A woman called recently to ask how we use medication at Dakota Boys and Girls Ranch. She said, "I recently learned that most of the kids at the Ranch are on medication. Is that true?"
According to Dr. Wayne Martinsen, Medical Director at the Ranch, and Heatthyr Haugeberg, Director of Nursing at the Ranch, she is correct. About 90% of our children are on a psychotropic medication at any given time.
This is not surprising when you remember that the Ranch is a psychiatric residential treatment facility, providing hope and healing for the most troubled children in our communities—children who have experienced chronic stress and trauma.
Several in-depth studies, using neuro-imaging technology to map the brains of trauma sufferers, have outlined dramatic changes in brain structures and functions. They have also found that medication can change brain structure and function in a positive way. Combined with effective therapies and healthy experiences, medication can rewire the brains of children who have experienced significant trauma.
One of the most compelling reasons to use medication in treatment is to reduce pain. All children who come to the Ranch are experiencing significant emotional pain. That pain can be displayed in anxiety, loss of control, anger, depression, or destructive behaviors. Dr. Martinsen sees it as an act of compassion to treat their emotional and physical pain. He likened it to someone experiencing physical pain, and ask, "How much physical pain would you allow someone to be in before you treated their pain with medication?"
As hard as national and local organizations are trying to change it, mental health diagnoses and medications carry a stigma. We don't think twice about taking insulin for diabetes, chemotherapy for cancer, or a statin for heart disease, but start talking about medication for psychiatric disorders and people have very strong opinions.
Unfortunately, some still hold negative attitudes and stereotypes towards people with mental illness—thinking medication is the easy way out, that it changes people's identities, or that it's different than taking medication for a physical illness.
Many of our children are in so much emotional pain they think they'd be better off dead. North Dakota's suicide rate has increased 57% since 2000, and the state has one of the highest adolescent suicide rates in the nation. If we can alleviate some of this intense pain and despair with medication—if we can keep kids alive--Dr. Martinsen believes we are obligated to do so.
Another reason to prescribe medication is to stabilize their conditions so kids can go home to their families as healthy and quickly as possible. Taking kids from their families is hard on them, and adds yet another trauma to their already traumatic lives. Medication works in conjunction with therapy so kids can heal and return home more quickly.
Dr. Martinsen, and his colleague, Tammy Uleberg, Family Nurse Practitioner at the Ranch, put a lot of thought and expertise into medication decisions. Every decision is based on the individualized needs of the child and a variety of factors, including psychological testing and GeneSight testing. GeneSight is a sophisticated genetic testing tool that helps providers know and understand which medications will be the most effective for the child with the least amount of side effects. All it takes to send a sample to GeneSight is a simple swab in the mouth.
Ranch children are placed on medication only with the permission of the child, the child's guardian, and the child's parents. At the Ranch, we go above and beyond what is required by getting permission from parents, even if the child has been placed by the court and the parent doesn't have custody. Dr. Martinsen gets a signed release from the parents allowing him to prescribe medication (except in the very rare case where the parent is significantly impaired and unable to make a decision). Another exception to this rule is for kids who don't have parents--approximately one out of six children at the Ranch have no parents or family involved in their lives.
Dr. Martinsen follows children closely, often seeing them weekly to determine the effectiveness of the medication and evaluate any side effects. After every single appointment, he attempts to reach the parents to let them know he saw their child, if the child is experiencing side effects from the medication, and what he recommends moving forward.
The use of medication for psychiatric disorders is complicated and at the Ranch, we do not take it lightly. To provide the most effective care to our kids, we continually stay on top of scientific advancements in brain research and the effectiveness of medications. All of our efforts are centered around what we can do to provide compassion and healing to these troubled, complicated and amazing kids.
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