History of Minor Consent Laws for Mental Health Treatment in the US.

IMPORTANCE

To facilitate access to mental health treatment for minors who are unwilling to involve parents or guardians in their care, states have enacted statutes granting minors the legal capacity to independently consent (ie, without parental/guardian consent) to mental health services. Understanding changes in these laws over time may facilitate research that assesses whether these laws increase access to care, and support legal and clinical interventions to advance minors' access to mental health care.

OBJECTIVE

To analyze the adoption and amendment of minor consent laws for mental health services in all 50 states and Washington, DC, from 1950 to 2024 while focusing on the capacity of minors to independently consent and the confidentiality protections that apply to the mental health information of independently consenting minors.

DESIGN AND

SETTING

This study used legal epidemiological methods to code state statutes, state regulations, and relevant case law regulating the legal capacity of minors in all 50 US states and Washington, DC, from 1950 to 2024 to consent independently to (1) general health care (inclusive of mental health care), (2) outpatient talk therapy, (3) mental health medications, and (4) residential treatment.

MAIN OUTCOMES AND MEASURES: The main outcome was the youngest age of capacity to consent to general health care, outpatient therapy, mental health medications, and residential treatment, respectively, as well as confidentiality protections that prohibit, enable, or require disclosure of minors' mental health treatment information to parents or guardians.

RESULTS

From the 1950s to 2019, there was steady growth in the number of states that allowed minors to consent independently to mental health treatment, with outpatient therapy being the most common. In 2024, for the first time since states started allowing minor consent, multiple states revoked the capacity for minors to consent independently to mental health treatment. Few laws protect minors' mental health treatment records against disclosure to their parents or guardians.

CONCLUSIONS AND RELEVANCE: The results of this study suggest that research that assesses the effect of these laws (and their revocation) on clinical practice, access to care, and mental health outcomes for minors is needed to inform practice and policies that increase access to mental health care for minors in the US.