This blog post is part of a series spotlighting nonprofit organizations and the pro bono collaborations that help extend the impact of their work.
Catherine Titzer, PBI Intern
Navigating the complexities of state laws regarding mental health coverage and consent to treatment is particularly challenging for unhoused youth and young adults, who are among the most in need of mental health resources. To address this issue, the National Homelessness Law Center (NHLC) and pro bono attorneys at Alston & Bird*†, a Pro Bono Institute Law Firm Pro Bono Challenge® signatory, partnered to create Access to Mental Health Treatment: Unhoused Youth and Young Adults, a comprehensive guide on state policies related to consent, mental health treatment insurance, and access to medical coverage for unhoused youth.
NHLC and Alston & Bird’s guide takes an important step toward raising awareness about the legal rights of and resources for unhoused youth. This significant pro bono partnership equips both unhoused youth and their advocates with the knowledge and tools necessary to navigate the complexities of legal systems and access critical services.
Addressing the Urgent Need for Mental Health Support for Unhoused Youth
With housing instability reaching record levels, addressing mental health challenges among unhoused youth and young adults is a critical issue. Estimates indicate that as many as 4.2 million youth and young adults experience homelessness in the United States each year. Data shows that on a single night in 2023, 34,703 unaccompanied youth were experiencing homelessness in the United States, with 90.6% between the ages of 18-24 and 9.3% below 18.
The mental health crisis among this population is alarming: 89% of homeless 16-19 year olds meet the criteria for one or more mental health disorders, a rate nearly triple the 30% prevalence observed among their housed peers. Elevated rates of traumatic experiences compound the mental health crisis among homeless youth: up to 77% of homeless youth have faced physical and/or sexual abuse, and the experience of homelessness itself has been described as a form of psychological trauma, characterized by impoverished conditions, constant threats to survival, and repeated victimization.
Unhoused youth face a critical need for mental health services, but being part of a marginalized and underserved population makes it significantly more challenging for them to access essential resources. Challenges include lack of medical coverage, navigating complex consent laws, and limited availability of specialized care, all of which exacerbate the mental health crises they may face. Further complicating matters, mental health policies and access to care can vary significantly across states, creating inconsistencies in the support available and leaving many of these young people without the treatment they need.
The NHLC and Alston & Bird Partnership: Shedding Light on the Legal Landscape
In response to these challenges accessing resources, NHLC and Alston & Bird recently published an update to Access to Mental Health Treatment: Unhoused Youth and Young Adults. The guide answers the following questions regarding youth mental health access for each state:
- Is there an age range for consent?
- Is consent conditional on the status of a youth (g., only homeless youth)?
- Are there limitations on the consent?
- Can a youth apply for medical coverage that includes mental health treatment on their own?
- Can someone over age 19 access coverage?
- Are there any programs for undocumented youth?
- What do the state insurance programs cover regarding mental health treatment?
- Is there anything in state law that would negatively affect LGBTQ youth in accessing nondiscriminatory and gender-affirming mental health treatment?
To address these questions, NHLC and Alston & Bird coordinated a multi-stage effort involving over 100 volunteers.
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NHLC is a national legal group dedicated to ending and preventing homelessness through policy advocacy, public education, impact litigation, and advocacy training and support. Leveraging its legal expertise and the pro bono power of the private bar, NHLC fights to establish a right to housing in the United States. |
Led by Katie Scott, NHLC’s Youth Homelessness Program Director, and Mary Benton, Alston & Bird’s Pro Bono Partner, the project thoroughly verified and reviewed each response for quality. This comprehensive review process revealed significant trends and areas for policy reform that can improve access to mental health services for unhoused youth.
Scott highlights a critical issue she has observed in her advocacy: older unhoused teenagers who are not connected with the child welfare system or a legal guardian often have no way to apply for state health insurance. She explains:
“We’re in a situation where these young people would 100% qualify if there were a Children’s Health Insurance Program through Medicaid. If you were an unaccompanied homeless youth, you qualify for that program. But the problem is you can’t actually apply for it because you don’t have legal status. Then you’re really just in a situation where you don’t have health insurance.”
Scott suggests two solutions to addressing this gap: automatically enrolling every child in their state’s health insurance system or creating a clear process that allows unaccompanied youth to apply independently, without the need for a legal guardian. To the latter solution, she adds, “That, to me, is something I’ve seen across the board—it’s really missing in most states and would be such an easy fix.”
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States like Washington and Illinois provide important examples of solutions to this issue. In Washington, the state has a clear exception for unaccompanied homeless youth, allowing them to consent to general medical care on their own. Similarly, Illinois has implemented a process where unaccompanied minors can access medical care without parental consent if they provide documentation from an adult relative, a representative of a homeless service agency, an attorney, a public school homeless liaison, a social worker, a social service agency, or a representative of a religious organization. |
Scott further explains that some states impose specific consent limitations, allowing youth to approve only a limited number or type of services. For instance, in states like Michigan, youth
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Under Michigan law, a minor who is 14 or older can request up to 12 outpatient counseling sessions or four months of counseling. After the 12th session or four months, the counselor must stop providing services unless the minor agrees to have their parent, guardian, or another responsible adult give permission for more sessions. |
may only consent to a set number of mental health sessions, while other states permit youth to access treatments like talk therapy and counseling but not mental health medication. “What I think would work is that youth can consent to the mental health care that they need and providers can help make that assessment,” she says. “There should be some back and forth between a provider and a young person of trying to figure out what is it they need and then allowing youth to be able to consent on their own to accessing those services.”
Parsing through legal text and convoluted insurance websites and applications, NHLC and Alston & Bird volunteers have gathered key information regarding statutory exceptions for youth to consent to their own medical treatment and when Medicaid is available for youth. Their research and plain language presentation of information makes the legal landscape more accessible for both youth and those advocating on their behalf. The guide is also a living document, regularly updated as policies evolve and new legislation is enacted.
Impacting Change through Pro Bono Collaboration
Pro bono work is essential in addressing the ongoing challenges faced by unhoused youth. Mary Benton, who spearheaded the team of volunteer attorneys, emphasizes the importance of direct client representation. “We can help with a clinic, filling out paperwork, make phone calls to verify information, or staff a hotline where people can call and ask questions,” Benton explains. “Those are significant, necessary efforts.”
Scott also underscores the importance of attorneys engaging with their local communities, whether through advocacy efforts to improve laws or by volunteering with local organizations to support youth. “Large-scale initiatives are really important,” she notes, “but there also needs to be a focus on community involvement at the local level.”
The collaboration between NHLC and pro bono attorneys at Alston & Bird demonstrates the powerful impact of partnerships between legal professionals and advocacy organizations. Together, they created an up-to-date, comprehensive guide on state laws for mental health treatment and consent, addressing critical access gaps for unhoused youth and empowering them and their advocates to navigate complex policies. The guide is a significant step toward addressing the mental health crisis among unhoused youth, demonstrating how pro bono efforts can play a key role in creating systemic change and advancing social justice for underserved populations.
* denotes a Law Firm Pro Bono Challenge® signatory
† denotes a Law Firm Pro Bono Project® member