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III-130
Adolescent Health-Volume III: Crosscutting Issues in the Delivery of Health and Related Services
State statutes that create an exception to the
call for an inquiry by a neutral fact finder to
parental consent requirement with respect to serv-
determine whether the statutory criteria for admis-
ices for drug or alcohol abuse would appear to
sion were met. About two-thirds of the States now
represent an acknowledgment on the part of State
have statutes that allow parents to make a voluntary
legislatures of the seriousness of drug and alcohol
commitment to a mental health facility of a minor
abuse problems among adolescent minors. They
child. These statutes vary substantially in the safe-
would also appear to be the product of a concern on
guards they provide against inappropriate use of
the part of State legislatures that minors may not
hospitalization or institutionalization to manage
obtain care related to such abuse if they have to
"troublesome" minor children who do not have
secure parental consent for such care, because
severe mental health problems. 23 According to one
"communications" between parents and minors
analysis, "In general,
minors are significantly
regarding alcohol or drug abuse may "be strained or
less able than are adults to resist mental hospitaliza-
nonexistent" (81).
tion sought for them by others" (85).
Exceptions for Mental Health Services²
About half of the States have statutes that
little under half of the States have statutes that allow
authorize minors to apply for admission as an
some minors to obtain outpatient mental health
inpatient to a mental institution or facility without
services without parental consent. These statutes
parental consent. Most of these statutes impose
typically impose age restrictions and pertain only to
minimum age limits, the most common being 16
adolescent minors. Underlying these statutes ap-
years of age or older. Finally, a few States have
pears to be a legislative realization that a parental
statutes that require both the minor's consent and a
consent requirement might deter some adolescent
parent's consent for inpatient mental health services.
minors who have mental health problems from
seeking needed treatment because of a reluctance to
reveal such problems to their parents.
Confidentiality and Parental Notification
Inpatient mental health services for minors pre-
Requirements
sent special problems in the area of consent. The
involuntary commitment of a person to a mental
It has long been accepted that the confidentiality
institution or facility results in the deprivation of that
of the relationship between a physician and patient
person's liberty, so certain safeguards are in place
as well as of the relationship between other types of
(e.g., substantive criteria for commitment and proce-
health care providers and their patients or clients, is
dures pertaining to due process) to ensure that such
essential to a patient's trust in a health care provider
commitment is necessary. For voluntary commit-
and to a patient's willingness to supply information
ment, however, such safeguards are not mandated,
candidly (68). Courts and legislatures have estab-
and as a concomitant of the parental consent
lished a physician-patient privilege to protect the
requirement for the provision of health services to
confidentiality of communications between physi-
minors, parents have sometimes been allowed to
cians and their patients and have established similar
make a "voluntary commitment" of a minor child
privileges to ensure the confidentiality of communi-
to a mental institution or facility, regardless of the
cations between other types of health care providers
minor's desire or need for services.
and their patients or clients (29). Furthermore, there
is a developing case law imposing liability on
In Parham V. J.R. [442 U.S. 584 (1979)], the U.S.
physicians for unauthorized disclosure of confiden-
Supreme Court rejected the contention that an
tial information about their patients (8) (although all
adversary hearing was required to decide whether a
health care professionals are required by law to
minor may be committed by his or her parents in
disclose information in situations where there is a
order to protect the minor, but held that the risk of
strong societal interest in disclosure-e.g., in the
error in the parental decision to commit a minor to
reporting of cases of suspected child abuse to the
a mental health facility was sufficiently great as to
public child welfare authorities (47)).
22Mental health services for adolescents are reviewed in ch. 11, "Mental Health Problems: Prevention and Services," in Vol. II.
23Some people are concerned that the rising admission to psychiatric units of private hospitals are indicative of widespread misuse of commitment
to control "troublesome" minors (85). See ch. 11, "Mental Health Problems: Prevention and Services," in Vol. II, for further discussion.
