Adolescent Mental Health

When she was in ninth grade, Fiona Lu fell into a depression. She had trouble adjusting to her new high school in Orange County, California, and felt so isolated and exhausted that she cried every morning.

Lu wanted to get help, but her Medi-Cal plan wouldn’t cover therapy unless she had permission from a parent or guardian.

Her mother, a single parent and immigrant from China, worked long hours to support Fiona, her brother and her grandmother. Finding time to explain to her mother what therapy was and why she needed it seemed like too much of an obstacle.

I wouldn’t want her to have to sign all these forms and go to therapy with me, said Lu, now 18 and a freshman at UCLA. There is a lot of rhetoric in immigrant cultures that says having mental health problems and getting treatment for them is a Western phenomenon.

In her senior year of high school, Lu turned that experience into activism. He campaigned to change state policy to allow children 12 and older living in low-income households to receive mental health counseling without their parents’ consent.

In October of last year, Governor Gavin Newsom signed a new law expanding access to young patients covered by Medicaid, which is called Medi-Cal in California.

Commercially insured teenagers have had that privilege in the state for more than a decade. However, parents of children who were already able to access care on their own were more opposed to Medi-Cal’s expansion of such coverage.

Many parents took advantage of the bill to air complaints about the control they believe the state has over their children, particularly when it comes to gender identity and care.

A mother appeared on Fox News last spring calling out school therapists as indoctrinators, saying the bill would allow them to fill children’s heads with transgender ideas without their parents knowing.

These arguments were then repeated on social media and at protests held in California and other parts of the country in late October.

In the California Capitol, several Republican lawmakers voted against the bill, AB 665. One of them was Assemblyman James Gallagher of Sutter County.

If my child has a mental health crisis, I want to know about it, Gallagher said while discussing the bill in the Assembly last spring. This misguided, and I believe misguided, trend in our policy now that continues to exclude parents from this equation and say they don’t need to be informed is wrong.

State legislators’ salaries are too high for them or their families to qualify for Medi-Cal. Instead, they are offered a choice of 15 commercial health insurance plans, meaning children like the Gallaghers already have the privileges she railed against in her speech.

To Lu, this was frustrating and hypocritical. He said he thought the opponents who lined up against AB 665 at legislative hearings were mostly middle-class parents trying to hijack the narrative.

It’s not authentic that they’re advocating against a policy that won’t directly affect them, Lu said. They don’t realize that this is a policy that will affect hundreds of thousands of other families.

AB 665’s sponsors introduced the bill as a common-sense update to an existing law. In 2010, California lawmakers made it easier for youths to access outpatient mental health treatment and emergency shelters without their parents’ consent by removing the requirement that they be in immediate crisis.

But at the last minute, lawmakers in 2010 eliminated Medi-Cal’s expansion of teen coverage for cost reasons. More than a decade later, AB 665 aims to close the disparity between public and private insurance and level the playing field.

It’s about fairness, said Assemblywoman Wendy Carrillo, D-Los Angeles, who authored the bills.

The original law, which regulated private insurance plans, passed with bipartisan support and had little significant opposition in the Legislature, he said. The law was signed by a Republican governor, Arnold Schwarzenegger.

Since then, the extremes on both sides have become so extreme that it’s hard for us to talk about the need for mental health, he said.

After Carrillo introduced the bill last year, his office faced death threats. He said the purpose of the law is not to divide families but to encourage communication between parents and children through counseling.

More than 20 other states allow young people to consent to outpatient mental health treatment without their parents’ permission, including Colorado, Ohio, Tennessee and Alabama, according to a 2015 paper by Rowan University researchers.

For opponents of the new law, like Erin Friday, a San Francisco Bay Area attorney, AB 665 is part of a larger campaign to take away parental rights in California, which oppose regardless of the type of health insurance the children have.

Friday is a lifelong Democrat. But then she discovered her teenager had come out as transgender at school and for months teachers had referred to him by a different name and pronouns, unbeknownst to her on Fridays. He dedicated himself to fighting bills he felt promoted transgender ideology. He said he plans to file a lawsuit to try to overturn California’s new law before it takes effect this summer.

They were giving children autonomy they should never have, he said Friday.

Under the new law, young people will be able to talk to a therapist about gender identity without their parents’ consent. But they cannot get residential treatment, medication or gender-affirming surgery without their parents’ consent, as some opponents have suggested.

Nor can minors run away from home or emancipate themselves before the law, as opponents have also suggested.

This law does not deal with inpatient psychiatric facilities. This law is not about changing child custody laws, said Rachel Velcoff Hults, an attorney and health director of the National Center for Youth Law, which supported AB 665.

This law is about making sure that when a young person needs counseling or needs a temporary roof over their head to ensure their own safety and well-being, we want to make sure they have a way to access it, he said.

Eliminating the parental consent requirement could also expand the number of mental health doctors in California willing to treat youth on Medi-Cal. Without parental consent, under the old rules, Medi-Cal could not pay doctors for the counseling they provided, whether in a private practice or in a school counselor’s office.

Esther Lau struggled with mental health as a high school student in Fremont. Unlike Lu, she had the support of her parents, but was unable to find a therapist who accepted Medi-Cal. As the only native English speaker in her family, she had to navigate the healthcare bureaucracy alone.

For her, AB 665 will give doctors incentives to accept more young people from low-income households into their practices.

For the opposition, it’s just about political tactics and promoting their agenda, Lau said. The bill was designed to expand youth access to Medi-Cal, period.

What questions do you have about Southern California?

  • KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and surveys, KHN is one of the three main operational programs of KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization that provides information on health issues to the nation.

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