January 1st, 2018

Minors can be treated without permission

Vermont minors can now consent to receive outpatient treatment from a mental health professional without the consent of a parent or legal guardian.

Newly enacted legislation, “An act relating to consent by minors for mental health treatment” went into effect Jan. 1. “Outpatient treatment” in the context of the act refers to psychotherapy and other counseling services that are supportive, but not prescription drugs.

Originally, the legislation was drafted specifically to allow minors to consent to mental health treatment for conditions related to the minor’s “sexual orientation or gender identity.”

Rick Barnett, Psy.D., M.S., LADC, the Vermont Psychological Association’s legislative advocate and a clinical psychologist in private practice, provided testimony on the legislation as an individual psychologist (not on behalf of VPA) and said he was generally supportive, but questioned those limitations and asked that it be more inclusive.

“I didn’t know why it would be restrictive to just those issues,” Barnett said. “I work with minors who want to talk about substance abuse and often feel afraid to talk about their alcohol or drug use because their parents would find out.”

David C. Rettew, M.D., testified in favor of the legislation but also questioned the initial restriction of the bill. He is associate professor of psychiatry and pediatrics; director, Child & Adolescent Psychiatry Fellowship; and director, Pediatric Psychiatry Clinic, University of Vermont College of Medicine.

Rettew said prior to the legislation, there had been a lot of concern about suicide and self-harm rates among Vermont adolescents. “I think the idea was, there may be reasons why these teens might be reluctant to bring up some of these things with their parents,” Rettew said.

“(The legislation) was designed to provide an outlet for them to get a conversation going in a safe place and to try to help provide services to people who might otherwise avoid them.”

“There could be lots of reasons why a teen might be reluctant to bring up a mental health concern,” Rettew said. “We shouldn’t just reserve it for one group of people and I think people understand that. Suicide is suicide and we want to try and prevent it in everybody.”

JP Hayden, MA, licensed psychologist-master in private practice in Stowe, who has worked with many children and families, said she thinks the legislation is well-intended. However, “there are some inherent ethical concerns about it right out of the gate,” she said. Hayden worried that when reviewing the limits of confidentiality with a child – if the child would be able to grasp that information. She also questioned how legally binding the signature of a minor would be on these types of documents.

Rettew said in late November that the issue of insurance and payment was a concern, and he is still trying to find out what to do in that regard at his own pediatric psychiatry clinic.

“I think one of the issues about this law is that it sounds good on paper, but operationalizing it is pretty tricky,” Rettew said. “If you come to a university clinic or private clinic, the insurance is going to be billed and that’s going to go to the parent.” He said payment may not be as big of an obstacle in cases where mental health professionals aren’t paid per visit or where a bill doesn’t come out of that appointment (for example, mental health counselors embedded in schools).

Rettew said he hoped decisions on such issues would be made proactively, before problems arise, in Vermont. He cited research that shows how consent laws regarding minors seeking treatment for drug and mental health treatment vary widely across the nation.

Some states allowed minor consent for inpatient but not outpatient; substance use treatment but not mental health; or vice versa. Some states have no specific law on the books.

“It seems like these laws are getting brought up in piecemeal fashion without any kind of global coherent strategy with what makes the most sense,” he said. “I think this may be a wakeup call to really think this through in a rationale way.”

While the legislation doesn’t include an age range or limit, Barnett doesn’t anticipate there will be many cases where younger minors seek their own treatment. But “for mid-adolescents and late adolescents, anywhere from 14-18 – I see real benefits (from the legislation),” he said. Still, he questions whether youths will even be aware of this option.

Also, “Kids are challenging to engage, and not ones to often seek out their own treatment,” Barnett said. “I’m not sure it’s going have a huge effect, even if we did do a massive public information campaign, but for those select few kids who are interested in talking confidentially and feeling safe doing so, it’s great.”

The same limits to confidentiality apply to minors as they would to adults seeking mental health treatment Barnett said. So in cases where this is a risk of suicide or an abuse situation, “parents can still feel secure knowing that the therapists who are seeing their kids are going to report things like that,” he said.

By Pamela Berard

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