8 University of Rochester students pose solutions to meet U.S. health policy challenges
The Democrat and Chronicle is publishing these eight guest essays written by University of Rochester students about health policy challenges and their possible solutions.
They and their classmates were enrolled this spring in UR History 373, a class focusing on American Health Politics and Policy.
Mical Raz, UR’s Charles E. and Dale L. Phelps Professor in Public Health and Policy, a Professor of History and a Professor of Clinical Medicine in the School of Medicine and Dentistry, invited D&C Executive Editor Mike Kilian in mid-March to visit the class and discuss the students’ opinion essays about health policy challenges. The range of topics and the depth of thought in the essays was impressive.
A thank-you to Professor Raz and her students for granting the D&C permission to publish a selection of those essays here.
They are presented below in this order:
Devices are costing our children their hearing, by Grace Galati
Disabled veterans deserve help in claim appeals, by Gizelle Villanueva
Antidepressants warning hurts adolescents, by Josie Ertl
7-year-olds should be able to walk to school, by Gloria Ng
More focus needed on postpartum depression, by Shreya Mandalapu
Monroe County can do better on drug misuse, by Roni Kirson
Local government needs to take lead on food access, by Lois Wang
Polypharmacy can be too much of a good thing in treating mental-health disorders, by Grace Lee
Devices are costing our children their hearing
By Grace Galati
One of the worst sounds in the world is a screaming child on a flight. One that’s arguably worse? A quiet child whose headphones cannot contain the deafening volume of their iPad.
It’s undoubtedly appreciated when parents soothe their children in crowded spaces – but at what cost? The temporary gripes of unhappy passengers, in the long run, are significantly better than a child’s hearing becoming irreparably damaged before they reach double digits.
The epidemic of ‘iPad kids’ has taken millennial parents by storm. It’s a convenient way to keep children occupied, sometimes even educationally, while the parent is busy shopping, or the family is sitting down at a restaurant. In the name of courtesy, parents often provide their child headphones so others are not incessantly tortured with the high pitched sing-songy voices of children's programs. This comes with a significant cost to the child.
There is a lack of correlative data on general headphone use – often referred to as personal listening devices – and hearing loss, for children under the age of 12. Seemingly, this is because this phenomenon is so new, and long term implications will not truly be known for several years. A study published by JAMA, The Journal of the American Medical Association, cited a 4.6% increase in the prevalence of general hearing loss in twelve to nineteen-year-olds, from 1988 to 1994, and 2005 to 2006.
However, the American Osteopathic Association cites a 30% increase in hearing loss among teens in the last 20 years, 1 in 5, which is largely anticipated to be from increased headphone use.
So, how did we get here? The iPhone came out in 2007, and the iPad in 2010. As of 2021, 75% of households with children under five years of age own a tablet. That rate jumped to 81% for homes with kids aged five to seventeen, and remained at 81% for houses with both age groups, according to the United States Census Bureau.
This is, oftentimes, in addition to time spent using similar technology, accompanied by personal listening devices, while at school.
Needless to say, electronic devices are at the fingertips of young children today, now more than ever. But simply having them is not the issue. How frequently are these devices used by kids?
And how often with headphones?
In terms of habit, 26% of children aged zero to 17 spend at least four hours a day in front of an electronic device, according to the National Survey of Children’s Health. This figure, again, excludes schoolwork, so that percentage is almost assuredly a baseline onto which time can only be added. The primary concern is what proportion of this usage is paired with some sort of listening device.
To answer this question, the University of Michigan recently conducted a study asking parents about their children’s listening habits when using devices. Two out of every three parents of kids aged five to 12 admitted to letting their children use personal listening devices. That figure remained shockingly high, at around 50%, for parents of five to eight year olds.
While it’s common for parents to check in on what their children are watching, the volume at which the child is doing so often does not cross their mind.
Earbuds for iPhones at full volume can reach 112 decibels, according to the Oklahoma Hearing Center. This is as loud as the average lawn mower. Exposure to noise at this volume starts to cause damage after just three minutes. This particularly causes an issue when devices are given to children to use in public, as they often increase the volume to accommodate for background noise.
