Can adolescents in AL make better treatment decisions than those in MS?
According to state law, adolescents living in Alabama, Colorado, Indiana, Louisiana, Minnesota, New Mexico, South Carolina, and Vermont do not need parental consent for either inpatient or outpatient treatment of substance abuse or mental illness.
Editor: Saad Shaheed
In Delaware, Mississippi, and North Carolina, parents must provide consent for inpatient treatment for both substance abuse and mental illness, while decision-making authority for outpatient treatment is more lax. In Utah, parental consent is required for substance abuse treatment, but not for mental healthtreatment, and in Nevada, New Jersey, and North Dakota, parental consent is required for treatment of mental illness, while adolescent consent suffices for substance abuse.
A recently published review of state laws regarding decision making for adolescent drug abuse and mental health treatment by MaryLouise Kerwin1 and her colleagues will make your head spin. It will also make you wonder how laws regarding consent for treatment are made. As you think about this, it’s important to acknowledge that most state laws give parents the authority to consent for medical treatment for their children for most problems up to the age of majority.
The lack of consistency across states is troubling. Are adolescents in Alabama more able to make treatment decisions than adolescents in Mississippi?
Even more troubling is how these laws came to be.
Beginning in the late 1960s, state governments began to recognize that the interests of minors, their parents, and the state were not always congruent. Health professionals believed that adolescents might be more encouraged to seek treatment if they had control over their health care decisions. Seeking to right these wrong, states began to accord minors autonomy to provide consent for treatment of pregnancy, sexually transmitted diseases, and drug, alcohol, and mental health problems.
Since these laws permitting adolescents greater autonomy over health care decisions were enacted, questions have been raised about whether minors have the competence to provide informed consent for treatment. The debate centers on the cognitive abilities of adolescents to make decisions affecting their long-term welfare. Initial evidence for minor competence was bolstered by Piaget’s work findings that children as young as 12 years old were capable of formal operational reasoning.
While a spate of research bolstered the argument that minors have the capacity for informed decision-making, the extent to which adolescents have the competence to understand and accurately assess the risks of not undergoing treatment remains ignored. Peer pressure, impaired thinking resulting from alcohol or drugs, and the short-term positive effects of drugs and alcohol themselves are powerful dis-incentives to seeking treatment, raising doubt that adolescent decision-making about the long-term benefits of treatment is sound.
In 2010, 1.8 million American adolescents between the ages of 12 and 17 needed treatment for an alcohol or illicit drug use problem, yet rates of treatment for adolescent substance abuse are close to 8%.2 Few adolescents enter drug treatment on their own accord.
Kerwin’s analysis found that more than twice as many states required parental consent for mental health treatment than for substance abuse treatment. Is this because mental illness is more closely aligned with physical illness than is substance abuse? Parental consent was sufficient to admit a minor to inpatient drug and mental health treatment in just over half of the states and in about half the states for outpatient mental health treatment. However, parental consent was sufficient in only 20 states for admission to outpatient drug treatment. State laws clearly favor the rights of minors to independently access drug treatment compared with mental health treatment.
As if this situation can get even more disturbing, for states that stipulated a minimum age for minor consent, the modal minimum age for minor consent to drug treatment was 12 years old compared to 14.5 for mental health treatment.
So, what can parents living in a state that requires a minor to consent to treatment do when their child refuses treatment? Not much. They can try to force their child into treatment, but of course this is not effective. The child can refuse the treatment and discharge himself. They can transport their child across stateliness to a state where minor consent is not necessary. In a review of The National Association for Therapeutic Schools and Programs, 85% of these programs are in states where parent consent is sufficient for either drug or mental health treatment. Interestingly, 31% of these programs are located in Utah, a state in which a parent may submit a non-consenting minor for treatment if a neutral, detached fact finder determines that the minor needs treatment.3 These programs are expensive and have questionable efficacy as most have not undergone rigorous scientific study.