Health Affairs has published a powerful new Narrative Matters essay by child and adolescent psychiatrist Rupi Legha, MD, that calls into question the harms of mandated reporting in clinical practice and argues for an alternative: mandated supporting.
“When Protection Becomes Punishment” details the story of “Maya,” a 12-year-old on the autism spectrum, whose loving Black transgender parents found themselves at risk of child protective services (CPS) involvement after a simple misunderstanding. Dr. Legha uses this case and others from her career to illustrate how mandated reporting, though designed to protect children, often reinforces racialized assumptions, punishes families in crisis, and subjects Black, Indigenous, immigrant, disabled, and poor communities to unnecessary surveillance.
“Protecting children is best accomplished through listening, support, and presence, not through surveillance and punishment,” said Dr. Legha.
The piece situates mandated reporting within a historical continuum of family separation, from Indigenous boarding schools to modern-day CPS investigations, and draws on the work of legal scholar Dorothy Roberts and community advocacy groups such as Movement for Family Power. It also highlights investigative journalism documenting wrongful abuse diagnoses and their devastating consequences.
A New Model: Mandated Supporting
Dr. Legha believes in mandated supporting as a clinical and policy framework that emphasizes:
- Supportive psychoeducation for families about their rights and risks.
- Protective documentation that highlights strengths rather than deficits.
- Clinical activism that resists unnecessary system involvement.
- Policy reforms that expand alternatives to CPS reporting and guard against racialized bias.
Programs in California, New York, and Texas are already piloting elements of this approach, demonstrating that family safety can be protected through community-based support rather than punitive oversight.
About the Author
Rupi Legha, MD, is a child and adolescent psychiatrist, writer, and speaker whose work centers on equity, systemic reform, and protective care in medicine. She has worked across public hospitals, community clinics, and state systems, and is an internationally recognized advocate for justice-centered mental health.
Accessing the Article
The full essay, “When Protection Becomes Punishment,” is available in the November 2025 issue of Health Affairs at www.healthaffairs.org.