While high volume levels may not be causing them pain, it is certainly doing them harm.
There are several ways to approach solving this issue. On most Apple devices, there is an option within the Settings application to set a maximum volume. This allows parents to decide and maintain safe listening levels for their children. Alternatively, there are readily available volume controlled headphones that also include noise cancellation, to ensure safe listening conditions. Both options give the parent and child more leeway, reducing the need to regularly check in on volume levels.
Prevention, however, should be the number one priority. Schools must teach children about the harms of prolonged exposure to loud noise, especially when noise is as concentrated as it is in headphones and earbuds. Education is only effective when paired with action, which would mean reducing headphone use during school time. Additionally, we as a society need to be more patient and understanding in regards to children using technology without headphones.
While it may be true that the last thing anyone wants to hear on a long flight or early commute is Bluey or Barney, it’s imperative to remember the alternative: hearing loss.
Disabled vets deserve help in claim appeals
By Gizelle Villanueva
With shaking hands, my mom unfolded a year-long awaited decision letter from the Department of Veterans Affairs (VA) on a disability claim she filed for my dad. Her hope dissolved into despair: Denied. Eight months after appealing — her heart shattered: Denied again. Despite 32 years of military service, my dad continues to fight for disability benefits.
As a first-time claim filer, the heavy weight of rejection and distress overwhelmed my mom. Seeking help, she turned to a local Disabled American Veterans (DAV) chapter, which offers free assistance to veterans pursuing benefits and services. Without their support, my mom would not have persevered in this strenuous process. Many veterans struggle to secure VA disability benefits. The process requires filing a claim to receive monetary benefits for service-connected disabilities. Once initially reviewed, a decision determines whether a disability is service-connected and assigns a severity-based rating, affecting how much money beneficiaries receive. Discontented veterans can appeal for a higher rating or establish a service connection.
The VA disability claims process is lengthy and complicated. In 2018, the VA Office of Inspector General found that resolving a disputed claim takes an average of 6 years. In resolved cases, 7% of veterans died while waiting for a decision. Efforts to improve VA systems are hindered by frequent issues causing delays, such as the discovery of technical errors four months ago that led to 120,000 lost claims over the years.
Claiming benefits symbolizes more than just financial aid for my family; it validates the toll on my dad’s declining health after three decades of sacrifices. Every form, medical record, and appeal submitted represents a battle for recognition and support. Like my parents, veterans and their families may request guidance from private representatives in navigating this battle. The DAV, for example, is a private VA-accredited representative. While accreditation authorizes these organizations, attorneys, and agents to assist with claiming benefits, not all provide free services.
Under federal law, private VA-accredited representatives cannot charge veterans for help filing an initial claim. For handling appeals, they can freely charge veterans within specified limits.
Some private representatives have preyed on and scammed desperate veterans amid a surge in initial claims. As compensation, they receive a portion of veterans’ disability payments. Repeated denials lead to a taxing, years-long cycle that impairs their quality of life.
Disabled veterans seeking private help in appealing denied claims should be entitled to free services from the VA. They rightfully deserve relief from burdens, personalized expert support, and lawful advocacy of private representatives. All resources for obtaining owed disability benefits should be made freely accessible.
Disabled veterans encounter significant difficulties. Poorer functional status reduces the likelihood of receiving benefits. Denied applicants experience worse health outcomes than beneficiaries. Disabled veteran households face the highest rates of hardships in terms of home, medical, bill-paying, and food.
Providing free services to disabled veterans recognizes their disadvantages, lessens the broader consequences of denied claims, and fosters an honorable system for those who have served. This reform would address the barriers to securing accurate and fair disability benefits throughout the claims process.
As the third-largest disability program, funding free services may lead to further strain. Yet, the future budget estimates reveal over twice the spending on discretionary items compared to health care and compensation in the coming decade. Veterans deserve a system prioritizing their needs above bureaucracy, and VA disability compensation is imperative for timely and comprehensive support. Improving accessibility for all veterans pays tribute to their sacrifices and challenges.
