Lee Terry G, Walker Sarah C, Bishop Asia S
The authors are with the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (e-mail:
Psychiatr Serv. 2016 Feb;67(2):214-20. doi: 10.1176/appi.ps.201400544. Epub 2015 Oct 1.
Stakeholders have expressed concern over the appropriate use of psychiatric medications and adequacy of mental health services for youths involved with the juvenile justice system. This study assessed the impact of implementing psychiatric practice guidelines on medication costs and youth aggression in a juvenile justice facility. The study examined whether implementing psychiatric practice guidelines in a facility with an organized psychosocial treatment program would reduce psychiatric medication costs, compared with two other facilities, and whether lower psychotropic medication costs would be associated with increases in youth aggression.
Administrative data from three state-run juvenile justice facilities were analyzed to determine psychiatric medication costs and rates of youth aggression. Psychiatric practice guidelines that involved screening, shared decision making, psychosocial treatments, medication prescribing, and monitoring of side effects were implemented in only one of the three facilities, with a goal of applying evidence-based psychopharmacology and benefit-risk considerations.
Over the ten-year study period (2003-2012), psychiatric medication costs decreased 26% at the facility implementing the psychiatric practice guidelines, whereas costs at the two comparison facilities increased by 104% and 152%. As psychiatric medication costs decreased at the facility implementing the guidelines, youth aggression there did not increase.
Implementing psychiatric practice guidelines in juvenile justice facilities can reduce psychotropic medication costs without an increase in youth aggression. Implementation of the guidelines requires an organized psychosocial treatment program to help deter an inappropriate focus on psychotropic treatments.
利益相关者对涉及少年司法系统的青少年精神科药物的合理使用以及心理健康服务的充足性表示担忧。本研究评估了在一家少年司法机构实施精神科实践指南对药物成本和青少年攻击行为的影响。该研究考察了在一个设有有组织的社会心理治疗项目的机构中实施精神科实践指南，与另外两家机构相比，是否会降低精神科药物成本，以及较低的精神药物成本是否会与青少年攻击行为的增加相关。
分析来自三个州立少年司法机构的管理数据，以确定精神科药物成本和青少年攻击行为发生率。精神科实践指南涉及筛查、共同决策、社会心理治疗、药物处方和副作用监测，仅在这三个机构中的一个实施，目标是应用循证精神药理学和效益风险考量。
在为期十年的研究期间（2003 - 2012年），实施精神科实践指南的机构精神科药物成本下降了26%，而另外两个对照机构的成本分别增加了104%和152%。随着实施指南的机构精神科药物成本下降，那里的青少年攻击行为并未增加。
在少年司法机构实施精神科实践指南可以降低精神药物成本，而不会增加青少年攻击行为。指南的实施需要一个有组织的社会心理治疗项目，以帮助避免不恰当地专注于精神药物治疗。
