More than three decades ago, lawmakers in Washington state set the age of consent for mental health care at 13 to make it possible for teenagers to seek treatment without needing to involve their parents. That law also lets anyone over age 13 refuse mental health care — and keep all the details about their treatment private.
“The kid saying ‘no’ means you can’t even initiate an appointment,” said Dr. Carol Rockhill, a psychiatrist at Seattle Children’s Hospital and professor at the University of Washington School of Medicine. “The parents are often in a very different place, feeling stuck and wanting help.”
Parents have pushed for change for years, arguing that the measure has hamstrung their ability to help their teenagers who urgently need mental health care, but aren’t willing or ready to go to treatment on their own. Now, Washington lawmakers are poised to give parents more rights — while still trying to strike a delicate balance that gives teens authority over their own mental health care.
This week, the state House overwhelmingly passed a bill that would allow parents to initiate an evaluation for outpatient therapy, residential treatment, and other forms of mental health care for teenagers, even if those teens don’t consent to the treatment themselves. Right now, parents have a process to initiate only inpatient treatment for young people over age 13, but no other forms of mental health care. The bill, sponsored by Democratic Rep. Noel Frame, would also let mental health providers — at their discretion — give some information to parents about a teen’s diagnosis and care in cases if there’s an imminent risk to that patient’s health or safety.
“This [bill] should really be about good, useful, helpful sharing, and trying to help kids be safe and get better,” said Kathy Brewer, a licensed mental health counselor and administrator at Seattle Children’s. Brewer was involved in crafting the legislation, which would also apply to legal guardians, relatives known as “kinship caregivers,” and case workers for children in foster care.
The Washington bill — which would still need to be passed by the state Senate — fits into a complicated landscape around adolescent consent to mental health care across the U.S. State laws vary, with some putting the age of consent as low as 12 and others as high as 18 and a range of options for parents to initiate treatment.
“Every state is different. And every state has approached it differently,” Brewer said.
Washington parents say the measure could provide a much-needed path to get their teens care. When Mary Hart’s daughter was 15, she stopped wanting to receive counseling for her severe depression and developed suicidal thoughts. Hart’s options were limited.
“I was terrified that I was gonna lose my daughter,” said Hart, who lives in Seattle. “It’s a horrible thing [when] you know they’re in a difficult place, resisting treatment, and you can’t get them help,” she said. Hart ultimately took her daughter to Oregon for inpatient psychiatric treatment.
“I didn’t want to go. … I would have signed myself out if she had sent me [anywhere] in Washington,” said her daughter, Olivia Klco, who is now 22.
She spent 19 months receiving treatment at facilities in Oregon and Utah, which she said has given her healthy coping skills and more awareness of when symptoms of her mental health conditions are growing worse. “It completely saved my life,” Klco said. She’s hopeful that the Washington legislation will make it easier for parents to find mental treatment in-state for their teens.
The bill is the product of more than a dozen meetings of a working group that brought together parents, youth advocates, and mental health providers. After much debate about the best way to improve adolescent mental health care, the group agreed last year on a set of recommendations, which included keeping the age of consent at 13.
“It needs to be a nuanced approach, and this bill allows a more nuanced approach,” said Peggy Dolane, who started advocating for legislative changes after running into challenges trying to get mental health care for her children.
Some young people and youth advocates have voiced concerns that giving parents access to information about a teen’s mental health treatment — against that teen’s wishes — would breach the trust needed between patients and mental health providers.
“If I had thought that my parents would find out about what’s going on with me, then I wouldn’t have been able to trust my therapist to any point,” Alex, a teen who became depressed and suicidal at 13, told the Seattle-area news outlet KUOW.
Brewer of Seattle Children’s said those concerns are why it’s critical for mental health providers to communicate clearly with teens about what they will — and won’t — share with parents.
“We’re not gonna tell their parents everything,” Brewer said. The bill says that providers can only talk to parents about certain topics — such as a diagnosis, treatment plan, or resources — with a teen’s permission or if they have immediate concerns about a teen’s health or safety. And the measure makes it clear that mental health providers have to give patients a heads up before talking to their parents and give them a chance to voice their objections.
Providers said it’s important to try to get teens on board with sharing information with their parents whenever possible. Rockhill of Seattle Children’s said her preference will continue to be to work with teens to come up with a plan together to involve their parents when appropriate. Even if the bill becomes law, Rockhill added that she doesn’t anticipate sharing information with parents against a teen’s objections often.
“It is a hard judgment call to say when you need to override [a teen’s wishes],” she said. “We still need to be very careful about that.”