For many, like my dad, delivering owed disability benefits is essential for accessing necessary medical care and financial support. Granting disabled veterans free private assistance when appealing ensures fair access to benefits. These benefits determine their quality of life and restore their losses in service — a moral betrayal of our promises to them if neglected.
Disability payments are vital care for veterans. As the veteran population ages, there is no time to wait.
Antidepressants warning hurts adolescents
By Josie Ertl
The year is 2004, theaters are packed with families watching “The Incredibles,” radios are blasting Usher’s top-selling album and the Food and Drug Administration (FDA) issues a life-threatening warning.
Within two years of the FDA’s warning, there was a significant decrease in the prescription of antidepressants across all age groups. Prescriptions for antidepressants for adolescents decreased by 34% and the rate of diagnoses decreased by 44%. Since 2011, the rate of high schoolers reporting persistent feelings of hopelessness or sadness has risen by 21% for girls and 8% for boys.
Showing the decrease in diagnosis had nothing to do with the true rates of depression and almost everything to do with fear created by the FDA warning.
The Black Box Warning, named for the strong black border placed around the warning on antidepressant packaging, was issued following a study showing a slight increase in suicidal thinking in adolescents taking antidepressants in comparison to those taking a placebo, meaning a medication-free pill. The goal of this warning was to educate clinicians about the potential risks associated with antidepressants.
In reality, the warning seems to have increased the rate of undiagnosed and untreated depression.
The risks of this underdiagnosis and treatment can have life-ending results. In a survey of high schoolers’ conducted in 2021, 1 in 5 students reported seriously considering suicide, and 1 in 10 reported having attempted suicide. On top of this, the measures used as proxies for attempted suicide have been steadily increasing, since 2004.
With suicide being the third-leading cause of death for people aged 10-19 in the United States, it is clear that any form of effective treatment should be utilized to its fullest potential. In a 2018 guide for parents, the American Academy of Pediatrics made its stance on antidepressants clear.
The guide assures parents that antidepressants are one of the most effective forms of depression treatment in adolescents.
The rate of depression in adolescents and young adults is concerning, but this pattern does not have to continue. Antidepressants, selective serotonin reuptake inhibitors (SSRIs) in particular, work by impacting the synapses in our brain and stopping the reuptake of serotonin thus allowing for more serotonin to be in the brain. An increase in serotonin has been shown to improve focus, emotional stability, and sleep-wake cycle, and lead to a happier mood.
In a world with an ever-growing mental health crisis increasing the prescription of a known and accessible treatment seems like the easiest way to ensure young adults receive the care they deserve.
To be sure, Cognitive Behavioral Therapy has long been considered the gold standard for depression treatment. However, many suffering from major depressive disorder struggle to complete basic daily tasks. This causes many patients to miss appointments thus diminishing the effectiveness of Cognitive Behavioral Therapy. The use of SSRIs has been shown to increase the effectiveness of therapy as antidepressants help patients manage appointments.
On top of this many people do not have access to therapy and SSRIs can help to bridge that gap until therapy becomes more accessible. While SSRIs might not be the only form of treatment for depression, they are a vital step in receiving proper care.
When the FDA issued the Black Box Warning in 2004, the intention was to inform clinicians and patients of the need to be vigilant when prescribing or taking antidepressants. It is clear, that the warning has failed to guard those suffering from depression and instead has hurt the very population it was issued to protect. In light of this and with a seemingly ever-growing mental health crisis, it is clear that it is time to say goodbye to the Black Box Warning.
7-year-olds should be able to walk to school
By Gloria Ng
Once upon a time, elementary school students who lived nearby could walk home alone at the end of the day. They could go in groups without adult supervision and exit on their terms without waiting to be dismissed.
Such displays of independence in youth are rarely seen now. Since the 1960s, children’s time spent on their own has been decreasing due to the rise of restrictive parenting styles. This hinders children’s ability to play independently, paralleling the alarming rates of anxiety and depression among youth today.
