Podcast-outro/music

The age of consent for mental health treatments in the U.S. varies from state to state. Some states set the minimum age at 12, while others set it at 18. Recent increases in mental health disorders have prompted some states to allow minors to make their own treatment decisions if they are capable of communicating their thoughts and feelings. However, there are limitations on the types of treatments minors can consent to. In California, for example, minors can consent to outpatient treatment and counseling at 12, but not inpatient treatment, drugs, or psychosurgery until they turn 18. All 50 states allow minors to consent to testing and treatment for sexually transmitted diseases, with the exception of HIV treatment. Some states rely on a case-by-case basis for determining consent for mental health treatment. There are also considerations for legally emancipated individuals and situations where life or death is at stake. Religious and cultural beliefs can also influence the age of conse Hello, everybody. Welcome to today's episode of Coffee and Consent Brewing Bioethical Discussions. I'm Josh and I'm your host for today. I would like to share with all of you a little bit about the topic of the age of consent for mental health issues and treatments. The age of consent for mental health treatments in the U.S. differs from state to state. Three states say the minimum of age of consent is 12 years old, two states say it's 13 years old, 13 states say it's 14 years old, two states say 15 years old, 11 states say 16 years old, and the remaining 18 states say 18 years old. Historically, most states agreed to only allow parents to make decisions about mental health for their children, but recent upticks in the magnitude and severity of mental health disorders and required treatments have made many states say that as long as a minor is smart and mature enough to communicate their thoughts and feelings, then they are capable of making decisions about treatment on their own. There are limitations to what types of treatments a minor can consent to, however. In California, a minor can consent to outpatient treatment and counseling through a qualified professional at 12 years old, but they cannot consent to inpatient treatment, drugs, or psychosurgery at 12 years old and have to wait until 18. For those who don't know, outpatient treatment is any treatment where a patient is not admitted to a hospital, and inpatient treatment is where a patient sometimes stays overnight or multiple nights in a psych ward in a hospital due to an attempted suicide. There are also exceptions on the other side where some states do not completely limit it to 18 years old for the 18 that say. All 50 states have laws allowing minors to consent for testing and treatment of sexually transmitted diseases. There's an exception to this as well. The only exception is that HIV, specifically only HIV, can only be tested for, not treated with a minor's own consent. So a minor can consent to be tested for HIV, but if they test positive, they cannot consent to treatment on their own, only for HIV. Many states to this day do not have a set age for consent to mental health as a result of infectious diseases or other trauma, and simply rely on a case-by-case basis. So there's no minimum age, it's just see what happens and determine the best possible outcome based off that. I would like to bring a professional in to get an extra opinion on this topic. I hope you all give a warm welcome to Dr. Irene Wise. Welcome to the podcast, Dr. Wise. How are you doing today? I'm doing well. My name's Irene. Oh, by the way, I just want to let you know I'm a nurse practitioner, so you don't have to call me Dr. Makes me feel like a fraud. You can just call me Irene. Sounds great. All right, and what is your medical background? I'm a family nurse practitioner, which means we do a variety of things from infants to elderly people and including mental health. Okay, okay. And do you have any religious or political views that potentially influence your stand on bioethical topics? Not really, no. I would consider myself a half-baked Buddhist, so not really any, you know, prohibitions on health care. Okay. As a mental health professional, do you have any personal thoughts on the age of consent for mental health treatments in the United States? No, not really. It seems like most states will actually, 18 out of the 50 states, the mental health, the age for consent is 18, and I think I would agree with that for the most part. There's a few states where it's younger, and some of them are on a case-by-case basis, and I would agree with that, too. I think, for personally me speaking, I think for some 18-year-olds are more mature than others, and so I think some 18-year-olds may not be able to make a, you know, able to make a, you know, consent, informed consent, and so especially if, so if the parents feel that way and they've obtained, like, a guardianship for their 18-year-old, then I feel in those situations the parents should be able to continue to at least help the child make informed decisions until they can make those decisions for themselves. Yeah, okay, that makes sense. What has your experience been with age of consent when it comes to mental health treatments? As a professional? Yes. So it, when I worked in family practice, most of the time, you know, an adolescent would be brought in by a parent, and so sometimes the parent would be in the room, sometimes they wouldn't be, but usually if a parent was bringing a teen in for mental health problems, they were wanting your professional opinion or advice on treatment, so it was often a shared decision. On a college level, you know, most of our students are 18 and up, so they have the legal right to make their own decisions about mental health, and so we, you know, we rarely have parents coming in with the student, and