States spend significantly less on psychiatric drugs for poor minority children than they do for white ones, according to a 36-state study produced by the Brown School at Washington University-St. Louis.
Among Medicaid-eligible children, expenditures for psychotropic drugs varied widely by race. The mean spending for white children in the nearly 10,000-child sample is $1,456, which is $292 greater than African-American youth when factoring for the children who do not receive any medications. Expenditures for Latinos were $144 less than the mean for white children.
In a smaller sample made up entirely of children involved in abuse and neglect investigations, states spent $614 less on African-American children than on white children.
The gap is not due to a disparity in need for the drugs between whites and other youths, said Professor Ramesh Raghavan, a lead author on the study.
“What seems to be happening is on the demand side,” he said. “African-American children are not able to access services they ought to, and when they do, it doesn’t seem to be for services that are the most high quality.”
The finding suggests that there is racial disparity when it comes to parlaying access to Medicaid services into actual services rendered. It means that states will have to do more than expand Medicaid to reach more minority youth in need of mental health services.
“Simply bringing more people into the circle with the Affordable Care Act won’t do it,” said Raghavan. “If the goal is high-quality mental health services, access won’t be sufficient.”
The extent to which psychotropics constitute high-quality treatment is a matter of some debate, particularly in regard to children in foster care. President Barack Obama has proposed a $750 million plan to curb the over-use of such medication on foster youth, in the wake of a Government Accountability Office study that found staggering numbers of foster youths had been prescribed more than one of the powerful drugs at a time.
Raghavan said he believes it’s a two-way street. “There’s a lot of research that we’re drugging the heck out of kids in child welfare, and there’s evidence that we aren’t providing psychotropics to some kids who really need them.”
John Kelly is the editor-in-chief of The Chronicle of Social Change