An important part of growing up involves being away from adults to develop your own experiences and ideas, learning and exploring with other children that will later set up the foundations for future independence. With increased adult supervision, however, children are not able to be self-sufficient and learn for themselves.
Children learn from their experiences and the choices they make, whether right or wrong. If they fall off a rock and scrape their knee, they will learn to be more cautious next time. Parents automatically telling them to get off the rock eliminates their chance to learn on their own.
Restricting autonomy in childhood leads to heightened stress and anxiety when individuals must eventually make their own decisions. Furthermore, when children are taken to the park with their parents, they tend not to have as much time as they would like to play because parents may not have enough time or patience, and this takes away from their playtime which is an enriching experience for them.
Monitoring also reduces the chance of adventurous behavior, such as climbing taller trees, and there may be no playgroup when they are on their parents’ time.
In England, permission to walk home alone from school dropped from 86% in 1971 to 25% in 2010, and permission to use public buses alone went from 48% in 1971 to 12% in 2010. On top of this, average homework increased by 11.4 hours per week from 1981 to 2003 yet recess time has decreased. There are fewer and fewer opportunities for children to be independent and learn for themselves.
Naturally, parents are protective and hesitant to let children walk alone due to fears of abduction or harm. However, the odds of a minor being abducted by a stranger are 1 in 720,000. It is more likely they are taken by a relative or acquaintance than a stranger. This is not to diminish the risk and such worries, but rather to give a realistic representation of such events happening.
Parents also frequently attribute children’s declining well-being to their use of technology. However, it is more complex than that; some kids say that they are on their devices because they are not allowed to visit or play with other children. Our efforts should be geared towards fostering independence in playtime to boost confidence and enhance well-being in the future.
Parents are not wrong for focusing on keeping their children safe, but limiting independence is detrimental to their development. While it is culturally ingrained in us to protect them by not allowing them to venture out alone, we should consider giving them more independence.
Nevertheless, outdoor independence depends on the safety of the surroundings – in areas with high crime rates, indoor alternatives should be offered. We can encourage them to help around the house more, even if tasks are time-consuming and quicker when done alone by adults. They will not learn and grow if not given the chance to.
Talk to them about what they would like more freedom with, and work with your community to get children to walk or socialize together.
The correlation between deteriorating mental health and less independence should not be ignored for the well-being of our youth. We must establish a middle ground between keeping them safe and providing them with opportunities to explore the world around them and build resilience with fellow children.
More focus needed on postpartum depression
By Shreya Mandalapu
In May 2023, the US Department of Health and Human Services directed $65 million to health centers across the country to address the maternal mortality crisis.
With the maternal mortality rate being the highest of any developing country, this grant might seem to be a step in the right direction. However, the grant falls short of solving a longstanding systemic issue that plagues this country. And it fails to target one of the most at-risk and often overlooked parts of pregnancy, the postpartum period.
The postpartum period is a critical phase for mothers. Complications include post-traumatic stress disorder, depression, and psychosis. Postpartum depression (PPD) occurs in upwards of 20% of mothers and if left untreated, can lead to prolonged depressive episodes, increased risk of suicide and developmental impacts on the child.
Some mothers may hear mentions of PPD, whether that’s from a brief warning from a doctor or the latest celebrity Instagram post. But for most mothers, it remains a secluded, taboo period after birth. Allie Strickland, a South Carolina woman profiled by The New York Times, thought she would be experiencing enormous joy after the birth of her first baby. However, she was quickly met with bouts of depression and panic. “As soon as the sun set, I would feel this intense doom,” she said.
More than half of maternal mortality deaths occur during the postpartum period. Despite this prevalence, mothers face significant barriers from insurance interruptions, appointment scheduling issues and limited physician visits.
The saying is true, it takes a village to raise a baby. But what happens if we do not set up our mothers to receive a supportive environment? At what point does this eventually lead a mother to falter? We are failing to set up women for healthy postpartum care and an effective solution starts with a substantial increase in federal funding.
It was estimated in 2017 that perinatal anxiety and mood disorders cost $14 billion in the US. While a one-time $65 million fund is a large sum of money at first glance, it is clear that we need more comprehensive funding to aid all 50 states, not just the 25 states that this grant supports. Only 35 health centers are supported, none of which are near upstate New York.
