California: minor consent, confidentiality, and custody

Who consents to treatment

A person reaches the age of majority in California at eighteen (Family Code § 6500). A minor is emancipated, and consents to medical care as an adult, by marriage, by active duty in the armed forces, or by a court declaration of emancipation, which a minor fourteen or older may petition for (§§ 7002, 7120). Outside those cases, a parent or guardian consents, and the exceptions below apply.

Outpatient mental health services: Family Code § 6924 and Health and Safety Code § 124260

California has two parallel statutes, and since July 1, 2024 they say the same thing. A minor twelve or older may consent to outpatient mental health treatment or counseling, or to residential shelter services, if, in the opinion of the attending professional, the minor is mature enough to participate intelligently in the services. Until 2024, § 6924 also required that the minor be in danger of serious physical or mental harm or be the alleged victim of incest or child abuse; AB 665 (2023) removed that requirement, so the maturity standard is now the only test under either statute, including for care paid by Medi-Cal.

Three limits travel with the minor's consent:

• Medication is excluded. Neither statute authorizes psychotropic medication, convulsive therapy, or psychosurgery without the consent of the parent or guardian.
• The parent is to be involved unless that is inappropriate. The professional must involve the parent or guardian in the treatment unless, in the professional's judgment, involvement would be inappropriate, and must record in the treatment record whether and when the parent was contacted or why contact was not attempted.
• The parent is not liable for the cost of services the minor consented to unless the parent participates in the treatment.

Youth in foster care have an independent right, at twelve or older, to consent to or decline mental health services (Welfare and Institutions Code § 16001.9).

Drug and alcohol treatment: Family Code § 6929

A minor twelve or older may consent to medical care and counseling related to the diagnosis and treatment of a drug- or alcohol-related problem. The same parental-involvement rule applies: involve the parent unless inappropriate, and document it. The section does not authorize a minor to consent to replacement narcotic treatment without parental consent, except that a minor sixteen or older may consent to treatment with buprenorphine (added by AB 816, 2023).

The section also states the Legislature's intent that a parent's right to seek care for a minor's substance problem be respected even when the minor does not consent, and it requires the treating physician to disclose information about care the parent sought to the parent on request, even over the minor's objection. Records of a program that meets the federal definition are also subject to 42 CFR Part 2.

Inpatient treatment

• Voluntary admission on a parent's application. A parent or guardian may apply to admit a minor to a mental health facility as a voluntary patient (Welfare and Institutions Code § 6000). Private psychiatric facilities must have admission procedures for minors fourteen to seventeen that include an independent clinical review (§ 6002.10). A minor admitted during minority cannot be held past eighteen on that application.
• Voluntary admission on the minor's own application. A minor twelve or older may apply to the juvenile court for admission as a voluntary patient; the court may authorize it if the minor consents and admission is in the minor's interest (§ 6552). This is the route when a parent will not consent.
• Involuntary. A minor who, as a result of a mental disorder, is a danger to self or others or gravely disabled, and for whom voluntary treatment is not available, may be taken into custody and held for seventy-two hours of evaluation and treatment under the Children's Civil Commitment and Mental Health Treatment Act (§ 5585.50). The facility must make every effort to notify the parent or guardian as soon as possible. Further holds follow the same procedures that apply to adults.

What a parent is entitled to know

A parent or guardian is ordinarily the minor's representative for purposes of inspecting medical records (Health and Safety Code § 123110). Two provisions limit that:

1. Care the minor consented to. Under § 123115(a)(1), the parent is not entitled to inspect or copy records of care that the minor lawfully consented to on their own, and under Civil Code § 56.11(c) it is the minor who signs the authorization to release those records. HIPAA points the same way (45 CFR 164.502(g)(3)). For treatment under § 6924, § 124260, or § 6929, the minor controls the record, whichever parent is paying.
2. Detriment. Under § 123115(a)(2), a provider may deny a parent access to a minor's records where the provider determines that access would have a detrimental effect on the provider's relationship with the minor or on the minor's physical safety or psychological well-being. The provider is not liable for that decision unless it is made in bad faith.

Where a minor has been removed from parental custody under the juvenile court, a psychotherapist may not release the minor's mental health records to the parent without a court order (§ 123116).

Outside those situations, California does not give adolescents a general right to confidentiality from parents. Agree on confidentiality expectations with the family at the first visit: what will be shared, what stays between clinician and adolescent, and the safety situations in which the parent will always be involved.

Divorced or separated parents

California distinguishes legal custody from physical custody. Joint legal custody means both parents share the right and the responsibility to make decisions about the child's health, education, and welfare (Family Code § 3003). Three practical rules follow:

• Ask for the order when the family is separated. When joint legal custody is ordered, § 3083 requires the order to specify the circumstances in which the consent of both parents is required; in all other circumstances either parent acting alone may exercise legal control. So the order itself tells you whether one signature is enough for mental health treatment. If the order gives one parent sole legal custody, that parent's consent is the one that counts.
• The non-custodial parent keeps access to records. Under § 3025, a parent may not be denied access to the child's medical, dental, and school records because that parent is not the custodial parent, unless a court orders otherwise.
• When parents disagree about treatment and the order requires both, pause non-urgent treatment, document what each parent was told, and leave the dispute to the parents and the court rather than picking a side.

When the minor is at risk

Duty to protect. California's rule is statutory. Under Civil Code § 43.92, a psychotherapist has a duty to protect when the patient, or a member of the patient's immediate family, has communicated to the therapist a serious threat of physical violence against a reasonably identifiable victim or victims. The duty is discharged by making reasonable efforts to communicate the threat to the victim or victims and to a law enforcement agency. The statute, as amended in 2013, speaks of a duty to protect rather than a duty to warn, which matches the Tarasoff decision it codifies; warning and notifying police are the safe harbor, and hospitalization or other reasonable steps may also be appropriate. Document the threat, the assessment, and the steps taken.

Mandated reporting. Under the Child Abuse and Neglect Reporting Act, Penal Code § 11165.7 lists physicians, psychologists, marriage and family therapists, clinical social workers, professional clinical counselors, nurses, school personnel, and many others as mandated reporters. Under § 11166, a mandated reporter who, in their professional capacity, knows or reasonably suspects that a child has been abused or neglected must report immediately, or as soon as practicably possible, by telephone to the county child welfare agency or a law enforcement agency, and must send a written follow-up report (form SS 8572) within thirty-six hours. The duty is individual and cannot be delegated to a supervisor. Failure to report is a misdemeanor; good-faith reporters are immune.

Hospitalization. See the inpatient section above.

School records

A school's records about a student, including records from a school counselor or school-based clinician employed by the district, are governed by FERPA rather than HIPAA, and parents have rights of access under FERPA until the student turns eighteen. Records a school receives from an outside clinician become part of the education record once filed. Send the school what it needs to act, not the full evaluation.