we can't even talk with parents unless the student has given written permission for us to be able to talk to them, and a lot of times I find that the student wants to discuss it with their parent before they, you know, make a decision, and so I make a recommendation, and so they might discuss it with their parent before they, you know, fill the medication or take the medication, and then many students, you know, just they might talk to the patient, to the parent, but not in front of me. Sweet. You don't have to answer this, but are there any cases that have stood out to you in the past? Let me think about that. I think one case in particular I'm thinking about where there was an 18-year-old who was very immature, and the parents had legal guardianship, and when this adolescent had when this adolescent had attempted suicide with an overdose, and when the parents sought care in the emergency room at first, the emergency room was not going to let the parent come into the room with the patient until they, you know, procured the paperwork to show that they were the legal guardians, and then the social worker recommended inpatient hospitalization, and so the parent talked with them, and, you know, again, there was a great deal of thought put into the decision to admit the adolescent, and then the next day the parent got a call from the inpatient psych facility saying your guardianship doesn't cover you for inpatient care, and so the parent had to get an emergency hearing to expand their guardianship to include inpatient hospital care, but in the meantime, the staff had gone to the patient and had them re-sign all of the paperwork to consent for themselves, and in this situation, the parents have to go back yearly and meet with the judge and the lawyers to determine if they're going to continue that, the inpatient portion of the guardianship, so in this situation, I think it came out, everything came out fine because the parents and the adolescent had a good relationship, and everybody was kind of on the same page with wanting to help the adolescent, you know, but I can see in some situations where it could be very problematic for either the parents or the adolescent if there was a disagreement about how the adolescent should be treated. Okay, yeah, interesting. Are there any special considerations when treating someone who is legally emancipated? So, no, I don't think so because when a person is legally emancipated, that means that they have the legal right to make decisions for themselves for health care, and some states, in some states, a minor as young as 12 can make decisions about their health care, and, you know, usually if an adolescent is legally emancipated, then they've gone through, they've taken the legal steps to obtain that designation, so I think in that situation, they are able to make a decision for themselves. Okay, yeah. Are there any cases regarding treatment where age of consent is disregarded altogether, like if life or death is brought up? That's a really good question. Are we talking about mental health still? Yes. Are we talking about mental health still? Yes. Yeah. So, if a person is expressing suicidal ideation and it's determined that they're pretty serious about it, then they can get, the health care professional can do something called, get a Title 5950 where they are hospitalized for their own safety, but kind of against their will, and I think this even goes for people over 18, even for adults. They, you know, the health care professionals do everything they can to give the person as much autonomy and decision-making as they can, but there are times, like, because this is a life or death situation, there are times when a person might be admitted to the hospital against their will, and it's for their safety. Another time would be if they were expressing homicidal thoughts, you know, thoughts about hurting or killing somebody else, and in that situation, they could also be titled. Okay. Yeah. That makes sense. What training do mental health professionals receive regarding ethical issues related to training minors, if any? You know, I don't, I don't remember having, like, a specific ethics class, at least not, I'm trying to think, when did I last have, I remember being in school and having to write an ethics paper, and I'm trying to remember if that was when I was in undergrad, but I feel like it's kind of an integral part of my education, and I think it's it's kind of an integral part of our training, even if it's not a separate class. Okay. Yeah. Are there any cultural or religious considerations that impact the age of consent for mental health treatment, like, in our society? Yes, definitely. I think there are certain religions that are opposed to any kind of, you know, medical intervention, and then it seems like some states that, if the state is conservative and is, you know, the powers that run the state are of a religious or conservative political background, then the state, that state might govern you know, the age of consent in which a person can make decisions for themselves, and so they tend to be, you know, those states are going to be definitely like 18, you know, whereas other states, like California, that are fairly liberal are going to be 12, like the age in California is 12. Also, Maryland and Illinois, they have, down to age 12, can make decisions for themselves. But I think in every situation is a little bit different, you know. I'm sure there's, like, exceptions to every rule, and I think it's probably on that case, you know, it's taken on a case-by-case basis. Yep, of course. All right, well, thank you so much for coming on, and I hope I have a, I hope you have a great rest of your day. Thank you. You have a good day, too. All right. Hello, Brooke, Savannah, and Rachel. Thank you for joining with me here to talk about the age of consent for mental health issues and