Texas

Can a Texas Teenager Get Mental Health Care Without a Parent?

By Dr. Stacey Forbes, DNP, APRN, PMHNP-BC

Teenagers often reach for help before their parents know anything is wrong — a school counselor, a friend’s mother, a search at two in the morning. Sometimes they want help precisely because home is part of the problem. Texas law has a clear default and a small number of important exceptions, and knowing them helps teens and parents alike understand what is possible and why confidentiality is handled the way it is.

The default: a parent consents

Texas sets the age of majority at 18. Until then, consent to medical care — including a psychiatric evaluation and prescription medication — generally comes from a parent or legal guardian. Chapter 32 of the Texas Family Code sets out who may consent to treatment for a child and the limited situations in which a child may consent for themselves. Outside those situations, a clinician will ordinarily need a parent’s consent before treating a minor.

When a teen can consent to counseling

Section 32.004 creates an exception built around safety. A child may consent to counseling for suicide prevention, for chemical addiction or dependency, and for sexual, physical, or emotional abuse. The counseling must come from a licensed or certified physician, psychologist, counselor, or social worker who has reasonable grounds to believe the child needs it. Three details in the statute matter to families:

• The counselor may tell a parent or guardian about the treatment given or needed, with or without the child’s consent.
• A parent who did not consent is not obligated to pay for counseling provided under this section.
• The exception covers counseling for those three concerns. It does not create a general right for a minor to consent to all mental health care.

Other situations where a minor consents

Section 32.003 lists circumstances in which a child may consent to their own medical, dental, psychological, and surgical treatment. Most are uncommon, but several bear on mental health: a minor who is 16 or older, lives separate and apart from their parents, and manages their own financial affairs; a minor seeking examination and treatment for drug or chemical addiction or dependency, or any other condition directly related to drug or chemical use; and a minor on active duty with the U.S. armed forces. Consent given under that section cannot later be undone on the grounds that the patient was a minor.

What this means for psychiatric medication

Prescribing psychiatric medication involves more than a conversation: a diagnosis, sometimes lab work, monitoring for side effects, and follow-up over weeks and months. Section 32.004 does not mention medication, so for most teenagers psychiatric medication is a decision made together with a parent or guardian. That is also clinically sensible. Many medications used with adolescents are best started with a watchful adult at home, particularly in the first weeks, and parents are usually the first to notice when something is helping or when it is not. Read more about teen and adolescent psychiatry.

Privacy: the conversation worth having up front

Even with a parent’s consent, teenagers talk more honestly when they know what stays private. A common approach is that the day-to-day details of what a teen shares stay between the teen and the clinician, while anything involving a risk to the teen’s safety or someone else’s is shared with parents. The specifics vary between practices, so ask at the first appointment and agree the rules with everyone in the room.

• What will be shared with parents, and what will not?
• What happens if my teen says something suggesting they are unsafe?
• Will parents join part of each appointment, or only some of them?
• If a parent calls with a question, will the teen be told?

For a teen who feels unable to talk to a parent at all, a school counselor, another trusted adult, or 988 can be a first step. 988 takes calls and texts at any hour.

Common Questions

Sources & Further Reading

• Texas Family Code §32.004 — Consent to Counseling
• Texas Family Code §32.003 — Consent to Treatment by Child
• NIMH — Child and Adolescent Mental Health
• 988 Suicide & Crisis Lifeline