We need to be thinking about our vulnerable populations. How will we reach Black mothers who rarely get diagnosed with postpartum disorders? What about non-native English speakers or mothers without a partner or family support?
We need bilingual doula care, mental health guidance and telehealth for mothers who can’t commute to health centers. We need funding to employ patient navigators to facilitate appointment scheduling and knowledge gaps for new mothers. Home visitations have significantly positive impacts on postpartum care, reducing neonatal mortality by 24%.
The Maternal Infant, and Early Childhood Home Visiting program is an important program for new mothers. It includes at-home visitations and connects families with necessary services in their community early on to prevent any isolation. It ensures that mothers do not have to learn crucial skills alone such as breastfeeding and safe sleeping. However, many states do not have the funding to support enough visitations. In New York, there were only 7,286 participants in the in-home visitation program this past year of the 69.9% of households that are at or below the federal poverty line.
The ROSE program is another excellent preventative measure. This free program by the University of New Mexico includes prenatal and postnatal sessions to educate mothers on navigating PPD. Not only does it educate new mothers on the prevention of PPD, but it also creates a social support network, so mothers do not feel isolated during this period. It is also open to anybody who wants to learn about PPD and ways to manage it.
An increase in state budgets could spread access to such programs across the country rather than a select few cities and states. There needs to be money aimed at vulnerable populations to uplift programs for marginalized mothers.
With funding to support a bottom-up approach, we can provide services to centers that demand drastic interventions and ensure that we are protecting mothers such as Allie Strickland and also future children.
Monroe County can do better on drug misuse
By Roni Kirson
In 2021, over 80,000 Americans died from opioid overdoses, reaching the highest annual death toll since the late 1990s. In Monroe County, the number of opioid deaths is disproportionately high relative to the rest of the state – reaching roughly 1.75 times the New York state rate.
Of the fatal opioid overdoses in Rochester specifically, the victims were disproportionately Black or Hispanic. Clearly, the opioid epidemic that has taken an enormous toll on this country has not spared this corner of upstate New York, and it hasn’t affected everyone the same.
Rochester offers an important and timely opportunity to address the opioid epidemic through a public health and social justice lens. Because of its existing treatment options, Rochester is uniquely positioned to do this by offering mobile treatment centers for opioid misuse.
It is no secret that this city has a fraught history of racial discrimination and industry collapse that profoundly increased racial disparities in socioeconomic status. According to a report from the U.S. Department of Health and Human Services, there is a close correlation between lack of economic opportunity and opioid hospitalizations and fatal overdoses. In Rochester, the harms associated with opioid use disorders cannot be separated from issues of racial and economic injustice.
Opioid users often face stigma and misunderstanding, with 78% of Americans believing that opioid addiction is the fault of the users themselves. The reality is that opioid addiction isn’t a choice, and seeing it that way makes it harder to enact non-punitive policies about opioid use that are backed by evidence. Because addiction is neither a choice nor a moral failure, punitive approaches to substance use are ineffective and even harmful.
So what can we do about it?
Currently, the city of Rochester itself and organizations within it provide free harm reduction resources like naloxone training and kits, fentanyl test strips and syringe exchanges to users. Additionally, there are many providers of medication-assisted treatment, including those who accept Medicaid. But transportation in the Rochester area is highly car-dependent, with minimal public transit options.
Treatment resources are not always available directly in the neighborhoods in which they are needed. This can contribute to a disconnect between people experiencing opioid use disorders and those offering support.
For example, the Father Tracy Advocacy Center, in partnership with the University of Rochester, found that for Latino people in Rochester, the opioid epidemic hit hardest in a mostly Latino neighborhood surrounding St. Michael’s Church on North Clinton Avenue. For someone living in this area, getting to the University of Rochester Medical Center’s outpatient center for substance use could easily be at least a 15-minute drive or a 45-minute commute on public transit.
