An intensifying mental health crisis among American youth has pushed hundreds of desperate parents to an agonizing decision: relinquishing custody of their own children to the state, simply to obtain the urgent, specialized mental health care unavailable to them otherwise. Recent stories brought to light by USA TODAY, including the harrowing experience of Nina Richtman in Iowa, highlight not only immense personal suffering but also systemic gaps in health and social support across the United States, reverberating with important lessons for Thai families, policymakers, and healthcare providers alike (USA TODAY 2025).
For many families, the breaking point comes after years of navigating an overwhelmed, underfunded, and fragmented behavioral health system. Nina Richtman’s son, adopted from foster care and diagnosed with reactive attachment disorder as well as an intellectual disability, repeatedly failed to access adequate support services. As his behaviors escalated dangerously, including setting fires at home, Richtman exhausted every available therapy and care avenue. With no other recourse, she gave up legal custody—handing her child over to the state’s care in a last-ditch effort to secure a safe placement and specialized treatment.
Iowa is not an outlier. An analysis by the U.S. Department of Health and Human Services found that between February 2017 and February 2018 alone, up to 25,000 American children entered foster care principally to receive mental health or disability support—not because of parental abuse or neglect (USA TODAY, 2025). The COVID-19 pandemic has further intensified youth mental health needs, especially among adolescents aged 12–14, who increasingly present with severe, sometimes violent or self-harming behaviors that overburden families and outstrip the capacity of local providers (Yahoo News, 2025).
State officials and mental health advocates report a growing trend of “custody relinquishment” as a measure of last resort. Janee Harvey, director of family well-being and protection for Iowa’s Department of Health and Human Services, describes youth presenting with “very, very challenging and sometimes very disturbing, perplexing, hard behavior”—including extreme violence or dangerous self-injury—for whom community-based support is simply not available. According to Harvey, “It is an all-hands-on-deck, fire-drill situation…[but] we are struggling” (USA TODAY, 2025). Fellow advocate Kim Scorza, executive director of the Crittenton Center, notes that families often reach a “breaking point,” completely exhausted after years of searching for help.
Recent statistics paint a stark picture. In Iowa alone, the number of children aged 21 and younger receiving behavioral health and substance use services rose 40% between 2018 and 2023. Yet, a 2024 Mental Health America report found that 50% of young Iowans with major depression received no mental health treatment in the previous year. Nationwide, untreated youth depression rates ranged from 31.5% up to 82.1% depending on the state (Mental Health America). Workforce shortages, fragmented funding, and unclear administrative pathways contribute to what one state health official called a “firehouse model”—one that only reacts to emergency crises rather than building sustainable, preventive care structures.
The system’s complexity means that even those with relative privilege—such as adoptive parents deeply versed in advocacy—find themselves up against bureaucratic walls that can seem insurmountable. Nicole Woodley, mother of five, was forced to file multiple “child-in-need-of-assistance” court cases to secure residential care for her adopted sons with autism and other disorders. The Woodleys’ insurance refused to cover long-term care, while in-state providers rejected their children due to behavioral and intellectual complexities. Placing their children in the state welfare system was, in Nicole’s words, “a horrendous thing, but…I was willing to do it if I knew that the outcome would be better” (USA TODAY, 2025).
These cases echo research findings in the field of child psychology and social medicine, which make clear that unmet mental health needs can have cascading impacts on homes, educational outcomes, and future criminal justice involvement (PubMed: Housing Insecurity and Child Maltreatment Risk). In the absence of a robust, navigable system, the burden falls directly on families—who must weigh the trauma of family separation against the risk of continued harm or loss of life.
Iowa state officials acknowledge the dire gaps: “There isn’t a clear way for parents. There isn’t a way right now, today, for folks to navigate,” says Marissa Eyanson, state behavioral health director. The lack of streamlined services and the high liability associated with severe youth behavioral issues make most private providers reluctant to accept these cases, leaving expensive, trauma-centered state institutions as a last resort. Experts agree that this patchwork, crisis-driven safety net is not only insufficient—it perpetuates enormous psychological, financial, and long-term social costs.
While legislative reforms and the overhaul of Iowa’s behavioral health system are underway, including more funding for early-intervention and preventive services, providers and officials remain “cautiously optimistic.” They emphasize that improvements must include a more unified, easier-to-navigate structure, accessible with or without private insurance or Medicaid (USA TODAY, 2025). Without such changes, families will continue, in Kim Scorza’s words, to feel “they can’t do it anymore.” As Richtman herself powerfully concludes, “A parent shouldn’t have to lose custody for their kid to get care. There needs to be another way for kids that have complex needs.”
For Thai readers, these sobering U.S. developments sound a clear warning. Thailand in recent years has seen its own youth mental health needs surge, particularly since the onset of the COVID-19 pandemic (WHO Thailand youth mental health). A 2023 Mahidol University survey revealed a dramatic uptick in depression and anxiety among Thai teenagers, with barriers to care including long wait times, urban-rural disparities, and a shortage of clinical psychologists—mirroring many of the bottlenecks in the U.S. system (Bangkok Post, 2023).
However, there are structural and cultural differences. Thai families typically rely on extended networks for care and support, and there remains social stigma surrounding psychiatric diagnoses and institutionalization. Unlike many U.S. states, Thailand has yet to see parents surrender legal custody solely to access care, but financial hardship and lack of insurance coverage routinely push families to seek costly private hospitals or, in desperate cases, leave conditions untreated. Thai advocates warn that without proactive investment in school-based counseling, early intervention, and a more coordinated public health system, similar cases of “last-resort” crisis responses could emerge.
Globally, many experts advocate for multi-layered systems of prevention and care—a model that emphasizes early detection in schools, rapid crisis response, caregiver and family education, and robust funding for adolescent psychology and social services. Dr. Somsak Chunharas, president of the National Health Foundation of Thailand, notes, “When families and schools are connected to trained mental health teams, and services are accessible without stigma or financial hardship, crises become less frequent—and custody relinquishment can be avoided altogether” (WHO Thailand).
For Thai policymakers and community leaders, the U.S. scenario highlights the urgent need for preventive care, more specialized staff, and transparent pathways linking families to services. Schools should serve as trusted entry points for mental health referrals, with dedicated funding to expand youth counseling and crisis intervention programs. Public education campaigns can help reduce stigma and ensure families seek support early, rather than waiting until needs spiral out of control. Thai social welfare law must also be reviewed to guarantee that vulnerable children receive care without requiring family separation, and equity of access must be addressed so rural and lower-income families are not left behind.
For families currently struggling with children’s behavioral or emotional challenges, the most immediate recommendation is to seek support early—even if problems seem manageable at first. Engage with school counselors, utilize helplines like the Thai Mental Health Hotline (1323), and keep written records of symptoms and prior interventions. Sharing experiences with other families can reduce the sense of isolation and help advocate for better services nationwide. And for society as a whole, pressing for more public investment in adolescent mental health—through public forums, local initiatives, and support for evidence-based reform—can help ensure Thai children and parents never face the impossible choice of surrendering custody for essential care.
Source citations:
- USA TODAY: Parents are so desperate to get their children mental health care they’re giving up custody (2025)
- Yahoo News: Parents are so desperate to get their children mental health care they’re giving up custody (2025)
- Mental Health America: Youth Data 2024
- PubMed: Domains of housing insecurity and child maltreatment risk
- Bangkok Post: Thailand youth mental health crisis
- WHO Thailand: World Mental Health Day - Facing the Youth Mental Health Crisis