Why Colorado Teens May Refuse Mental Health Treatment, Against Their Parents’ Wishes

Maria’s 14-year-old daughter Anabel began having nightmares in the fall of 2020. She had spent the previous summer living with her father, who Maria said emotionally and physically abused the teenager. As Anabel’s sleep patterns deteriorated further that winter, Maria begged her child to see a mental health professional to discuss the abuse. Anabel refused. Maria, who asked that her family’s real names not be released to protect her daughter’s privacy, called psychologists anyway, but none wanted to see Anabel, not without first getting permission. of the minor.

In 2019, the Colorado Legislature passed legislation to expand adolescents’ access to mental health care. However, many mental health professionals interpret part of this law to say that children must consent before they can be treated, even if their parents believe care is needed. Anabel could have been admitted to an inpatient facility without her permission if she had been seen as an imminent threat to herself or to others. But the teen’s symptoms had not increased to this point.

Not until the start of 2021, that is. “She took knives from the kitchen,” says Maria. “She was crying in pain, saying, ‘I don’t want to live. I don’t want to be alive. It’s too painful. Maria called Colorado Crisis Services, who dispatched an emergency response team to her home. But after Anabel was no longer an imminent threat, she still refused to see a therapist. No matter how hard she tried, Maria couldn’t convince her daughter to get help.

April 16, 2019 Dafna Michaelson Jenet walked up to the podium inside the Colorado House of Representatives, brought the microphone closer to her mouth, and leaned against the wooden plinth. For three years, the Democrat of Commerce City had tried unsuccessfully to pass legislation that would make mental health services more accessible to young people. Her third proposal, she believed, was her most balanced attempt to date.

The Youth Mental Health Education and Suicide Prevention Act that resulted was personal to Michaelson Jenet. “This bill is for my son,” she told MPs. When he was nine, Michaelson’s son Jenet attempted suicide. He survived and it became Michaelson Jenet’s mission to improve the mental health treatment of Colorado children. “It’s not just for my son. It’s for your sons. And for your daughters…. I don’t know about you, but I would give my child access to anything in the world …anything in the world– that would prevent his death.

The bill was not born out of Michaelson Jenet’s personal tragedy alone. Colorado was in crisis: Between 2007 and 2020, the number of suicide deaths among 10- to 19-year-olds in the state more than doubled. A provision in Michaelson Jenet’s law would lower the age of consent in Colorado, making it legal for children as young as 12 to access mental health services even if their parents object. Research has shown that minors often avoid mental health treatments because they don’t want their secrets shared with their parents. So, in addition to lowering the age of consent from 15 to 12, Michaelson Jenet’s bill would make it illegal for providers to disclose a minor’s information to their parents unless teens have given consent or show serious symptoms, such as suicidal ideation. “Our children deserve privacy that can save their lives,” said Michaelson Jenet.

The Youth Mental Health Education and Suicide Prevention Act was enacted by Governor Jared Polis on May 16, 2019. “With mental health we have a fragmented set of programs, caregivers don’t know how to access services available, and the programs are so limited that many don’t have access to them at all, ”said Jena Hausmann, President and CEO of Children’s Hospital Colorado, at the signing. “This bill is how we are starting to change that.”

Dr Christian Thurstone only found that standard procedures would change when her employer began to prepare to follow the mandates of the law. As Director of Denver Health’s Department of Behavioral Health Sciences, Thurstone oversees the adolescent psychiatry inpatient unit of the hospital, where children between the ages of eight and 21 are treated with severe seizures. Mental Health.

Often, teens are admitted to an inpatient unit like Denver Health for 72-hour stays, referred to as “mental health detentions,” or “M-1 detentions.” This means that a health care professional or licensed law enforcement official has determined that the child meets one of three criteria: suicidal behavior, homicidal behavior, or severe disability caused by mental illness. After three days, if the patient no longer exhibits these symptoms, state law requires facilities such as Denver Health to release the child or adolescent.

In the past, Thurstone has called on guardians if he thought the miners would get an extra day or two on the unit so the medics could stabilize them further. Under Michaelson Jenet’s law, however, if patients aged 12 or older want to get checked out, “we have to let them out of the hospital,” Thurstone says. “And it comes back every week.”

