Forced Drugging of Immigrant Children Highlights an Issue We Don't Talk About

The country watched in (almost) unanimous horror as immigrant children were separated from their parents at the U.S. Southern border. A lawsuit filed by the Center for Human Rights & Constitutional Law has only added to the outcry, alleging children staying in government-funded facilities have been routinely forced or tricked into taking psychotropic drugs without their parents’ consent, Reveal reported.

According to the lawsuit, young people at Shiloh Treatment Center in Texas reported being given up to nine different pills in the morning and six in the evening. They were told they wouldn’t be allowed to leave if they didn’t take these drugs, and some reported being held down and given injections if they refused. The center serves youth with “behavioral and emotional problems,” housing children who may have exhibited challenging or worrying behavior.

Understandably, this news only added fuel to the anger many were feeling about the situation. But, these passionate conversations about immigrant children and forced medication have left some disability and mental health advocates asking, “Where have you been?”

Honestly, everyone surprised/outraged by forced drugging, where've you been? If answer's calling ppl who q how psych meds prescribed/administered Scientologists/anti-med, ask yourself y was it so destabilizing to your worldview when we spoke that you felt need to misrepresent us.

— Katharine Celentano (@kcelentano) June 20, 2018

“That is not a system or a framework that was immediately, spontaneously constructed at this moment,” Katharine Celentano, policy coordinator at Drug Policy Alliance, told The Mighty. “It’s something that preexists and it’s often applied to other vulnerable populations.”

Medication being administered without consent at mental health facilities isn’t new. Whether it’s to curb depression, manage episodes of psychosis or reduce anxiety, psychiatric medication is prescribed to support mental health and treat mental illnesses. Ideally, someone visits a mental health professional or enters a treatment facility willing, and if medication is deemed a potentially helpful option, a psychiatrist writes a prescription. Medication isn’t for everyone, but it can help some live happier, more fulfilling lives. Mental health treatment should be a partnership, one that gives patients a say in their treatment plan.

Legally, there are exceptions to this. Medication can be administered involuntarily when a patient is deemed a danger to themselves or others. An individual who is up against serious legal charges can also be forcibly medicated if it’s likely that medication will restore their competence to stand trial. Even though this is supposedly a narrow window, it still gives mental health professionals power to use medication to curb unwanted behaviors in certain situations.

In the case of immigrant children, medication is being used to help the children “calm down,” without taking into account the trauma most of them have endured. Celentano argues this response addresses the behavior of the children without taking into account the context in which the behavior is occurring. Medication isn’t being given as part of a treatment plan – it’s being used to curb the children’s (justified) agitation.

Although it may seem shocking that “agitated” immigrant children are forced to take medication, this happens in other settings, too.

When we asked our community to share their own experience with non-consensual psychiatric drugging on The Mighty’s mental health Facebook page, one person shared:

Two security guards were called to the waiting room at the hospital because I got scared and freaked out. One tackled me and put me in a wrist lock. I was even more scared, but compliant. He took me to a padded room and told me if I didn’t “behave” he would, “pull my pants down in front of everyone and the nurse would put a needle in my bum.” He didn’t say what the needle would contain, my best guess is a sedative. He then asked me if I would, “Like that to happen?” I was terrified.

Another said:

I was in the ER and I was underage so my mom had to approve all the medicines being given to me. My mom was out at the time and I was in there all alone. I have sensory issues so I was closing my door a little ways. Within minutes after that happening the nurse and doctor came in the room trying to give me a shot because I was “going psycho,” when in reality all I did was close my door a little and go sit back down in my bed. I remember asking them if they had my mom’s permission to give me that medicine and they said they had it but they wouldn’t let me speak to her. Later I found out my mom had no idea about it until afterwards. After they held me down to give me the shot they restrained me and I passed out for the first time in my life. It was a really scary experience 

Community members also told us they had been injected with psychiatric medication during a panic attack at a psychiatric hospital. “I know it was for my own safety, but I felt so invaded and exposed,” one woman recalled.

Celentano explained that just as drugging immigrant children is unethical considering the context, people in other psychiatric settings deserve the same amount of discretion.

