Michigan: minor consent, confidentiality, and custody

Who consents to treatment

A person reaches the age of majority in Michigan at eighteen (MCL 722.52). Until then, a parent or legal guardian consents to medical and mental health treatment, with the exceptions below. A minor emancipated by court order or by operation of law, for example by marriage or active military duty, consents as an adult (MCL 722.4 et seq.).

Outpatient mental health services: MCL 330.1707

A minor who is fourteen or older may request and receive outpatient mental health services from a mental health professional without the consent or knowledge of a parent or guardian, within limits the statute sets:

• Psychotropic medication is excluded, as is referral for pregnancy termination. A minor cannot consent to medication under this section at any age; a prescriber needs the parent.
• Services under the minor's own consent are limited to twelve sessions or four months, whichever comes first, per request. At that point the professional must either end the services or, with the minor's consent, notify the parent or guardian and obtain consent to continue.
• The parent or guardian is not told that services have been provided unless the minor consents, with one exception: where the professional finds a compelling need to disclose, based on a substantial probability of harm to the minor or to another person, and the minor has been told of the intent to disclose. The disclosure is then limited to what is needed to address the harm.
• The parent is not liable for the cost of services the minor consented to on their own.
• Nothing in the section relieves the professional of the duty to report suspected child abuse or neglect.

Clinically, the twelve-session window is a bridge to family involvement, not a way around it. Most clinicians use it to build the alliance and the case for telling the parent, since medication, a higher level of care, and anything beyond four months will need the parent anyway.

Inpatient mental health treatment: MCL 330.1498d and following

Hospitalization of a minor is governed by Chapter 4A of the Mental Health Code:

• A parent or guardian may request hospitalization of a minor, and the minor may be admitted if found suitable for hospitalization (MCL 330.1498d).
• A minor fourteen or older may request their own hospitalization and may be admitted if found suitable (§ 1498d). A minor who was admitted on their own request may later give written notice of intent to leave (§ 1498o).
• Objection. A hospitalized minor fourteen or older may object to the hospitalization in writing within thirty days of admission, and a parent or guardian may object when the admission was at the minor's own request. Hospital staff must help a minor who has been hospitalized at least seven days file the objection (§ 1498m). The court holds a hearing within seven days and must order discharge unless it finds by clear and convincing evidence that the minor is suitable for hospitalization (§ 1498n).
• Emergency admission at the request of a parent, guardian, or peace officer follows § 1498h and requires notice to the parents.

Involuntary proceedings for minors are outside the scope of this page.

Drug and alcohol treatment: MCL 333.6121

A minor who is, or professes to be, a substance abuser may consent to substance-use-related care from a hospital, clinic, or authorized health professional. The consent is as effective as an adult's, and parental consent is not required. The provider may, but is not obligated to, inform the minor's parent, guardian, or spouse of the treatment given or needed, and may do so without the minor's consent, even over the minor's express refusal. The parent is not liable for the cost of services the minor consented to. Records of a program that meets the federal definition are also subject to 42 CFR Part 2, which requires the patient's consent for most disclosures and is stricter than the state rule on telling the parent.

What a parent is entitled to know

Mental health records in Michigan are confidential under MCL 330.1748, with disclosure to the recipient's legally authorized representative and under listed exceptions. For a minor whose parent consented to treatment, the parent is ordinarily that representative and the minor's personal representative under HIPAA.

Two situations change that:

1. Services the minor consented to under MCL 330.1707. The statute itself prevents the professional from telling the parent without the minor's consent, outside the compelling-need exception, and HIPAA defers to that: where a minor lawfully consented to care and no parental consent was required, the minor controls the protected health information for that care (45 CFR 164.502(g)(3)). The same applies to substance-use services under MCL 333.6121, subject to the provider's discretion to inform the parent.
2. Psychotherapy notes kept separately have their own protection under HIPAA regardless of who consented.

Outside those situations, Michigan 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

Michigan's Child Custody Act allows joint custody, which the statute defines as the child living alternately with each parent, the parents sharing decision-making authority over the important decisions affecting the child's welfare, or both (MCL 722.26a). Three practical rules follow:

• Ask for the custody order when the family is separated. If one parent has sole legal custody, that parent's consent is the one that counts for major medical decisions. If decision-making is shared, either parent can ordinarily consent to routine treatment, but a major decision that one parent opposes is a dispute for the parents, and if necessary the court, to resolve. Pause non-urgent treatment, document what each parent was told, and do not pick a side.
• The non-custodial parent keeps access to records. Under MCL 722.30, a parent shall not be denied access to records or information concerning the child, including medical records, because the parent is not the custodial parent, unless a protective order prohibits it. A custodial parent asking you to withhold records from the other parent is not, on their own, a basis to do so. Mental health records have their own confidentiality statute, and a parent without legal custody may face additional limits; when in doubt, ask for the order and consult your institution's counsel.
• The minor's own consent is unaffected. A fourteen-year-old's right to consent under MCL 330.1707 does not depend on which parent has custody.

When the minor is at risk

Duty to warn or protect. Michigan's duty is statutory. Under MCL 330.1946, a mental health professional who is treating a patient incurs a duty when the patient communicates a threat of physical violence against a reasonably identifiable third person and the patient has the apparent intent and ability to carry out the threat in the foreseeable future. The professional discharges the duty by hospitalizing the patient or initiating hospitalization proceedings, or by making a reasonable attempt to communicate the threat to the third person and notifying the local police, the county sheriff, or the state police. Where the third person is a minor or is incompetent for a reason other than age, the professional must also notify the county department of health and human services and the person's parent or guardian. Michigan courts have also recognized a common-law duty of reasonable care to foreseeably endangered persons alongside the statute.

Mandated reporting. Under the Child Protection Law, MCL 722.623, physicians, psychologists, nurses, licensed counselors, social workers, marriage and family therapists, school personnel, and other listed professionals who have reasonable cause to suspect child abuse or neglect must make an immediate report to Centralized Intake by telephone at 855-444-3911 or through the online reporting system, followed by a written report within seventy-two hours; an online report that contains the required information counts as the written report. The duty is individual. A reporter acting in good faith is immune from liability; a mandated reporter who fails to report is civilly liable for the resulting harm and may be charged with a misdemeanor. Reporting is not excused by the confidentiality of a minor's treatment under MCL 330.1707.

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.