Minors and Mental Health Minors and Mental Health Treatment: Who Gets to Treatment: Who Gets to Decide?Decide?

Center for Children’s Advocacy Center for Children’s Advocacy KidsCounsel SeminarKidsCounsel SeminarSeptember 29, 2009September 29, 2009

Jay E. Sicklick, Esq.Jay E. Sicklick, Esq.Deputy DirectorDeputy Director

Center for Children’s AdvocacyCenter for Children’s AdvocacyHartford, Connecticut Hartford, Connecticut

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Goals of this PresentationGoals of this Presentation

1.1. Review the adolescent’s right to Review the adolescent’s right to confidential mental health treatmentconfidential mental health treatment

2.2. Examine the statutory protections for Examine the statutory protections for minors seeking confidential MH minors seeking confidential MH treatmenttreatment

3.3. Examine the tensions and cohesion Examine the tensions and cohesion between statutory guarantees and between statutory guarantees and clinicians’ ethical guidelines clinicians’ ethical guidelines

4.4. Reminder of mandatory reporting Reminder of mandatory reporting requirements requirements

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Laying the FoundationLaying the Foundation

• Status of the patient … i.e. minor or Status of the patient … i.e. minor or adult adult

• Examine the Examine the legal rightlegal right at hand … at hand … i.e. what is the i.e. what is the lawlaw regarding regarding independent/confidential treatment independent/confidential treatment of a minor (vs. the provider’s ethical of a minor (vs. the provider’s ethical obligation)obligation)

• Does the minor’s parental/guardian Does the minor’s parental/guardian status affect these analyses? status affect these analyses?

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Overview – Treating the Overview – Treating the

AdolescentAdolescent Provider’s Ethical Obligation

Risk Management

Obligations

Patient’s Legal Rights

Mandatory ReportingRequirements

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Conn. Gen. Stat. § 1-1dConn. Gen. Stat. § 1-1d

Principles of Confidentiality Principles of Confidentiality - Definitions -- Definitions -

Who is a minor?Who is a minor? Anyone under Anyone under the age of 18, the age of 18,

except as except as otherwise otherwise indicatedindicated

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...definitions continued...definitions continuedWhat is informed What is informed

consent?consent?Signed consent from a Signed consent from a

patient patient acknowledging that acknowledging that the patient has been the patient has been made aware of the made aware of the

risks and benefits of risks and benefits of alternative alternative

procedures and the procedures and the consequences consequences

resulting from those resulting from those procedures.procedures.

A minor A minor CANNOT giveCANNOT give

informed informed consent!consent!

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...definitions continued...definitions continued

What is the What is the patient’s right to patient’s right to

self-self-determination?determination?

A minor patient, A minor patient, possessing enough possessing enough

information to information to enable an enable an

intelligible choice, intelligible choice, should be involved should be involved

as much as possible as much as possible in decision making in decision making

concerning her concerning her medical care.medical care.

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……definitions continueddefinitions continued

Who is a mature Who is a mature minor?minor?

A minor who exhibits A minor who exhibits the “maturity” of an the “maturity” of an

adult and is therefore adult and is therefore permitted to make permitted to make

decisions, decisions, traditionally reserved traditionally reserved for those who have for those who have attained the age of attained the age of majority, regarding majority, regarding

her own medical care.her own medical care.

Connecticut courts Connecticut courts have not recognized have not recognized the mature minor the mature minor doctrine in any doctrine in any reported casereported case

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……definitions continueddefinitions continued

• EmancipationEmancipation: : – The legal process available by which a The legal process available by which a

16 or 17 year old minor achieves adult 16 or 17 year old minor achieves adult status. status. •Requires termination of parental rightsRequires termination of parental rights

•May be brought by either child or parentMay be brought by either child or parent

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Treatments That Treatments That Except the Rule Except the Rule

• Drug and Alcohol TreatmentDrug and Alcohol Treatment

• Mental Health Treatment Mental Health Treatment

– Outpatient and Inpatient– Outpatient and Inpatient

• Reproductive RightsReproductive Rights

• Testing/treatment of STD’s Testing/treatment of STD’s

• Testing and Treatment of HIV Testing and Treatment of HIV

and AIDSand AIDS

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Drug and Alcohol TreatmentDrug and Alcohol Treatment

• A minor CAN consent for A minor CAN consent for drug/alcohol treatment from drug/alcohol treatment from licensed treatment provider.licensed treatment provider.

• A parent CANNOT be told that A parent CANNOT be told that his/her child is receiving his/her child is receiving treatment without consent treatment without consent from the minor.from the minor.

