Identifying best practice recommendations for antipsychotic prescribing

Objective: Identify current challenges, trends and recommendations for improving prescribing practices of antipsychotics using qualitative interviews with child mental health experts in Wisconsin. Methods: This qualitative study used surveys and semi-structured interviews with stakeholders and prescribers to identify upstream causes of children's poor mental health and antipsychotic use. Data was abstracted from 41 semi-structured interviews with medical doctors in Wisconsin from a variety of prescribing communities and 21 surveys of other Wisconsin thought-leaders and stakeholders. Practitioners and stakeholders were identified using a snowball method. Results: Stakeholders reported that much of the antipsychotic use in Wisconsin might be preventable through early intervention and/or coordination of other services. The impact of early childhood trauma and disrupted attachment in highly stressed families was cited as an important factor in the emotional and behavioral difficulty of many children, especially those in the foster care system. The stresses of poverty were also identified as significant contributors to mental health issues. Providers identified the lack of available developmentally appropriate, evidence-based non-pharmacological therapies and the need for rapid behavior improvement as barriers to reducing the number of children receiving antipsychotics. Conclusions: Many barriers to appropriate antipsychotic prescribing practices were identified, particularly lack of funding, lack of coordination of care, and increasing adverse childhood events. Experts in Wisconsin believe that early intervention, family support services, and school-based population health interventions may help to reverse the trend of increasing antipsychotic prescribing in Wisconsin. However, to date such programs do not exist on a large scale in Wisconsin.