Washington: minor consent, confidentiality, and custody

Who consents to treatment

A person reaches the age of majority in Washington at eighteen (RCW 26.28.010). A married minor consents as an adult, and a minor sixteen or older may petition for emancipation under Chapter 13.64 RCW. Outside those cases, a parent or guardian consents, with the behavioral health exceptions below, which are among the broadest in the country.

Outpatient treatment at thirteen: RCW 71.34.530

A minor thirteen or older may request and receive outpatient treatment for a mental health condition or a substance use disorder without the consent of a parent or guardian. Parental authorization is not required, and the parent is not notified without the minor's consent. The statute does not carve out medication; most prescribers nonetheless involve the parent, both for safety and because the parent administers it, and institutional policy usually requires parental consent for psychotropic medication. Treat the minor's independent consent as a way to begin, not as a reason to keep the family out.

Inpatient treatment at thirteen, and family-initiated treatment

• The minor's own consent. A minor thirteen or older may be admitted to inpatient mental health or substance use treatment on the minor's own consent, if the professional finds it clinically appropriate. The facility must notify the parent of the admission (RCW 71.34.500, 71.34.510).
• Family-initiated treatment. A parent may bring a minor of any age to an evaluation and treatment facility, a hospital, or an outpatient provider and request a determination of whether the minor needs treatment. If the professional finds that the minor has a mental health or substance use condition that would benefit, the minor may be admitted to inpatient treatment, or receive outpatient treatment, on the parent's consent and without the minor's consent, subject to review of continued inpatient need (RCW 71.34.600 and following). This is the route when a thirteen-year-old refuses care the parent believes is needed.
• Involuntary. A minor thirteen or older who presents a likelihood of serious harm or is gravely disabled may be detained under the involuntary treatment provisions of Chapter 71.34, which are outside the scope of this page.

What a parent is entitled to know

Washington's health information statute gives a minor thirteen or older control over the information about treatment the minor consented to (RCW 70.02.230, 70.02.240), consistent with HIPAA's deference to state minor-consent law (45 CFR 164.502(g)(3)). The 2019 amendments that created family-initiated treatment also allow a provider to share limited information with a parent to support that treatment, including the fact of admission, the diagnosis, and the treatment plan, without the minor's consent in defined circumstances; read the current text of Chapter 70.02 for the exact scope. Psychotherapy notes kept separately have their own protection under HIPAA.

For treatment the parent consented to, the parent is the minor's personal representative and may access the record, subject to those provisions. 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

Washington custody is set out in a parenting plan under RCW 26.09.184, which allocates decision-making authority for education, health care, and religious upbringing as sole or joint, and sets a residential schedule. Three practical rules follow:

• Ask for the parenting plan. If it gives one parent sole decision-making for health care, that parent's consent is the one that counts. If decision-making is joint, either parent can ordinarily consent to routine treatment, but a major decision one parent opposes is a dispute for the parents, and if necessary the court or the plan's dispute-resolution process, to resolve. Pause non-urgent treatment, document what each parent was told, and do not pick a side.
• Both parents have full and equal access to records. Under RCW 26.09.225, each parent has full and equal access to the education and health care records of the child absent a court order to the contrary, and neither parent may veto the other's access. The minor-consent limits above apply to both parents equally.
• The minor's own consent is unaffected by the parenting plan. A thirteen-year-old's right to consent does not depend on which parent the child lives with.

When the minor is at risk

Duty to protect. Washington's duty is the broadest in the country. In Volk v. DeMeerleer (Wash. 2016), the Supreme Court held that a mental health professional treating a voluntary outpatient owes a duty of reasonable care to all foreseeable victims of the patient, not only to a victim the patient has identified or threatened, and that whether a victim was foreseeable is a question for the jury. The statutory provision, RCW 71.05.120, limits a professional's liability for failure to warn to cases where the patient has communicated an actual threat of physical violence against a reasonably identifiable victim and provides that the duty is discharged by reasonable efforts to communicate the threat to the victim and to law enforcement; after Volk, the statute operates as a safe harbor for the identified-victim case rather than the outer limit of the duty. The practical standard is careful risk assessment at every visit, documentation of the reasoning, and action, which may include hospitalization, warning, and notifying police, whenever the assessment finds a foreseeable risk to a particular person.

Mandated reporting. Under RCW 26.44.030, practitioners, licensed counselors, social service counselors, psychologists, nurses, pharmacists, school personnel, child care providers, and the other listed reporters who have reasonable cause to believe that a child has suffered abuse or neglect must report to the Department of Children, Youth, and Families (1-866-363-4276, 1-866-ENDHARM) or to law enforcement at the first opportunity, and in no case later than forty-eight hours after there is reasonable cause. The duty is individual and is not satisfied by telling a supervisor. Failure to report is a gross 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.