So what can Monroe County do better? By expanding the availability of free mobile treatment centers, like the one run by Trillium Health, people with opioid use disorders could access high-quality care more easily. This community-based approach could greatly improve long-term outcomes among those experiencing an opioid use disorder, reducing disparities in treatment and improving outcomes across the board.
The benefits of community-based care have been shown in other areas. Stigma can be addressed, and with effective education and marketing campaigns, as well as a positive reputation for community programs built over time, hopefully we will see a real improvement in addressing the opioid epidemic.
The time has come for community-based mobile treatment centers equipped with medication-assisted treatment certified providers, free resources like Narcan, fentanyl test strips, and needle exchanges, and other medical professionals who can streamline access to broader care resources. These non-punitive approaches make personalized and holistic care accessible and affordable, removing barriers to quality care and treating opioid use like the public health crisis and social justice issue it is.
Local government needs to take lead on food access
By Lois Wang
“Onions, garlic, celery, balsamic vinegar — that’s a big word for Elmo.”
– Elmo, the Muppet Sesame Street character, as he listed off the ingredients for a Sloppy Joe to talk show host Jimmy Fallon.
Onions. Garlic. Celery. Potatoes— fresh staples easily found at Wegmans, Whole Foods, Trader’s Joe’s and Tops. Such a thought process is straightforward, but for many others, it’s a complex web of thoughts. And it goes a little like this:
“Consider the transportation options: bus (1hr 7min), car ($23), or bike (43 min). I need to get back to work within the hour and could save the $23 for rent. Let’s go on Saturday and sustain my leftovers till then, maybe the Cheetos and powdered doughnuts are sufficient for today’s meal.”
Proximity to the store, heightened by transportation accessibility, followed by the prospect of rationing a meal into meals, are all factors in how healthily many families and individuals eat. Despite its efforts, the city of Rochester continues to fail to address the many food concerns of the community.
The frame of Rochester’s modern food retail landscape can be traced back to the 1880s, when the Rochester government held great promotions of the Public Market, a space that provided fresh groceries for all. This soon changed in the 1920s and 1930s as food chain stores like the Great Atlantic & Pacific Tea Company (A&P) and Hart’s Local Grocers began to take over.
With many of these stores all over Rochester, the food retail landscape was quite homogenous with not much regard to racial, social, or economic heterogeneity.
On the other hand, it opened possibilities for these stores to control food accessibility, which became evident in the mid-1930s to 1950s. Within this time frame, Hart’s gradually shut down a majority of its many Rochester chain stores while investing into the new business model of Star Supermarkets concentrated in suburban areas and middle-class neighborhoods.
In 2003, Wegmans exhibited these practices by closing its store on Mt. Hope Avenue.
Although Constantino’s Market, a Cleveland-based grocery store chain, sought to fill Wegmans’ absence in 2015, its role as the Mount Hope community’s grocery store quickly came to an end.
Constantino’s had limited inventory and high prices that were not competitive with those of other stores like Walmart. Its unsuccessful economic model led to their closure. These changes left lower and mixed-income neighborhoods in Rochester devoid of a real supermarket.
What’s missing in this timeline is the municipal government’s continuous proactive involvement in providing access to food. The shift away from food accessibility and toward privatization of food retail businesses in the 1900s played a big role in the stratification of the food retail landscape.
To restore influence in the landscape, it created the Regional Market, a food distribution center. However, it only created competition with the Public Market while further failing to involve the public sector in the food retail sector.
Even with federal funds from the Health Food Financing Initiative that were meant to reduce food deserts, this issue remains. While the initiative has the right intentions, it doesn’t really allow for the core issue of a degrading food retail landscape to be effectively and properly addressed.
Successful interventions require a complex of community engagement, nonprofit support and municipal engagement. For example, Chester, Pennsylvania (population: 32,535) did not have a supermarket for 12 years until Fare & Square opened up.
Fare & Square, a nonprofit supermarket, was deemed successful. Fare & Square’s operations involved business, nonprofit and individual donations, as well as federal, state and local funding. Despite its takeover by Cousin’s Supermarket in 2018, the model set by Fare & Square is one that is highly replicable in other food deserts like Rochester.