• No reported decisions on No reported decisions on whether a physician must whether a physician must report results of a drug test, report results of a drug test, done during a routine physical, done during a routine physical, to a parent.to a parent.

Conn. Gen. Stat. § 17a-688d.Conn. Gen. Stat. § 17a-688d.mlpp

Conn. Gen. Stat. § 17a-688d.Conn. Gen. Stat. § 17a-688d.

Drug and Alcohol TreatmentDrug and Alcohol TreatmentCaveats:Caveats:• No third party billingNo third party billing• Confidential recordsConfidential records• Minor liable for care and Minor liable for care and

treatmenttreatment• Must be a licensed specialist in Must be a licensed specialist in

a general facility for a general facility for confidentiality to attachconfidentiality to attach

• Universal principles re payment Universal principles re payment and confidentialityand confidentiality

• Does not apply to emergency Does not apply to emergency care re substance abuse care re substance abuse

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Mental Health – Outpatient Mental Health – Outpatient TreatmentTreatment• A minor CAN receive initial treatment without parental consent if:A minor CAN receive initial treatment without parental consent if:

– The consent requirement would cause the minor to reject The consent requirement would cause the minor to reject treatment;treatment;

– The treatment is clinically indicated;The treatment is clinically indicated;– The failure to receive treatment would be seriously detrimental The failure to receive treatment would be seriously detrimental

to the minor’s well-being;to the minor’s well-being;– The minor knowingly and voluntarily sought such treatment; ANDThe minor knowingly and voluntarily sought such treatment; AND– The provider deems the minor mature enough to participate in The provider deems the minor mature enough to participate in

treatment productively.treatment productively.

Conn. Gen. Stat. § 17a-688d.Conn. Gen. Stat. § 17a-688d.mlpp

Id. Id.

Outpatient Treatment:Outpatient Treatment:continuedcontinued

• A minor can only receive 6 session of outpatient mental health treatment without notification of parents.

• After the 6 sessions, parental consent must be secured.

• Parental consent is not necessary if the provider believes that notification would be seriously detrimental to the minor’s well-being.

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Mental Health Treatment: Mental Health Treatment: InpatientInpatient• Minor = Minor = 15 or younger 15 or younger for purposes of inpatient for purposes of inpatient

mental health treatmentmental health treatment

• A minor A minor 14 or 15 years of age14 or 15 years of age may be admitted may be admitted for inpatient treatment of a mental health for inpatient treatment of a mental health disorder without parental consent, but the disorder without parental consent, but the parents must be notified within 5 days.parents must be notified within 5 days.

• If a parents requests, in writing, the release of a If a parents requests, in writing, the release of a child who admitted herself for inpatient child who admitted herself for inpatient treatment, the hospital must either release the treatment, the hospital must either release the child or commence a commitment proceedingchild or commence a commitment proceeding

Conn. Gen. Stat. §§ 17a-75, 79, Conn. Gen. Stat. §§ 17a-75, 79, 81, 540-55081, 540-550

Inpatient Treatment (cont.):Inpatient Treatment (cont.):

• Emergency mental health treatment can be provided without parental consent as long as the condition is of an “extremely critical nature,” or “to prevent serious harm to the child.”

• A minor 16 years of age or older is treated as an adult for purposes of mental health treatment and can therefore be admitted as a “voluntary patient” without parental consent.

• A minor 14 or 15 years of age can sign herself out of a psychiatric hospital, unless she has been involuntarily committed.

Exceptions to the Exceptions: Exceptions to the Exceptions: Mandatory Reporting Mandatory Reporting RequirementsRequirements• Confidentiality –

requires adherence to legal and ethical mandates

• Mandatory reporting requirements supersede the ethical and legal guarantees of confidentiality

• The child’s residential situation should not affect the confidentiality guarantees provided by law

ResourcesResources

DCF Web Site: DCF Web Site: www.state.ct.us/dcfDCF Care Line: (800) 842-2288DCF Care Line: (800) 842-2288Fed Govt. - Administration for Children & Fed Govt. - Administration for Children &

Families: Families: www.acf.hhs.gov Center for Children’s Advocacy: Center for Children’s Advocacy:

www.kidscounsel.org (860) 570-5327 (860) 570-5327MLPP: MLPP: www.ccmckids.org/mlpp (860) 570- (860) 570-

53275327CCMC – SCAN Program (860) 545-9995 CCMC – SCAN Program (860) 545-9995 Yale Child Study Center (203) 785-2513Yale Child Study Center (203) 785-2513

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