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"ocrText": "III-130\nAdolescent Health-Volume III: Crosscutting Issues in the Delivery of Health and Related Services\nState statutes that create an exception to the\ncall for an inquiry by a neutral fact finder to\nparental consent requirement with respect to serv-\ndetermine whether the statutory criteria for admis-\nices for drug or alcohol abuse would appear to\nsion were met. About two-thirds of the States now\nrepresent an acknowledgment on the part of State\nhave statutes that allow parents to make a voluntary\nlegislatures of the seriousness of drug and alcohol\ncommitment to a mental health facility of a minor\nabuse problems among adolescent minors. They\nchild. These statutes vary substantially in the safe-\nwould also appear to be the product of a concern on\nguards they provide against inappropriate use of\nthe part of State legislatures that minors may not\nhospitalization or institutionalization to manage\nobtain care related to such abuse if they have to\n\"troublesome\" minor children who do not have\nsecure parental consent for such care, because\nsevere mental health problems. 23 According to one\n\"communications\" between parents and minors\nanalysis, \"In general,\nminors are significantly\nregarding alcohol or drug abuse may \"be strained or\nless able than are adults to resist mental hospitaliza-\nnonexistent\" (81).\ntion sought for them by others\" (85).\nExceptions for Mental Health Services²\nAbout half of the States have statutes that\nlittle under half of the States have statutes that allow\nauthorize minors to apply for admission as an\nsome minors to obtain outpatient mental health\ninpatient to a mental institution or facility without\nservices without parental consent. These statutes\nparental consent. Most of these statutes impose\ntypically impose age restrictions and pertain only to\nminimum age limits, the most common being 16\nadolescent minors. Underlying these statutes ap-\nyears of age or older. Finally, a few States have\npears to be a legislative realization that a parental\nstatutes that require both the minor's consent and a\nconsent requirement might deter some adolescent\nparent's consent for inpatient mental health services.\nminors who have mental health problems from\nseeking needed treatment because of a reluctance to\nreveal such problems to their parents.\nConfidentiality and Parental Notification\nInpatient mental health services for minors pre-\nRequirements\nsent special problems in the area of consent. The\ninvoluntary commitment of a person to a mental\nIt has long been accepted that the confidentiality\ninstitution or facility results in the deprivation of that\nof the relationship between a physician and patient\nperson's liberty, so certain safeguards are in place\nas well as of the relationship between other types of\n(e.g., substantive criteria for commitment and proce-\nhealth care providers and their patients or clients, is\ndures pertaining to due process) to ensure that such\nessential to a patient's trust in a health care provider\ncommitment is necessary. For voluntary commit-\nand to a patient's willingness to supply information\nment, however, such safeguards are not mandated,\ncandidly (68). Courts and legislatures have estab-\nand as a concomitant of the parental consent\nlished a physician-patient privilege to protect the\nrequirement for the provision of health services to\nconfidentiality of communications between physi-\nminors, parents have sometimes been allowed to\ncians and their patients and have established similar\nmake a \"voluntary commitment\" of a minor child\nprivileges to ensure the confidentiality of communi-\nto a mental institution or facility, regardless of the\ncations between other types of health care providers\nminor's desire or need for services.\nand their patients or clients (29). Furthermore, there\nis a developing case law imposing liability on\nIn Parham V. J.R. [442 U.S. 584 (1979)], the U.S.\nphysicians for unauthorized disclosure of confiden-\nSupreme Court rejected the contention that an\ntial information about their patients (8) (although all\nadversary hearing was required to decide whether a\nhealth care professionals are required by law to\nminor may be committed by his or her parents in\ndisclose information in situations where there is a\norder to protect the minor, but held that the risk of\nstrong societal interest in disclosure-e.g., in the\nerror in the parental decision to commit a minor to\nreporting of cases of suspected child abuse to the\na mental health facility was sufficiently great as to\npublic child welfare authorities (47)).\n22Mental health services for adolescents are reviewed in ch. 11, \"Mental Health Problems: Prevention and Services,\" in Vol. II.\n23Some people are concerned that the rising admission to psychiatric units of private hospitals are indicative of widespread misuse of commitment\nto control \"troublesome\" minors (85). See ch. 11, \"Mental Health Problems: Prevention and Services,\" in Vol. II, for further discussion."
}