Children taking psychotropic medications - GAO report

Experts have concerns that children with mental health conditions do not always receive appropriate treatment, including concerns about appropriate use of psychotropic medications (which affect mood, thought, or behavior) and about access to psychosocial therapies (sessions with a mental health provider). These concerns may be compounded for low-income children in Medicaid and children in foster care (most of whom are covered by Medicaid)--populations who may be at higher risk of mental health conditions. Within HHS, CMS oversees Medicaid, and ACF supports state child welfare agencies that coordinate health care for foster children.

GAO was asked to provide information on children's mental health. This report examines (1) the use of psychotropic medications and other mental health services for children in Medicaid nationwide, and related CMS initiatives; (2) HHS information on the use of psychotropic medications and other mental health services for children in foster care nationwide, and related HHS initiatives; and (3) the amount HHS has invested in research on children's mental health.

GAO analyzed data from HHS's MEPS --a national household survey on use of medical services--from 2007 through 2009 for children covered by Medicaid and private insurance. GAO reviewed two recent ACF foster care reports with data from a national survey conducted during 2008 through 2011. GAO analyzed data from HHS agencies that conduct or fund research and interviewed HHS officials and children's mental health providers, researchers, and advocates.

The findings of the GAO report include:

- Eighteen percent of foster children were taking psychotropic medications – including 48 percent of foster children who lived in group homes or residential treatment centers as compared to 6.2 percent of non-institutionalized children in Medicaid nationwide and 4.8 percent of privately insured children.
- Thirty percent of foster children who may have needed mental health services did not receive them in the previous 12 months – and outside of foster care most children whose emotions or behavior indicated a potential need for a mental health service did not receive any services within the same year.
- Many children who took psychotropic medication did not receive other mental health services (such as psychosocial therapy or counseling), despite the fact that experts find that medication alone is rarely adequate treatment for children with complex mental health needs.