Most recently, U.S. Sen. Kirsten Gillibrand, D-N.Y., prompted a foundational first step by promising adding $25 million to the HFFI program. To effectively use the HHFI funds, it is imperative that the city of Rochester foster stronger relations with nonprofits like Foodlink and the residents of the many food desert neighborhoods.
This engagement in planning sites and managing potential food stores or institutions supported through HFFI funds holds promise for better change. As we press forward, may we embrace the promising prospect of a more accessible and equitable food landscape for Rochester.
Polypharmacy can be too much of a good thing in treating mental-health disorders
By Grace Lee
There’s no doubt that medication is a powerful tool in the treatment of mental health disorders, but can there be too much of a good thing?
Polypharmacy refers to the use of multiple medications at once. Amidst a heightening youth mental health crisis, the number of children being prescribed multiple psychotropic medications has increased.
Mental health struggles are prevalent among American youth. In a national survey of high school students, more than 4 in 10 reported feeling persistently sad or hopeless and nearly one-third experienced poor mental health. In fact, nearly 20 percent of all children and adolescents ages 3-17 have a mental health disorder, with attention deficit disorder (ADD) and anxiety being the most commonly diagnosed.
Adolescents who struggle with mental health often rely on psychotropic medication as a solution. These medications work by artificially manipulating levels of brain neurotransmitters, and include selective serotonin re-uptake inhibitors (SSRIs) prescribed for depression and anxiety and central nervous stimulants prescribed for ADD and ADHD.
Psychotropic medication usage is common, and 8.9 percent of all American children, including 12.9 percent of teenagers, are on medication for a mental health concern. But while medication usage has increased, outcomes have only worsened. More than 1 in 5 high schoolers report that they have seriously considered suicide and 1 in 10 have attempted suicide. It’s time to re-evaluate the efficacy of the biomedical approach to adolescent mental health.
Polypharmacy often occurs when one medication doesn’t resolve all issues or causes side effects that need to be treated with another medication. For example, sleeplessness, a common side effect of some ADD and ADHD medications, is often treated with an additional prescription. Polypharmacy has grown increasingly common over the past two decades. As an example, an estimated 40.7 percent of people ages 2-24 who are prescribed ADHD medication are also prescribed at least one other psychotropic medication.
The use of multiple medications at once is not without risks. Children taking multiple psychotropic medications are more likely to experience harmful side effects from medication use. These include psychotic episodes, suicidal behavior, weight gain, metabolic disorders and interference with reproductive development.
Experts have pointed to a national shortage of child psychiatrists and a lack of access to therapy treatment options as causes of the increasingly widespread practice of pediatric psychotropic polypharmacy. Indeed, more than half of U.S. counties lack a psychiatrist, and 60 percent of psychologists report a lack of openings for new patients. Limited access to care impacts marginalized communities the most, and higher rates of psychotropic polypharmacy are observed among adolescents with disabilities or in foster care.
Given the severity of the mental health crisis facing today’s youth, it is imperative that accessible, evidence based solutions be found.
Telemedicine is a promising avenue in mental health care reforms that seek to improve accessibility of treatment options. For example, remote intensive outpatient programs (IOPs) remove geographical barriers to an effective approach to therapy, particularly for youth with more complex mental health needs. IOPs combine a variety of therapies such as art and recreational therapy in individual, group, and family sessions for several hours per week.
Another solution could lie in coordinated care models that allow prescribing clinicians to remotely consult with psychiatric specialists on medication management. The Massachusetts Child Psychiatry Access Project (MCPAP) is the longest running of these models and has improved access and quality of care by promoting collaboration between primary care physicians and child mental health specialists.
When it comes to addressing the youth mental health crisis, medication is only a part of the picture. The rest includes ensuring that medication usage is properly managed and improving the accessibility of counseling and therapy options. This comprehensive approach will be key to continued progress in adolescent mental health outcomes.
This article originally appeared on Rochester Democrat and Chronicle: University of Rochester students pose solutions for health policy issues
