Typically when it comes to mental health treatment for adolescents, it is the parents who motivate and push their children to attend an evaluation or treatment session. The teens themselves may be willing participants, but usually these appointments would never occur without a parent’s active involvement.
In some cases, however, things run in reverse, and it is the adolescent him or herself asking for help from a mental health professional. Most of the time, the parents are fully on board with seeking services, but not always. For a variety of different reasons, there can be times when parents resist the idea of their child seeing a mental health professional. They might be concerned about the stigma associated with any diagnosis that is made, or worried about a recommendation for the child to take medication, for example. There may also be instances when a teen is reluctant even to ask a parent about getting help, such as a teen who is experiencing abuse or an LGBTQ youth who is struggling but not yet ready to come out about his or her sexual orientation.
In Vermont this past year, a bill arose that would allow youth to seek mental health treatment without parental consent. This is already permitted here for certain problems such as substance abuse treatment and sexually transmitted diseases but not for general mental health concerns. The bill originally was written to apply only to LGBTQ youth in response to increasing concerns about suicide. As part of the legislative process, I was asked to testify earlier this year to a legislative committee about the subject and offer my opinion.
At first, I had to admit that I didn’t really have one. This wasn’t a subject that came up, and as far as I knew, there weren’t adolescents in our clinic wanting to come here but being held back by their parents.
Doing some homework, I discovered that states across the country had been grappling with this issue since the 1960s. A relatively recent published review from 2015 found that things were highly variable from state to state regarding who could give consent for what. For reasons that were rarely articulated, a state often had different rules when it came to substance abuse versus mental health treatment, inpatient versus outpatient settings. When it came to outpatient treatment, I was surprised to see that many states had already permitted adolescents to seek mental health treatment without their parents’ involvement.
While allowing teens to do this made a lot of sense on many levels, there were some concerns. Many times I’ve worked with an adolescent who had withheld bringing up a topic to their parents for fears of getting a negative response. When parents did eventually find out, they usually were quite supportive, much to the surprise of that patient. My worry was that a law like this might exacerbate situations like this. Then there was the issue of potential government intrusion into a parent’s right to parent. While philosophically sympathetic that that concern, I felt some trust regarding the professional conduct of my mental health colleagues. When faced with a situation such as this, psychiatrists and therapists are not looking to drive wedges between parents and children. Under most conditions, they will be trying to help a teen be able to think through what is troubling them and support them in presenting this to their parents or caretakers. In the rare cases when they don’t, there unfortunately are good reasons for it.
In my testimony, I also tried to add a dose of reality both to those who might think that the bill would either reverse the current trends in youth suicide and to those concerned that the very foundations of parent autonomy were about to crumble. Sure it might be great to remove the legal barriers preventing a teen from getting a mental health consultation, but there are a lot of other practical considerations. How would they get there? Who pays for it, and what happens with the bill? For all the good intentions, it did not seem like the bill would actually be utilized in a real world setting that often.
In the end, I advocated that the bill be approved and that it be applied to all adolescents, not just LGBTQ adolescents. It passed and is will be law at the beginning of next year. It provides for a minor (no age limit specified) to consent for mental health counseling with a professional without parental notification. It applies only to counseling and not to medications (something I supported in my testimony).
My guess is that the law will play out most frequently not at stand-alone clinics such as where I work, but more commonly in schools where community-based mental health professionals are often based. My hope is that the new law will give some of our struggling youth who feel the need to hide their difficulties from parents the cover they need to take that first step in bringing these problems out into the light. The door is about to open, and the question now is how many people will walk through.
@copyright by David Rettew, MD
David Rettew is author of Child Temperament: New Thinking About the Boundary Between Traits and Illness and a child psychiatrist in the psychiatry and pediatrics departments at the University of Vermont College of Medicine.
Kerwin ME, Kirby KC, et al. (2015) What can parents do? A review of state laws regarding decision making for adolescent drug abuse and mental health treatment. Journal of Child and Adolescent Substance Abuse. 24(3):166-176.