British government to expand use of drugs to control children's behaviour

The Blair government's review of the Mental Health Act proposes to give increased powers to psychiatrists to prescribe drugs to control children's behaviour. The plans could lead to up to three-quarters of a million children being prescribed psychoactive medication. Mental health workers have warned that the new legislation is so widely drawn that doctors will be given the right to prescribe drugs to children just because they are having difficulty with their maths or spelling.

Psychiatrists would also gain greater powers to order compulsory treatment in the community (CCTOs) to both adults and children deemed to have severe mental problems. Under the present legislation people can only be given treatment against their will if they “show seriously irresponsible or abnormally aggressive behaviour.”

The Green Paper on reform of the Mental Health Act proposes that doctors will generally be able to prescribe drugs to people if they have “any disability or disorder of the mind or brain, whether permanent or temporary, which results in impairment or disturbances of mental functioning”. No distinction is made between children and adults, either those voluntarily seeking treatment or under the provisions regarding CCTOs. Responding to the proposals, a spokeswoman for the charity Young Minds, explained: “Around 10 percent of children have a diagnosable mental disorder.... [The proposed legislation] is drawn so widely that it could cover a lot of children who have learning disabilities. The implications for kids is considerable.”

Widespread concern over the legislation follows alarming evidence of an increased reliance on drugs when dealing with children. Tens of thousands of school-age children, often with only common behavioural problems, are being prescribed Ritalin simply in order to control them.

Ritalin is a stimulant whose effects are similar to those of amphetamine, methamphetamine and cocaine. It is used to treat Attention Deficit and Hyperactive Disorder (ADHD)—a disorder of unknown causes that occurs in children of both sexes, but is diagnosed four times more frequently in boys. It is clinically defined as “developmentally inappropriate inattention and impassivity, with or without hyperactivity”. Symptoms include distraction, impatience and difficulty concentrating.

US sets the trend

In England alone the number of prescriptions for Ritalin shot up from 3,500 in 1993 to 126,500 in 1998—a staggering 3,600 percent increase. The UK is rapidly following the path of the US, where a report last month showed that 3 million children—one in every 30—are now being given Ritalin. Children as young as two are regularly being given mood-altering drugs, including anti-depressants.

A UN report published annually by the International Narcotics Control Board (INCB) revealed that the number of supposedly hyperactive children being prescribed drugs has increased alarmingly. The report said that the use of Ritalin for children with Attention Deficit disorder had gone up in more than 50 countries, and criticises the overuse of the drug in the US. Treatment rates for hyperactivity in some American schools are as high as 30 to 40 percent of a class, and children as young as one have been given the drug.

Professor Hamid Ghodse, president of the INCB, said in the report that despite efforts on international drug control many substances were being over-prescribed—particularly to young people with behavioural and social problems. He said they were being prescribed drugs in order to conform with a generally desired body image, because of emotional stress, and to improve school performance, but could then find it difficult to refrain from abusing drugs at a later date.

Ritalin is being prescribed in huge quantities despite the fact that very little research has been conducted on its long-term effects on health. Ritalin is not a cure for ADHD, but a stimulant which can help concentration whilst the child is on the drug. Ritalin's side effects include increased blood pressure, heart rate, body temperature and alertness, and it also suppresses appetite.

The implications of prescribing such mood-altering drugs on the still-developing brain of a child are not known. Evidence produced by the National Toxicology Program in the US draws attention to Ritalin's potential carcinogenic properties. Feeding mice Ritalin induced liver tumours, including very rare and highly malignant cancers.

Ritalin and other stimulants or anti-depressants are increasingly the only option being made available to millions who have been diagnosed with a mental disorder. ADHD diagnosis, which is difficult and complex at the best of times, is often made in cases where other social problems are prevalent and a comprehensive mental health examination has not been conducted. Its prevalence expresses the inability of the health services and governments to respond in any progressive way to the social disintegration and alienation confronting many, who are unable to cope with the mounting stress and struggle of everyday life.

Those with mental health problems are increasingly only offered medication to deal with their condition. Such an approach is largely about containing the immediate predicament they face rather than curing it, and is bound up with the gutting of more expensive social programmes based on rehabilitation, counselling and on-going care. Early pro-active intervention is virtually non-existent, contributing to an increase in mental illness.

The Mental Health Foundation last year noted that one in five young people under the age of 20 in Britain are estimated to have a mental health problem, ranging from anxiety to major psychotic disorders. They highlighted the fact that parents are forced to spend long hours at work just to make ends meet, reducing the amount of time they have to spend with their children, contributing to potential emotional and developmental difficulties. Britain currently has the longest working hours in Europe.

A report by the Audit Commission “Children in Mind” revealed huge discrepancies in mental health spending and staffing. Some health authorities spend just £5 per child and vacancies in some specialisms, particularly in London, are as high as 38 percent. Ten percent of Health Trusts could not offer an appointment for non-urgent cases within six months and two had waiting lists of two years. Twenty-nine percent of health authorities had limited services for children under 16 and over a third of specialist child mental health services had inadequate 24-hour cover. The rise of social deprivation is identified as a significant factor in the increased prevalence of mental health problems amongst children. The Commission says that children brought up by single parents and those with unemployed parents are, together with those whose parents have a mental illness, at greater risk of developing their own mental health problem.

Young Minds, whose council includes 21 professional organisations, listed the general causes of childhood depression as: bereavement, family break-up, bullying, moving home and/or school, having a parent with a mental illness, tension in the family, acquiring a new stepfamily, fear of failure, being abused or worrying about the future. Outside of addressing these broader social problems the rise in mental health problems cannot be overcome.