Affluent Parents Criticize California’s Mental Health Law for Low-Income Teens

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

Lu wanted to get help, but she needed a parent’s permission and her mother — a single mom and an immigrant from China — worked long hours to provide for Fiona, her brother and her grandmother. Finding time to explain to her what therapy was and why she needed it felt 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’s a lot of rhetoric in immigrant cultures that having mental health concerns and getting treatment for that is a Western phenomenon.”

During her senior year of high school, Lu campaigned to change the state policy to allow low-income teens like her to get mental health counseling without their parents’ consent, and in October, Gov. Gavin Newsom signed a new law doing so. Teens covered by commercial insurance have had this right for more than a decade. But it was their parents who were among the most vocal in opposing the extension of that right to youth covered by Medicaid — seizing the opportunity to air their grievances about how much control the state has over their children, specifically related to gender identity and care.

One mother went on Fox News last April, calling school therapists “indoctrinators,” saying the bill allowed them to fill kids’ heads with ideas about “transgenderism” without their parents knowing. Those ideas were then repeated on social media and at protests held across the country in late October. Within the state Capitol, several Republican lawmakers voted against the bill, AB 665, including Assemblymember James Gallagher from Sutter County.

“If my child is dealing with a mental health crisis, I want to know about it,” Gallagher said on the Assembly floor last spring. “This misguided and, I think, wrongful trend in our policy now, that is continuing to exclude parents from that equation and say they don’t need to be informed, is wrong.”

State lawmaker salaries are set by statute and are too high to qualify them or their families for Medicaid, called Medi-Cal in California. They are offered a choice of 15 commercial health insurance plans as part of their employment, so children like Gallagher’s already have the rights he objected to in his speech.

To Lu and other low-income youth, this was frustrating and hypocritical. It felt to them like the mostly white, mostly middle-class opponents were hijacking the narrative.

“It’s inauthentic that they were 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 was merely intended to make a common-sense update to an existing law, according to the bill’s sponsors. Back in 2010, California lawmakers made it easier for youth to access outpatient mental health treatment and emergency shelters without their parents’ consent by removing a requirement that they be in immediate crisis. But at the last minute, lawmakers cut out teens covered by Medi-Cal for cost reasons because of an ongoing recession. AB 665 was meant to close the disparity and level the playing field for all kids.

“This is about equity,” said Assemblywoman Wendy Carrillo, the bill’s author, a Democrat from Los Angeles.

The original law passed with bipartisan support, no opposition, she said, and was signed by a Republican governor, Arnold Schwarzenegger.

“Since then, the extremes on both sides have gotten so extreme that we have a hard time actually talking about the need for mental health,” she said.

After she introduced the bill this year, her office faced death threats. She said the goal of the law is not to divide families but to encourage dialogue between parents and children and to rely on counseling to facilitate that.

To opponents like San Francisco Bay Area attorney Erin Friday, AB 665 is an incremental piece of a broader campaign to take parents’ rights away in California, something she opposes regardless of what kind of health insurance kids have.

Friday is a self-described life-long Democrat who voted for same-sex marriage. But when she discovered her teenager had come out as transgender at school and was being referred to by a different name and pronouns by teachers for months without her knowledge, she devoted herself to fighting any and all bills that she saw as promoting “transgender ideology.”

“We’re giving children autonomy they should never have,” Friday said.

While youth will be able to talk to a therapist about gender identity without their parents’ consent under AB 665, they cannot get residential treatment, medication or gender-affirming surgery without their parents’ okay, as opponents have suggested. Youth cannot opt to run away from home or emancipate themselves under the law.

“This law is not about inpatient psychiatric facilities. This law is not about changing child custody laws,” said Rachel Velcoff Hults, an attorney with the National Center for Youth Law, which sponsored AB 665. “This law is about ensuring when a young person needs counseling or needs a temporary roof over their head to ensure their own safety and well-being, that we want to make sure they have a way to access it.”

For low-income teens from immigrant families, like Lu and Esther Lau, removing the parental consent barrier, above all else, is about making sure there is a robust network of mental health clinicians willing to treat youth on Medi-Cal. Without parental consent, clinicians can’t get paid for the counseling they provide, either in a private practice or a school counselor’s office.

Even with her parents’ support, Lau, now 18, couldn’t find a Medi-Cal provider to help with her mental health struggles when she was in high school in Fremont. As the only native English speaker in her family, she had to navigate the bureaucracy of the health system on her own. For her, AB 665 incentivizes more clinicians to accept more low-income youth into their practice.

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