Primary care doctors will need to check in before prescribing antipsychotics and other dicey psychiatric medications to many children in Minnesota. The state Department of Human Services has hired the Mayo Clinic to provide a new consult service to cut down on doctors who make questionable prescriptions of psychiatric drugs and to improve the quality of child mental health care in the state.
Doctors will be required to call the consult service prior to prescribing certain psychiatric drugs to children on Medicaid's publicly funded fee-for-service program. They will be encouraged to call in when their patients are funded by private insurance or other programs. In a letter to the Minnesota Medical Association, human services commissioner Lucinda Jesson said the consult service will assist doctors who often harbor doubts when prescribing drugs to children with mental and behavioral problems.
"The vast majority of children who are prescribed psychotropic medications are receiving care from primary care practitioners, due to the critical shortage of child psychiatrists. Primary care practitioners have accepted this responsibility of necessity, but public and private sectors together must assure that adequate psychiatric supports are available to physicians prescribing psychotropic medications and the children they serve."
The proof to Jesson that psychiatric drugs are being over prescribed and used incorrectly is the high rate of these drugs among Minnesota's foster children. The drugs are five times more prevalent among foster children.
"While it is certainly the case that children known to the child welfare system are more likely to be diagnosed with mental health disorders than either the general population or other children receiving Medicaid, the magnitude of the medication disparity is alarming."
As revealed by a Star Tribune series last year, the inappropriate prescribing of antipsychotics and other drugs has caused children to suffer additional problems and to be locked in psychiatric hospitals unnecessarily. Many prescribed drugs have never been tested or approved by federal regulators as safe for children. The state expects that the $1.7 million cost of this program over two years will be paid back by reduced hospitalizations and healthier children.
Primary care doctors will call Mayo social workers under this new service and provide details of children for whom they are considering prescriptions of certain psychotropic medications. The social workers will determine if consulting psychiatrists are needed to approve or discourage the prescriptions, and advise the doctors about other mental health services or options they could consider for their pediatric patients.
Reaction among doctors has been mixed to this program, which has been in development for a year. (The awarding of the contract to Mayo was the "new news" announced Monday.) Some doctors are upset by another barrier between themselves and their patients. Others have felt unease with psychiatric prescriptions they have issued to children, and welcome the new source of support and professional guidance.
The service launches this August.