treatments. After hearing my interview with Dr. Wise, I would like to talk with you a little bit about your thoughts. Do you guys have any major takeaways from the interview? I think just, like, hearing her overall thoughts on kind of the maturity of different minors and also the maturity of different college students was really interesting. Also, hearing about the particular case where an 18-year-old was still under the care of their parents, and they were, their legal guardians, definitely was something that was surprising to me. I feel like throughout my research, I didn't really, like, go to that side where, like, there are immature adults technically, but it makes sense considering that your topic is mental health. Yeah, my biggest takeaway was probably that she was talking about how some 18-year-olds aren't as mature as other 18-year-olds, which is why would they would have, like, their parents would still have legal guardianship over them. So that thought kind of leads me to think, why not just treat every minor based on maturity? Like, go case by case instead of putting a number on it, because turning an age doesn't make you, like, automatically as mature as any other adult. I definitely agree. I do think, though, that it would be difficult for our medical system to sustain a case-by-case kind of policy. I think that bioethicists already have a lot to handle with the cases that they do have to pay attention to and kind of discuss. Yeah, I think when I was, when I heard that, it was definitely something that I thought about, for sure. I'm not really sure how I feel about that. I mean, I definitely see the immature 18-year-old thing being in college. I'm seeing them constantly, but yeah, I don't know. Do you guys think that the age of consent for mental health treatments should stay determined state by state, or do you think that there should be a federal law that all states should follow? I think, just like how we asked this question in the different table talk, and I had the same answer. I think it probably should be federally, just because this sounds immature, but, like, it's not fair to, like, a child in different states going through the same situation, that one of them could have equitable treatment and, like, get better, essentially, from their mental health disorder, but one child just, like, if their parents say no, then it's a no, and they can't receive any treatment. No, I agree with that. I think it should be controlled federally. Of course, there are cases that are maybe more severe, but for the most part, I think that every child should have access to mental health treatments, no matter what age they are. As far as, like, antipsychotics or anything like that, that may be a little bit more controversial, just because it could have a negative effect on, yeah, psychosurgery. I think that's a little bit more controversial, but for the most part, every child should have access to mental health treatments and therapy. Yeah, I agree as well. I do think that access is probably the biggest roadblock for people in poorer communities and more rigid states, and so I think that a president being set by a federal judge on a federal level would kind of bridge that gap and give poorer communities more of an opportunity to thrive. I can agree with that. It definitely seemed strange doing the research on thinking about how many people don't have the ability that other people do when it comes to the option. So, I wanted to talk about case-by-case basis as well. Do you think that age limit should be determined different for cases where inpatient treatment is involved? I think it depends on what the inpatient treatment entails. I do think that psychosurgeries, especially psychosurgeries on minors, should be something that a parent is involved in. Also, depending on what the drugs are, whether or not they change a child's brain chemistry, I think that inpatient visits should maybe have a parent present just for support, and then if the parent isn't supportive of the child or the child doesn't feel safe with their guardian, then having social workers or assigned bioethicists to help the child through. Yeah, I can agree with that for sure. I think when we were talking about in the case of vaccines where minors have the option to have people like social workers and school nurses be able to give consent for them, I think that should also be an option in this case as well. So, I wanted to bring up a case that I found with the state of Connecticut where for mental health sessions, they allow minors to consent to up to a minimum of six sessions, and then after six and every other six, the licensed practitioner or whoever's doing the session has to re-evaluate whether or not treatment or more sessions are required. Do you think that other states, since Connecticut is currently the only one, should also offer something like that? I would say yes, just because it sort of gets rid of some of the roadblocks for a minor to just have a therapy session, nothing invasive or anything like that, and then hearing from a professional, especially as a minor who may not even really know what's going on, could give the minor more background information or help them explain maybe to parents who don't understand to help them get the support of their parents for therapies and treatments. Yeah, I agree. I think that Connecticut is setting a really important precedent for other states, especially with our generation being called kind of the anxious generation. We have so many more roadblocks and difficulties to face considering our access to technology and our kind of lack of social interaction due to COVID-19 and electronic use. So I do think that it's really important for minors to have access, especially when it's just having a conversation with a medical professional who's trained to understand them, trained to diagnose them, and is really