Courts are dealing with more mentally ill defendants than ever before. As Matt Ford writes for The Atlantic, the Cook County jail in Chicago is an example of how jails are rapidly becoming the country’s largest mental health facilities, ones ill-equipped to deal with the wide-ranging needs of patients. Judges and lawyers are involved in mental health treatment like never before, and this includes ordering criminal defendants and even children found delinquent or placed in foster care to take psychotropic medications.

One of the more familiar instances of court-ordered medication occurred after the horrific shooting in Tucson in 2011, when Gabby Giffords was injured and 6 others killed by Jared Loughner, who showed signs of severe mental illness. After experts convinced his original trial judge Loughner suffered from schizophrenia, he was forcibly medicated in order to become competent to stand trial. This decision was held up on appeal, as an AP article on Politico explained, and Loughner subsequently pled guilty to the shootings and avoided the death sentence.

Jared Loughner’s acts were monstrous, no doubt, and we’re better off with one less gun-toting maniac on the streets (though there seem to be plenty more where he came from). The judges more or less admitted he wasn’t capable of understanding the court system by forcibly medicating him before he entered the plea. Loughner is now serving seven life sentences plus change at a “federal prison hospital” in Missouri.

It’s at least unsettling, if not scary, that the government holds the power to invade an adult’s bodily autonomy in this way. Downright disturbing is the fact that children are subject to the same authority. Juvenile courts across the country are using medication in dispositions (a juvenile court term for sentencing and outcome orders) where children are either neglected or abused by their parents or accused of crimes themselves.

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A quick primer: There are generally two functions of juvenile courts. One is to resolve juvenile criminal charges, typically called “delinquency” charges. That system functions much the same as the criminal law system for adults but with much, much shorter sentences (the max in my last jurisdiction for violent felonies was 5 years if the case stayed in juvenile territory) and more attempts at rehabilitation, namely therapy and boot camps. The other half deals with what the law calls “dependent” children. Dependent children come into state custody because of alleged abuse or neglect.

A typical courtroom in a juvenile justice center (nice euphemism, right?), or the juvenile section of a larger courthouse contains a very small set of rows, maybe 3 or 4 rows of seating behind the tables. In addition to representatives of the state - Assistant DAs and lawyers that represent child protection agencies, for example - and defense attorneys for both parents and children, there are often other parties in the room, such as a guardian ad litem or volunteers from CASA. That can make for a great collaborative experience regarding a family’s well-being or a gigantic clusterfuck of conflicting opinions.

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When issues arise regarding behavioral problems, attorneys and judges often advocate and order, respectively, the psychiatric evaluation and medication of a child. Here’s a typical example of a law authorizing this in California that specifically vests the state with authority to administer psychotropic medication when a child has been declared dependent. Courts across the country have the same kind of authority - where parents have had

The most common scenarios in which I observe or participate in cases where children are medicated cover a startling age range. Children as young as 4 or 5 take ADHD medication. Teenagers and even younger kids are put on SSRIs and other antidepressants despite the FDA’s black box warning that those drugs may be dangerous for young people. (A followup study showed that suicide attempts went up after this warning was put in place, so the result may be a wash.)

ADHD - I hardly hear about plain vanilla ADD* when I’m in the courtroom - is by far the most common diagnosis mentioned in juvenile courts. The medication mentioned in this post’s title, Vyvanse, treats the disorder, along with Ritalin and Adderall, but the latter two are used less often, probably because of their potential for abuse. Besides depression and suicidal ideation, bipolar disorder shows up as a frequent diagnosis, even though there’s skepticism about whether the disease is overdiagnosed in children.

There is no doubt that many of these children have gone through other interventions that failed to solve mental health and behavior issues and that medication is appropriate. But courts don’t treat these drugs as a last resort. A San Jose Mercury-News special report published last year showed the alarming rates of prescriptions written for foster kids and the potentially devastating effects. Juvenile justice and welfare departments across the country are strapped for cash, leaving them without funding for extensive therapeutic services; judges want cases moved along out of their courtroom; cranky and overworked lawyers want to get out before lunch. We want to believe those in our juvenile courts especially have the best interests of children in mind - and so many people in the system do - but like courts for adults, the human beings that make up the system fall into damaging patterns.

Given these circumstances, hasty and financially viable fixes like medication are more likely to be used than those that wouldn’t alter a child’s brain chemistry and carry negative side effects. ABC News reported in 2011 that the problem stretches nationwide. The state of Pennsylvania has recently acted to curb overprescribing among foster kids, according to a local NBC affiliate. Let’s hope that other jurisdictions follow suit.


*Thanks to MisfitToy for the explanation!


A quick introductory note (at the end, of course): I’m not new to the Powder Room, but have written two articles (one on plea bargains, another piece on the law behind regulating the police) along with the amazing ladies of Elle Woods and Associates.

As those posts stated in the disclaimer, no part of this post or any I make is intended to serve as legal advice or as establishment of an attorney-client relationship. I can’t answer legal questions or give legal advice in the comments. My posts are only observations and opinions from practicing in various areas of law (and studying the law, and hanging out with lawyers - pity me) and I do hope you enjoy them.

And yes, I look exactly like my avatar. My life is like Space Jam, but set in a courthouse.