• At Northwest Justice Project -- Health Care Rights of those Under 18 Years of Age.

• At Washington State Department of Health -- Age of Consent Fact Sheet for Washington State -- One-Page Adobe Acrobat Document.

• At Washington State Department of Health -- Child and Adolescent Health Web pages.

• At the Juvenile Law Center -- Health and Mental Health Web page.

• At the National Alliance for the Mentally Ill Web Site -- Child and Adolescent Action Center.

Under current Washington State law, the age of consent for seeking and accepting treatment for a mental health problem is 13 (RCW 70.96A.095, RCW 71.34.030).

This sets Washington apart from other states in the west, and most others around the country. These laws enable teens to seek mental health care on their own. Interpretations of these laws have extended the rights of youth, 13 or older, to include an ability to refuse treatment in out-patient or in-patient programs.

Reproductive health rights are also assured for all individuals in this state (RCW 9.02.100). This applies to all women beyond puberty, which, on average, means at least 13 years of age. The age of consent for substance abuse treatment in Washington is 18 and parents can in certain circumstances take the initiative to force their child into a residential rehabilitation program. However the treatment community in this state is influenced by the spirit of the age of consent for mental health being 13 and that influences practice customs for youth with substance abuse problems.

For out-patient reproductive health, or mental health treatment services, confidentiality is assured for youth 13 years old, or older, without a signed release. This applies even to parents of youth seeking these services.

Some feel these laws have limited the ability of parents, service providers and state officials to force teens into outpatient care and in-patient facilities when their resistance to care places them in harms way. They have experienced great frustrations in assuring that troubled and oppositional young people receive services that will address their problems and keep them safe.

We now face reductions in funds for youth services and this will inevitably lead to ever more frustrations in our ability to adequately provide care for troubled youth. Some leaders in our state are seeking to redress these frustrations through a reexamination of our laws regarding age of consent.

A bill before the Washington State legislature in the 2002 session sought to change the age of consent to 16 years of age. This issue is being studied by legislators and others in our community prior to the next legislative session. The policy of King County, as articulated by its Department of Community and Human Service, is to resist changes to the age of consent.

The reasons for this policy stance require some understanding of the issues. This position paper will 1) examine risks that come with raising the age of consent, 2) provide an analysis of currently available solutions to problems the proposed change presumes to address, and 3) will make positive suggestions regarding how best to serve youth who are in trouble and who trouble us all.

Executive Summary

King County supports maintaining the age of consent for mental health and substance abuse services at age 13.

• Our state's recognition of the rights of youth to consent to care sets us apart from other states in the west and most other states around the country. Child rights generally have been regarded with ambivalence in our society.

• The rationale behind setting the age of consent at 13 is that physical maturation, despite variable emotional and social readiness, forces youth into making choices in an open society. It is best that the law acknowledged this reality and support youth in developing the ability to assume the necessary responsibilities.

• Our state has found that when funded and structured adequately, and when delivered skillfully, youth will accept care, including admission to residential care facilities.

• Studies have shown that children at 14 can, on average, make reasoned decisions about their health care, at least as well as adults. Most youth do seek parental support in making such decisions.

• Faced with caring for and protecting out of control youth, parents may require the ability to mobilize ITA, ARY or CHINS processes. The courts, juvenile justice and law enforcement should support parents in setting meaningful contingencies with their youth. Current laws are adequate to foster such support. Resources may not be.

• Non-family centered care has alienated many families, particularly those who are poor and disenfranchized. Forced treatment can be seen by some families as undercutting family integrity.

• Families who seek forced treatment for their youth often are frustrated by inadequate care in mental health clinics, and loss of control with the social service and juvenile justice systems. They presume that residential care that they initiate will be under their control, and if in a locked facility, will be more safe and efficacious. There is growing evidence that such treatment is neither.

• Youth treated in the context of their communities, despite risks for re-involvement in problem behavior, make more permanent and substantial changes.

• Well intended residential treatment facilities, staffed with expert youth workers and mental health professionals, have failed to show their programs to be effective. Data validating their treatment is inadequate, and what exists fails to prove their effectiveness and indicates serious problems with recidivism.

• When youth have no right to consent to care, exploitive facilities prey on fears of parents. Some such facilities abuse residents, or expose them to risks due to inadequate care.

• Effective treatment of youth demands a skilled practitioner who can forge an alliance with a youth. This demands a mutually respectful relationship that is fostered by the current age of consent laws in Washington State.

• Parents seeking support often have trouble mobilizing services that are effective for their family. This is aggravated by insufficient numbers of skilled and gifted professionals able to work with youth in trouble, and by shrinking resources. Family Centered Care is a policy of both the state and county in human services. Family supportive professionals and family advocates can empower families to regain control of troubled youth by mobilizing communities to help.

• The System of Care reform initiatives in Washington state offer the best methods of engaging families with troubled youth using "wrap-around principles" and similar methods. Models of successful application of such principles exist in King Co. through our Children and Families In Common grant. Such programs offer the best, most cost effective alternative to forced treatment.

• From Substance Abuse and Mental Health Services Administration (SAMSHA -- a federal agency) -- Treatment of Adolescents With Substance Use Disorders Treatment Improvement Protocol (TIP) Series 32 -- Chapter 8 -- Legal and Ethical Issues.

• From the National Mental Health Association, posted July 1999 -- Best Practices for Confidentiality and Consent.

- Best wishes, Ron Sterling M.D. (Seattle, Washington, USA)