NYT: Developmentally Disabled in New York Are Getting Too Many Antipsychotics

Many group-home residents with mental retardation are receiving psychotropic medications that may be doing far more harm than good.

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The New York Times continued on Friday its important, but distressing, series of articles on the maltreatment of the developmentally disabled in New York State and the lack of oversight of their care in the state’s group homes.

Friday’s article focused on the misuse of antipsychotic medication to restrain residents’ behavior, instead of treating their disorders. The Times reported:

Psychologists who have worked inside the system describe a culture in which the drugs are used to control the disruptive behavior of the developmentally disabled — people with conditions like autism, Down syndrome and cerebral palsy — an approach increasingly discredited in the field.

The problem is that people with mental retardation, because of their condition and diminished intellectual capacity, commonly exhibit symptoms similar to those seen among people who have impulse control, anxiety or attention deficit disorders.

As reporter Danny Hakim explained, however, mental health experts say these symptoms should be treated through therapy, not psychotropic drugs, which don’t address root problems and have many side effects. Indeed, despite their widespread use, data suggest the drugs may not even work to control behavior.

MORE: Drugging the Vulnerable: Atypical Antipsychotics in Children and the Elderly

Perhaps the most shocking fact revealed in Hakim’s story comes from a study published in 2008, which found that antipsychotic drugs — including the older-generation medication Haldol and the newer, expensive antipsychotic Risperdal — were actually less effective at reducing aggressive behavior in intellectually disabled people than a placebo.

The research, published in The Lancet, found that in one month of treatment, placebo reduced aggression by 79%, compared with 65% for the older antipsychotic drug and 58% for the newer drug. The authors concluded: “Antipsychotic drugs should no longer be regarded as an acceptable routine treatment for aggressive challenging behaviour in people with intellectual disability.”

Given how often these drugs are still prescribed, and that antipsychotics can cause terrible side effects ranging from extreme weight gain to uncontrollable movement disorders, diabetes and an increased risk of death, this finding is particularly troubling. As the Times reported, Risperdal is one of the top 10 drugs prescribed to the developmentally disabled in New York State, received by 6,124 group home residents in 2010. Although some of those prescriptions may have been appropriate — intellectually disabled people are more likely than the general population to suffer from mental illnesses that may require the drugs — the state’s health department has repeatedly cited group homes for poor oversight of medication use, and in many cases the drugs were used overly aggressively.

MORE: Why Are So Many Foster Care Children Taking Antipsychotics?

More than 100,000 developmentally disabled people currently receive residential services in New York State, which has more than 2,000 state-run group homes. Compared with other states, data suggest something has gone awry in New York: during the previous decade, 1,200 people have died in group homes in the state — 17% of unnatural or unknown causes. Moreover, New York spends $10 billion annually on group-home care, several times more than is spent in neighboring states. Yet deaths from natural or unknown causes in group-home residents in Massachusetts and Connecticut are four times less common.

We’ve reported earlier on Healthland on the overuse of antipsychotic medications in children in foster care and among the elderly, and noted that every major pharmaceutical company that makes new-generation antipsychotics has paid massive fines for selling these drugs for unapproved uses in these vulnerable groups.

It’s long past time for more to be done to stop it.

Maia Szalavitz is a health writer at TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland’s Facebook page and on Twitter at @TIMEHealthland.

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