Children in Maryland who need mental health services but don’t speak English are not always getting vital interpretation services that are required by law, according to findings from a pair of civil rights and advocacy groups released Wednesday.

The report found not all providers offer interpretation through bilingual staff or translation services although they are receiving federal financial assistance that mandates the services, and also that state health officials are not providing guidance or consistently enforcing the rights.

That means in some cases, children aren’t getting proper services or aren’t getting services at all at a time when the American Academy of Pediatrics and other groups believe there is a national emergency in child and adolescent mental health.

The findings were released by the Public Justice Center, a civil rights and legal services organization, along with the Center for Salud/Health and Opportunity for Latinos, or Centro SOL, a Johns Hopkins-based community advocacy group.

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“Children and adolescents in immigrant families are experiencing a mental health crisis, reflected in high rates of depression, anxiety, and self-harm,” the report said.

“Solving this crisis depends on greater access to quality mental health care,” it said. “Mental health care access depends on clinicians, patients, and family members speaking the same language.”

Access to mental health services became strained during the coronavirus pandemic, especially among adolescents and teens, with many families struggling just for appointments. Translation services are used not only to make those appointments but to fill out consent forms, understand instructions and communicate during sessions, report authors found.

The scope of the problem wasn’t fully clear, report authors said, because no one is keeping official data.

But the report cited three instances in which services were not properly provided, contrary to the federal law, which includes federal civil rights laws and the Affordable Care Act.

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The first case involved a 16-year-old girl with anorexia nervosa who was referred by her pediatrician for behavioral therapy, but a specialist refused to provide the care because her primary language was Spanish.

The second case involved a 15-year-old girl who wasn’t sleeping or eating properly and was deemed to be depressed and referred for therapy through a nonprofit agency. A social worker was told by the agency that because the mother spoke Spanish, the agency “did not have capacity” to provide services to the child.

In the third case, a new bilingual school-based social worker found that before her arrival students with limited English proficiency had been placed on a waitlist for mental health services that no one was monitoring because there were no interpreters at the agencies with which the county schools had been contracting.

The supply of interpreters is not the issue because most providers use phone-based services from anywhere in the country, said Dr. Sarah Polk, a co-founder of Centro SOL and a John Hopkins pediatrician.

She said many issues could be resolved if everyone was working from an updated list of service providers, although the report cited a list provided by state officials that had not been updated since 2010. Polk said sometimes the calls are needed only to assist a non-English speaking parent in making an appointment for an English-speaking child.

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“We could make meaningful progress on this with a reasonable amount of effort,” she said. “We can’t say that for a lot of other problems. There’s not much of an excuse not to make this better.”

Polk said the issues predate the pandemic, although the number of new patients and more of a willingness to seek treatment is adding to providers’ burden.

The services also come with a cost for the therapy providers, said Ashley Black, an attorney with the Public Justice Center’s Access to Health and Public Benefits Project.

Still, Black said the report needs attention from both providers and the state.

“We feel like mental health providers and the state are failing to meet these obligations,” she said. “We receive direct complaints and anecdotal evidence that they are failing and no one seems to be working on the issue.”

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The health department didn’t respond directly to the recommendations, including its monitoring and enforcement. But spokesman Chase Cook pointed to state policy that requires programs and services to be available to those with limited English proficiency.

Also, he said the health department works with LanguageLine — a company that provides language services for organizations — to provide access and support to Marylanders in over 200 languages around the clock, although advocates say providers have to create their own account and pay for it.

The report makes five recommendations that include providers developing plans to work with their non-English speaking patients and families if they don’t have bilingual staff.

The rest of the recommendations are aimed at the Maryland Department of Health. They includes updating guidance and translation service provider lists and providing funds for the services.

Lastly, the report also recommends the state adopt a monitoring and enforcement policy, and ensure there is public education about the right to translation services.

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Providers say mental health care generally faces crises from the surge in need. Shannon Hall — executive director of the Community Behavioral Health Association of Maryland — said providers support the advocates’ attention to the needs, and urged the state to seek more funding.

“Given the scale of the crisis and the spiking demand, we’ve called on the state to invest in a Certified Community Behavioral Health Clinic model,” she said, referring to federally supported specialty clinics that aim to provide comprehensive mental health and substance use services to anyone in need.

She cited a grant for a clinic in Montgomery County that allowed providers to invest in interpretation software to address language needs. Hall said state health officials could pursue funding to bring the model statewide and “break through language barriers at scale.”