In addition, M-1 deductions do not take into account the five-day work week. Recently, the Denver Health emergency department admitted a teenager with a 72-hour wait on a Friday. Thurstone didn’t see the teenager until Saturday and couldn’t reach the patient’s regular therapist. “Without their advice, I made medication changes that [the therapist later] interviewed and, you know, didn’t think it was a good idea, ”Thurstone said. Once the hold was over, Thurstone had to release the patient.

The Youth Mental Health Education and Suicide Prevention Act does not explicitly state that an adolescent can refuse mental health treatment. However, the law obliges providers to obtain a document signed by the minor indicating that he is voluntarily seeking treatment. Some members of the mental health community, including the Colorado Psychological Association (CPA), a statewide professional organization, have interpreted this to mean that children aged 12 and older can refuse services.

Dr. Julie Jacobs, psychologist and CPA legislative president, paints a hypothetical portrait of a child in desperate need of care to which both parents consent. [to indicate] you’re here on purpose, ”and the kid says“ no, ”Jacobs said. “Well, then, this therapist, if he manages the risk, potentially isn’t going to see this child.” That risk, Jacobs says, includes the possibility that therapists lose their license to practice in the state. (A spokesperson for the Colorado Department of Regulatory Agencies has neither confirmed nor denied whether any vendors are currently under investigation for violating the law.)

Despite these obstacles, Thurstone understands that Michaelson Jenet’s legislation has the potential to reap huge benefits. “I ran teen focus groups and then did a big review of the literature on why teens don’t seek treatment,” says Thurstone, “and the main thing teens say is confidentiality.… [The issues the statute is causing] are minor compared to the big steps forward created by this bill.

Although some mental health problems professionals believe the law compels them to inaction, there are others, including the state’s largest school district, who claim they are trapped between conflicting laws.

Denver Public Schools (DPS) employs more than 360 school psychologists and school social workers, as well as its teachers and principals. And, according to the federal Family Education Rights and Protection of Privacy Act (FERPA), these school psychologists must alert parents or guardians when their children seek mental health services from providers. DPS. (This does not apply to the 18 district school clinics operated by Denver Health.)

In other words, the Colorado Youth Mental Health Education and Suicide Prevention Act states that people aged 12 and over have a right to confidentiality, and federal law says they do not. are not. In theory, the FERPA violation could expose the district to trial; not adhering to state law has no clear consequence. So for now, DPS has chosen not to change its procedures to meet the requirements of Colorado law.

Michaelson Jenet plans to begin the process of tightening loopholes in the law by meeting with the CPA lobbyist in early 2022. She hopes to pass a so-called “cleanup bill” in the coming months that will include language specifying that Coloradians aged 12 and over cannot refuse mental health treatment when their parents and a therapist agree it is in the best interests of the young. “I think this is the first in a series of steps,” said Jacobs, CPA legislative chairman, “but it’s a very good step.”

Confusion surrounding the interpretation of Colorado’s Youth Mental Health Education and Suicide Prevention Act is indicative of a larger problem, adds Michaelson Jenet. During her five years on State Capitol, she says she learned that if she doesn’t follow her legislation after it is passed, the law may not fix what it was supposed to fix. So, in addition to the clean-up bill, Michaelson Jenet proposed a separate step to the Legislative Audit Committee, which she chairs, to establish a department whose only job would be to follow promulgated laws and report back to the legislature. General Assembly. Michaelson Jenet thinks she has the voices to push through the legislation, but she also knows that a bureaucratic overseer might not be enough. “Ultimately, until a law is sent to court and a judge makes a decision based on what he thinks is intent,” Michaelson Jenet says, “you are open to interpretation. . “

Waiting for the courts wouldn’t have worked for Maria, who ultimately felt she had no choice but to take a drastic step: Maria lied and told Anabel that to get the dog emotional support she wanted, she had to see a psychologist. “I’m not proud [about lying]. I don’t recommend it, ”says Maria. “But I also don’t want my child to start using drugs or to commit suicide.”

Maria is optimistic that Michaelson Jenet’s cleanup bill will provide more options for parents like her. “I hope I can have a voice, that I can be part of my child’s treatment,” says Maria, “and perform my authority as a parent. Because we are here to protect our children.