Speaking to what can happen in mental health settings, she said, “Each of those situations are vulnerable to the same sort of error we’re seeing at the border, in which assessment is not objective, and there will be the most errors in that assessment amongst populations who are particularly vulnerable. People who are the most disempowered in self-advocacy, they have the least amount of power.”

In these cases, Celentano said, medication meant for mental health “treatment” is instead used as enforcement, and when these lines are blurred, it’s easy for abuse to follow.

Not All ‘Forced’ Medication Is Violent

Although many might think forced medication is something out of the old asylum days, “forced” medication doesn’t have to look being held down and given injections. Celentano described her own experience living at a residential treatment center for two years.

“On paper, I was there consensually,” she told me. “On paper, most of the people I was there with were also there consensually. None of us were ever held down or injected with drugs, but I would say the framework in which we were being medicated was invalidating and not at all times consensual.”

She recalled witnessing a friend in her treatment program so “drugged” out, they would fall down the stairs on their way up to bed. She said those in the program were actively discouraged from learning about the medication they were taking, and that there were consequences for challenging or disagreeing with a medication you were prescribed.

“You could get in trouble for reading the physician’s desk reference when we were trying to understand what these drugs are,” she said.

Our community members told us similar stories. One woman shared:

When I went to the mental health hospital I was told I can take medication or stay longer for refusing medication. The sleep meds made me sleep all day so I missed groups and had to stay an extra day. The depression medication made me feel worse, like I was in a dream, and did not help my suicidal thoughts. And the anxiety meds made me shake worse. I took the meds so I could go home. The medication didn’t help my suicidal thoughts, but I lied and said they did so I could go home…. I was forced to take medication to have freedom.

Another:

As a teenager, I was forced to take them as part of an agreement from inpatient. The psychiatrist never listened to me about any of the side effects and it really turned me off to them. I was a minor at the time and considered highrisk, so I had no real say in my own health. I got lucky though because I found a therapist when I was 22-ish who really helped me… I’m on Prozac for panic disorder now, my choice to take them and my choice of prescription. I’m the most healthy and happy I’ve ever been. I have a permanent tremor because of one of the pills I was forced to take though.

Similarly, some immigrant children were reportedly told the psychiatric medication they had been given were “vitamins.” Even though withholding information or coercively getting people to take medication doesn’t conjure up the same violent imagery as holding someone down, it’s a practice that happens not just at our border, but in other parts of our mental health system as well.

This Isn’t About Being Pro-Drug or Anti-Drug

The conversation about how we use drugs in our mental health system — from immigrant children to people in psychiatric hospitals around the country — is not about being for or against drugs. Drugs, Celentano said, aren’t inherently good or bad. How the drugs are being administered, and the system that allows abuse to happen, is what we need to focus on.

The discussion is really about informed consent, and informed consent is neither anti- or pro-drug. Celentano added:

We need to be able to have a conversation about informed consent that focuses on both elements of that word: both consent and robust information… A framework that focuses on informed consent can capture the experience of someone who takes a drug they feel is helpful, but who feels stigmatized or can’t access that drug, and the experience of somebody who  takes a drug, perhaps the same drug, and finds the context in which it was administered or prescribed to be traumatic or damaging to them.

Whether there are ever exceptions to this, and how we figure out when to make those exceptions, is a question many leading mental health advocacy organizations face. While some fight for more opportunities to give treatment to those who deny it — because a person is struggling in psychosis, suicidal or aggressive — others say forced treatment is never necessary, and if it is, it should only be used as a last resort.

Wherever you fall on this issue, it seems most people can at least agree on this: Administrating drugs to minors without their parents’ consent, without considering context, and in a way that is coercive and misleading, is wrong. Period.

If we can agree that this is wrong, then we need to start talking about how this practice is ingrained in the larger framework of our mental health system. The Shiloh Treatment Center didn’t invent this. As Celentano said, “People have been self-reporting, for quite some time, that these experiences are traumatic… How these immigrant children are being treated now gives an example of how these abuses can occur, and how they are occurring. We need to start listening.”

And we need to listen — even after the news cycle has moved to the next public outrage. Whether it’s children being held at the border, or people unable to advocate for themselves in the mental health system, things will only change when we listen to people’s experiences and believe them.

Author’s note: An earlier version of this piece didn’t link to Reveal’s original reporting about the lawsuit. The piece has since been updated, and you can read Reveal’s article here.