Baltimore-area children face barriers in accessing mental health care based on language: report

A report released Wednesday by two Baltimore-based social justice groups says language barriers are preventing children from immigrant families in Maryland from receiving equitable access to mental health care services.

Under Title VI of the Civil Rights Act and Section 1557 of the Affordable Care Act, patients are guaranteed free access to translation and interpretation services if their preferred health care language is something other than English.

But the report found that young people from immigrant families, which include both children who are immigrants and those with immigrant parents, are frequently denied care when referred to mental health providers.

Dr. Sarah Polk is the co-director of Centro SOL, which stands for Center for Salud/Health and Opportunity for Latinos, and is a pediatrician at the Johns Hopkins University. She helped write the report and said this language-based discrimination is a “chronic frustration.” The report was jointly released by Centro SOL and the Public Justice Center.

“Language is not supposed to be the basis of eligibility for health care service,” Polk said.

The report describes patients being denied care despite being covered by Medicaid. In one example, a 16-year-old with anorexia was referred by her pediatrician to a therapist for behavioral therapy, but the specialist refused to provide care because the girl’s primary language is Spanish. Another child who was suffering from depression was denied care because her mother’s primary language is Spanish. The Sun was unable to independently verify the patient’s claims.

Polk noted that even if the child in question can receive services in English, they are sometimes barred from even making an appointment because of a lack of interpretation services for their parents who handle their health care.

Polk and three other authors were unable to quantify the number of children and adolescents impacted by lack of access.

In her practice, Polk has experienced patients being denied care by other providers either because of their lack of English proficiency or their parents’. Ashley Black, the lead attorney for the Public Justice Center’s Health and Benefits Equity Project and another report author, said her organization has received at least a dozen direct complaints in addition to hearing from providers, social workers and organizations “that see language access denials regularly.”

Black said most of the concerns have come from the Baltimore area but that doesn’t mean the problem is geographically limited. She added that the majority of the complaints are from Spanish speakers.

“We have really been experiencing a crisis in pediatric mental health really since the pandemic that seems to have been somewhat sort of a secondary effect of the pandemic and also maybe in a more helpful way the result of somewhat reduced stigma around mental health so people feel more comfortable talking about these things,” Polk said.

Additionally, children of immigrants may face more risk factors than their peers, such as higher rates of poverty or experiencing discrimination, whether firsthand or through observing treatment of their parents.

Polk said the most common issues, such as anxiety and depression, are treatable. But she added that “by the time you’ve identified a mental health concern and gotten a family to seek specialty care it’s usually because there’s a fairly significant level of concern.”

Language barriers going unaddressed can lead to harm, Polk said. Patients may take medication incorrectly or not follow proper care protocol if instructions are given to them in English.

Among the report’s recommendations is that the Maryland Department of Health should provide a guide to interpretation and translation services for mental health providers serving immigrant families and provide financial support for those services, which are not reimbursed by Medicaid.

The Maryland Department of Health declined to comment on the recommendations, referring instead to the state’s limited English proficiency policy. Spokesperson Chase Cook said he had not yet seen the report.

“We’re very hopeful that this report will elevate these issues, especially to the new administration, and serve as both a reminder for providers of their obligations to meet these requests but also a resource on how important these issues are and how to meet those requirements,” Black said.