of distressed children.
Study demonstrates need for path to ‘zero restraints’
The analysis published in Pediatrics examined more than 90,000 mental health hospitalizations across 43 children’s hospitals. It defined pharmacological restraint narrowly as intravenous or intramuscular administration of five heavy-duty antipsychotics.
Despite the average restraint rate holding constant at around 3% over the five years of the study, there were significant increases over time — ranging from 40% to 323% — in the drug restraint rates for children diagnosed with disruptive disorders, bipolar disorders, eating disorders and somatic symptom disorders, compared with a decline in the use of drug restraints for other diagnoses.
The analysis revealed racial minorities and economically disadvantaged children disproportionately undergo chemical restraints. Younger Black males faced double the likelihood of restraint compared to their white peers, as did children insured by federal programs, such as Medicaid, versus those with private insurance.
Patients from households earning under $25,000 per year likewise encountered heightened odds of restraint.
Although drug restraint use for children with autism spectrum disorder (ASD) decreased by 20% over the study period, it still topped all other conditions. When used, the drug restraints were applied for an average of nearly 8% of inpatient days.
The study authors noted a 138% rise in mental health patient days from 2016 to 2021, which they said may have contributed to the worsening shortage of inpatient and outpatient pediatric psychiatric resources, leading to an increase in the use of restraints.
The researchers attributed the patient load to “an increased severity and frequency of mental health conditions in the setting of the coronavirus disease 2019 pandemic,” noting, in particular, the incidence of “acute agitation,” but did not further analyze the underlying drivers.
The authors of a response posted alongside the study agreed with the study’s authors on the need to create a standardized national definition of pharmacologic restraint use in pediatrics and to tailor more individualized treatment strategies, including non-drug methods. However, they also called for envisioning a path to “zero restraints.”
Restraint drugs and their dangers
The Pediatrics study centered on the use of five antipsychotic drugs: aripiprazole, droperidol, haloperidol (Haldol), olanzapine and ziprasidone. These act as powerful nervous system depressants that rapidly sedate children.
All carry U.S. Food and Drug Administration (FDA) “black box” warnings for side effects that include the possible impairment of normal mental or physical functioning or increased mortality risks.
According to the FDA, aripiprazole may provoke suicidal thinking and behavior in children, and may also cause seizures, cognitive and motor impairment and other side effects.
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