just there to help. Yeah, I agree with that. I think there should be, I think other states should follow Connecticut's way of handling mental health treatments. I mean, six sessions is kind of a good amount. I'm just more concerned about the cost of these sessions and where this minor may be getting the money. I know it would be hard to be able to come up with the money without parental consent, so I feel like if states are going to follow, there should be a payment plan or something like that, or like financial aid for mental health treatments for these minors. Yeah, I can agree with that too. I think cost is definitely an interesting point to bring up because minors aren't financially dependent. So, but yeah, other states setting up something similar to that would definitely be important in the future. All right, I also wanted to ask you guys about this thing that I saw, that in 2018, the number of suicides among California youth ages 12 to 19 was 15% higher than it was in 2009, and incidents of youth self-harm requiring medical attention were 50% higher than in 2009. I wanted to ask what your thoughts were about those numbers. I think those numbers are definitely staggering and frightening. It makes me wonder what changed in our society and what faces the youth of today versus the youth in 2009. I think that a really big piece of that is social media use. I grew up in California, and I think that there are already a lot of social pressures that come along with growing up in a highly populated state. I don't know about you guys, but I went to high school with like 5,000 people. So I think there's just a lot of comparison and competition when you're growing up with that many people in your school. But I think that social media is huge. I think that as a girl that grew up in California as well, I think that we are faced with just a lot of outside noise. And they say that social media provides an outlet for people to connect, but realistically you're just seeing everybody else's posts. You're seeing parties that you might have been left out of or friend groups that you're not a part of. So I think that that just presents today's generation with a lot of mental hurdles. After I found out that the number of suicides among California youth ages 12 and 19 was 15% higher, I also found that the law passed in California for a minor to be over 12 in order to consent for mental health treatment passed in 2010. So do you think that that had an effect because the numbers still went up even though minors had more access to mental health treatments? I think the numbers still going up even though like even after laws were passed making it so a 12 year old could access their own mental health treatments sort of alludes to the fact that it's something else making these numbers go up. And my personal thoughts on this lead me mostly to believe that it's because of social media, especially because we're talking about California. And I feel like California is such like a large social media hub. I don't know, I'm not from California. But believing that it's because of social media makes me think that there should be more strict regulations on how old you have to be to be on social media because I mean I was on social media as a minor and there was no way of actually checking how old someone is when they sign up. You just enter a birthday and then they accept that as true even though it's like so easy to lie. Yeah, I think it's very interesting how the youth had more access to mental health care. Meanwhile, suicide rates increased. I do think a large portion of that has to do with what we consume as well. We consume media like what Brooke said, which affects our brain chemistry, the food we eat, the drinks we eat. So I think there's a lot of things that could go into this. I do think bullying is also an issue, a huge issue in schools. And so with social media, it can get out of hand. And I think there should be stricter laws on minors and social media to protect our youth from mental health disorders and suicide rates. Yeah, I definitely agree with that as well. I do think that a lot of the difficulties facing this generation are technology-based and are social media-based. I think that when you have so much information flying in from every side of the globe, you tend to get overwhelmed and not really understand what makes you happy or what things you truly identify with just by the sheer number of posts that children see a day. I think that there are also social media apps now that are modeled to create an addiction to them. And I think that the overuse of social media also contributes to the lack of social interaction between today's youth. And I think that that's such an important pillar of just growing older and kind of finding where your identity lies. I think that true mental health is supported by knowing oneself and also is affected by brain chemistry and hormones and things like that as well. But I do think that this next generation coming up has a lot more difficulties than past. Yeah, I also think that the seeking of mental health treatments for as young as 12 years old isn't marketed either. So a lot of minors don't know that they are able to seek mental health treatments and therapy without parental consent. So I think if we're going to be in a generation based around technology, there should be ads, there should be billboards, and it should be marketed correctly. That way, if people do want to seek mental health treatments, they have the option and they're well informed that they are able to get that on their own. Yeah, I definitely agree with all those points. I think also the fact that bullying is so much easier in today's age, with the theory of protection behind a screen, and no one can really see what you're saying, because no one really knows who you are, is definitely a problem that should be addressed as well.