This spring, lawmakers in the state of Washington passed a bill changing the rights of parents and teenagers about two important – and sometimes controversial – aspects of treatment for mental health and substance use disorders: consent to treatment and access to treatment information. Until the passage of House Bill 1874, teenagers had robust rights with regards to treatment for alcohol/substance use and/or mental health disorders.
Before the bill, parents were not allowed to force teens (13+) to receive outpatient treatment for alcohol or substance use disorders. Nor were they allowed to force teens to receive inpatient or outpatient treatment for mental health disorders. Parents were also prevented from access to diagnoses or treatment records about alcohol, substance use, or mental health disorders for their teenage children.
They were, however, allowed to check teens into inpatient alcohol or drug programs against their wishes.
Here’s what the new law changes:
- Parents may now commit their teenage children to outpatient alcohol, substance use, or mental health treatment without the consent of the teen. The law requires that a mental health professional determine the treatment is medically necessary. It also limits the number of non-consent session at twelve.
- Parents may now access to alcohol/substance use/mental health treatment and diagnosis records for their teenage children without the consent of the teen.
There are powerful arguments on both sides of this issue. In the U.S., citizens take things like consent to treatment and health record privacy seriously. Because of this social and cultural norm, teenagers have significant agency with regards to healthcare consent and privacy. The most well-known and well-protected rights they have revolve around reproductive health. We’ll leave that polarizing issue for others to discuss.
We will, however, address the issue as it pertains to mental health.
Treatment Consent and Teens: Alcohol, Substance Use, and Mental Health Disorders
The fundamental tension around this issue is the three-way tug-of-war between the rights of the individual, the health and well-being of the teenager, and the right of parents to make decisions for their minor teenagers.
On the one hand, most parents feel they should be able to make decisions for their minor children on all aspects of their healthcare. They’re often shocked when they find out some decisions are not theirs to make. Since some rights for teens are protected by law, parents are powerless – a situation that’s often new to them when the health of their children is concerned.
On the other hand, teenagers are often resistant to treatment for alcohol, substance use, and/or mental health disorders. They may not recognize they have a problem. They may not believe they have a problem. And if they do accept they have a problem, they might not agree that treatment is the right choice.
The final confounding element of this tricky triangle revolves around individual rights. Some teens are estranged from their families or come from households where they’ve been physically, emotionally, or sexually abused. These teens fear what might happen if their parents find out they sought treatment for issues stemming from their home life, including mental health disorders or substance use.
It’s a complex issue, and legislators in Washington are doing their best to safeguard the rights of the teens while simultaneously establishing laws that promote their overall health and well-being. While there is no simple right or wrong and there are no easy solutions to these conundrums, this is an important conversation to have at this moment in time.
Why?
Let’s take a look at the mental health statistics for teens. We’ll start with nationwide stats, then narrow our focus to Washinton.
Adolescent Mental Health: Facts and Figures
First, we must note that over the past ten years, several key metrics that measure teen mental health in the U.S. have revealed disturbing trends. Data from the American Academy of Pediatrics (AAP) and The National Alliance on Mental Illness (NAMI) indicates that:
- Between 2008 and 2015, emergency room visits for suicide attempts and suicidal ideation increased 140% for youth (12-17).
- 21% of youth in the U.S. experience a severe mental health disorder at some time in their life.
- 13% of children (8-13) in the U.S. experience a severe mental health disorder at some time in their life.
- 50% of all mental health conditions begin by age 14.
- Suicide is the 3rd leading cause of death for youth in the U.S.
- 90% of people who commit suicide have an underlying mental illness.
Now let’s look at the latest figures for Washington, published by Mental Health America in the report The State of Mental Health in America: 2019. The report shows the following figures for youth in Washington:
- 23% had a major depressive episode (MDE).
- That’s about 70,000 youth
- 43% were diagnosed with a substance use disorder
- That’s about 29,000 youth
- 10% had a severe major depressive episode
- That’s about 52,000 youth
- 61% of youth with MDE did not receive treatment
- That’s about 39,000 youth
- 5% of youth with MDE received some type of treatment
- That’s about 12,000 youth
Those statistics tell us that in the year 2018, roughly 30,000 youth who had a major depressive episode did not receive any treatment at all for that episode.
When we combine that number with the fact that suicide is the third leading cause of death for youth, and 90% of all people who commit suicide have a mental health disorder, the statistics change from concerning to alarming.
At-Risk Youth in Washington
They’re alarming because they show there are 30,000 youth in Washington at increased risk of suicide – and they’re not getting the care they need.
Do we know why they’re not getting the care they need?
No.
Do we know if they refused treatment, even if they needed it?
No.
What we do know now, though, is that parents can require teens to receive outpatient treatment – up to twelve sessions – for mental health disorders such as major depressive disorder, anxiety disorder, or alcohol/substance use disorders.
While we are fierce advocates for the individual rights of teens, and believe that in many cases, they should have direct input into their mental health care, we also know something about teenagers: the parts of their brains responsible for critical thinking, risk assessment, and rational decision-making is still a work in progress, and does not finish developing until around age 25. Paired with the knowledge that a mental health or substance use disorder can impair and temporarily impede typical brain development in these key areas, we recognize that in some cases, teens who do not want treatment do, in fact, need treatment.
And in some cases, that treatment could save their lives.
Privacy Rights and Personal Health
Quoted in a story published last month in Vice Magazine, Kathy Brewer, a counselor at Seattle Children’s Psychiatry and Behavioral Medicine Clinic in Seattle addresses the dynamic tension between individual rights and individual health:
“I’m okay with taking away a little bit of civil rights on a short-term basis if it keeps someone alive. I’d much rather have a resistant, alive youth than a dead one.”
Will this new law have the net effect of helping the youth of Washington, or will it unnecessarily compromise their individual rights?
We hope that it will help kids and save lives, but only time will tell. If the law causes harm, we can change it back – and that’s a good thing.