I saw parallels to Clancy case as a juvenile court judge

'Reckless indifference' of prescribing psychiatrists can have devastating consequences

THE TRAGIC DEATH of the beautiful Clancy children may portend a long overdue indictment of the cavalier use of powerful psychotropic medications over non-pharmacological methods of treatment for those suffering from mental illness.

For decades in Massachusetts, the reckless indifference of prescribing psychiatrists and other providers has caused lasting and harmful consequences for so many adults and children who need help but cannot get services any other way. I have seen it all too often behind the closed doors of the Massachusetts Juvenile Court, where I served as a judge for 20 years until this past January.

Petitions by the Department of Children and Families to forcibly medicate children in state custody sometimes as young as age 10 with powerful antipsychotic medications are common in the juvenile courts. Oftentimes, the stated support for the use of these medications is minimal and done for purposes of chemically controlling behavioral issues in children. In more recent years, children in state custody and on the autism spectrum are the victims of daily doses of powerful antipsychotics not tested or approved for children. Psychiatrists conveniently describe the use of unapproved, unstudied drugs in children as “off label” prescriptions.

In child abuse and neglect cases where parents are before the court following the removal of a child because of a parent’s serious mental health issues, the parent will often begin a course of antipsychotic medications. Many parents in my court related frightening stories of severe side effects experienced with these medications. Moreover, they often reported that the medications were prescribed after only one or two brief meetings with a psychiatrist or nurse practitioner. They reported there was little or no discussion with providers of the risks and benefits of powerful antipsychotic and other psychotropic medications.

Too often, I witnessed adults and children suffering from the involuntary movements of the mouth and face called tardive dyskinesia, and others who had dystonia, a side effect causing alarming body movements and muscle contractions. I saw massive weight gain in adults and children, a concerning side effect that caused other related and worrisome health issues like diabetes. Some very young children developed breasts and began lactating, a known, but uncommon, side effect of some antipsychotic medications.

It is rare that adults and children are prescribed only one psychotropic medication. Generally, multiple medications are prescribed at the same time, known as the “medication cocktail.” Lindsay Clancy’s attorney reported that she was prescribed 13 different medications, including the powerful antipsychotic Seroquel, mood stabilizers, anti-anxiety drugs, and antidepressants, often prescribed together. The medications, apart from the antipsychotics, are prescribed for sleep, anxiety, depression, mood instability, and for other problems related to the side effects brought on by the antipsychotic medication. Each of the drugs in the cocktail has its own harmful side effects.

It goes without saying that antipsychotic and other psychotropic medications can be lifesaving for many people who are suffering with mental health disorders correctly diagnosed after a proper and extended evaluation. But over the last three decades, the psychiatry profession and pharmaceutical industry has expanded the diagnostic criteria and minimum age for use of antipsychotics and other psychotropics exponentially to ensure that additional tens of millions will be prescribed the drugs, oftentimes after one brief appointment.

Patricia Deegan of the National Empowerment Center described this dynamic in an article focused on “reclaiming your power” during medication appointments with a psychiatrist. “The meetings usually last for 15 or 20 minutes,” she said. “During the meeting, we are expected to answer a few perfunctory questions and to leave with prescriptions for powerful drugs that can dramatically alter the quality of our lives.”

These types of appointments had been reported countless times in my years on the bench and the troubling side effects of these drugs were often minimized by dismissive prescribers as they are by the pharmaceutical companies that manufacture them. Despite attempts to minimize the side effects of antipsychotic medications and other psychotropics that include suicidal ideation, hallucinations, confusion, and at times psychosis, the safety warnings and side effects regarding certain psychotropics are clearly listed on the medication packaging.

Whatever the legal outcome of this unbelievably tragic case of a young women who went from a highly functioning, respected nurse, loving mother, and wife into the harsh reality of the unforgiving criminal justice system following the alleged senseless killing of her children, no one should ignore the painful and potentially avoidable trajectory that might possibly have prevented the horrific outcome.

Carol Erskine is the recently retired First Justice of the Worcester County Juvenile Court, where she presided over cases involving criminal matters, runaways, child welfare cases, sexually exploited children, and mental health and medical issues in children, including petitions to medicate children in state custody in connection with child abuse and neglect cases. She is currently an adjunct faculty member of the criminal justice program at Anna Maria College.