For these are all our children, we will all profit by or pay for what they become.
—James Baldwin
Notwithstanding the litanies of news stories and academic journals acknowledging that the United States is, and has long been, in a mental health crisis, there still exists a mental health stigma in this country. In large part, the literature on access to mental health treatment focuses largely on adults, and not nearly enough on our nation’s children and youth (persons under the age of 21). This lack of attention to the mental health of our nation’s youth ensures that the stigma and the consequences of lack of treatment will continue.
According to the American Psychological Association (APA), nationally up to 20 percent (about 15 million) of America’s youth have a mental or emotional illness. Of those youth, only 20 percent receive any mental health treatment, and of those who do receive mental health treatment, only 7 percent receive appropriate treatment; that is, receiving a continuum of home mental health services and supports, provided by the appropriate behavioral health provider, in the least-restrictive environment (at home and in the community), at the frequency, duration, and intensity needed to address a mental illness or condition. Attention deficit/hyperactivity disorder (ADHD), behavior problems, anxiety, and depression are the most commonly diagnosed mental conditions in youth.
Despite the rising numbers of youth being diagnosed with mental illnesses, there still remains an issue with accessing mental health services to address their conditions. The APA concluded in 2009 that the youth “most in need or at highest risk are least likely to have access to the highest quality [mental health] interventions.” Thirty-one percent of white youth receive mental health services, compared with 13 percent of youth of color. See J.S. Ringel & R. Sturm, “National estimates of mental health utilization and expenditures for children in 1998.” 28 J. Behav. Health Serv. Res., no. 3, Aug. 2001, at 319–33. Lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth additionally struggle with accessing mental health services, despite 60 percent of LGBTQ youth reporting to the Centers for Disease Control and Prevention that they experience feelings of depression and anxiety. That percentage, of course, is even higher when considering the unaccounted-for LGBTQ youth who are so burdened by their existence that they are too afraid to speak on it.
When left untreated, or not timely treated, mental health issues may contribute to learning difficulties, behavioral issues, and strained family, peer, and social relationships, and lead to juvenile justice involvement and, later, unemployment or underemployment. Individuals with mental health conditions have an increased risk of chronic medical conditions and a life expectancy that is 25 years shorter than that of persons who do not have a mental health condition. Tragically, “a recent study in the Journal of Community Health showed that suicide rates among black girls ages 13–19 nearly doubled from 2001 to 2017. For black boys in the same age group, over the same period, rates rose 60 percent.”
For the most vulnerable populations in the country, Medicaid-eligible youth, access to a comprehensive public behavioral health system is mandated by federal law. A state’s failure to provide Medicaid-eligible youth with the necessary home- and community-based services to address their mental health needs, on a consistent and statewide basis, violates the Early and Period Screening, Diagnostic, and Treatment (EPSDT) provisions and the Reasonable Promptness provisions of Title XIX of the Social Security Act (Medicaid Act), 42 U.S.C. § 1396 et seq. The resulting unnecessary psychiatric institutionalization of these youth, or the serious risk thereof, violates Title II of the Americans with Disabilities Act, section 504 of the Rehabilitation Act of 1973, and their implementing regulations.
Through the Medicaid Act and Title II and section 504, mental health advocates have filed class action lawsuits in states—among them California, Washington, Illinois, and Massachusetts—challenging the state’s inability to ensure the provision of home- and community-based mental health services to child Medicaid populations. Just recently, on November 7, the Southern Poverty Law Center filed suit against Louisiana, alleging that the state has failed to provide intensive home- and community-based mental health services to over 47,500 Louisiana Medicaid-eligible children and youth who have been diagnosed with a mental illness or condition.
My professional experiences have shaped my beliefs about the needs for mental health services for youth and created demonstrative evidence that, had those services been rendered, we would have more just outcomes. As a children’s rights attorney, I have been afforded a front-row seat to the school-to-prison and school-to-institution pipelines in real time. So many of the clients whom I serve are subjected to exclusionary disciplinary practices or encounter the juvenile justice system (or both), while having untreated or undertreated behavioral health issues. During my time as a public school kindergarten teacher, I realized early on that it was more effective to serve the role of a counselor for my students, rather than that of a disciplinarian. I reflect on the need for mental health services in my own self: It would have been great to have someone to talk through the struggles of being a black boy growing up in the Deep South (in Mississippi), who was raised by a single mother with very limited financial resources and who was chronically regarded as a behavioral problem by his nearly all white school teachers. As a nation with immense resources, we owe it not only to our youth but also to ourselves as an investment in the future of this country to prioritize mental health services as a civil right.
Children deserve the dignity of receiving quality mental health services that allow them to lead healthy and productive lives in their homes and communities. Access to mental health services for youth, therefore, is a civil right and should be treated as such.
