2.3 Minor Consent & Confidentiality

Minor Consent to Outpatient Mental Health Treatment

In California, the general rule is that unemancipated minors (under age 18) cannot legally consent to their own medical or mental health treatment; their parents or legal guardians must provide consent. However, recognizing that requiring parental consent can act as a dangerous barrier to minors seeking critical mental health care, the Legislature created statutory pathways that allow mature minors to consent to their own outpatient mental health treatment. Two statutes govern this area — Family Code § 6924 and Health & Safety Code § 124260 — and, following the 2024 amendment described below, they now apply a nearly identical standard.

⚠️ CRITICAL 2024 LAW CHANGE (AB 665): Effective July 1, 2024, Assembly Bill 665 (Stats. 2023, Ch. 338) amended Family Code § 6924 to remove the long-standing requirement that a self-consenting minor also present a danger of serious harm to self/others or be an alleged victim of incest or child abuse. Study materials, memory aids, and older practice questions written before this date frequently still list the "danger or abuse" requirement — that framing is now outdated and incorrect. On a current California Law & Ethics Exam, do not select an answer that requires a minor to be dangerous or an abuse victim before they can self-consent.

Pathway 1: California Family Code § 6924 (as amended by AB 665)

Under current Family Code § 6924(b), a minor may consent to outpatient mental health treatment or counseling (or to residential shelter services) if both of the following are met:

1. Age: The minor is 12 years of age or older.
2. Maturity: In the opinion of the attending professional person, the minor is mature enough to participate intelligently in the outpatient services.

That is the entirety of the consent threshold. There is no longer any requirement that the minor be a danger to self/others or a victim of abuse. AB 665 deliberately aligned § 6924 with Health & Safety Code § 124260 to reduce barriers to youth mental health care, and also expanded the definition of a qualifying "professional person" (which includes LMFTs, LCSWs, LPCCs, licensed psychologists, and their registered associates).

Parental involvement (Family Code § 6924(d)): The treatment must include involvement of the minor's parent or guardian unless the professional person, after consulting with the minor, determines that involvement would be inappropriate. The therapist must document in the clinical record whether and when they attempted to contact the parent/guardian, whether the attempt succeeded, or the specific reason contact was deemed inappropriate (e.g., involving the parent would exacerbate risk or cause the minor to abandon needed care).

Statutory limits (Family Code § 6924(f)): Minor self-consent under § 6924 does NOT authorize a minor to receive psychotropic medication, convulsive therapy, or psychosurgery without the consent of the minor's parent or guardian.

Pathway 2: Health & Safety Code § 124260

Health & Safety Code § 124260 provides a parallel pathway with the same core standard: a minor 12 years of age or older may consent to outpatient mental health treatment or counseling if, in the opinion of the attending professional person, the minor is mature enough to participate intelligently in the services. Like § 6924, it requires the therapist to consult with the minor about involving a parent or guardian and to proceed without that involvement only when it is determined to be inappropriate, documenting the decision.

Historically, the two statutes differed (§ 6924 formerly imposed the danger/abuse gate and was tied to Medi-Cal funding, while § 124260 did not). After AB 665, the practical consenting standard is effectively the same under both. A common exam point is simply recognizing that a mature 12-or-older minor with, for example, mild anxiety and no safety concerns can lawfully consent to outpatient therapy on their own.

Privilege and Confidentiality for Self-Consenting Minors

When a minor lawfully consents to their own treatment under either statute, a profound legal shift occurs: the minor becomes the holder of the psychotherapist-patient privilege for those clinical records.

Because the parents did not consent to the treatment, they generally do not have legal access to the treatment records, nor can they authorize the release of those records to third parties. If a parent demands the records of a minor who self-consented, the therapist must ordinarily deny the request to protect the minor's confidentiality, releasing records only if the minor signs an authorization or a judge issues a court order. This dynamic lets a therapist accurately assure a self-consenting adolescent that their parents cannot read the clinical notes — barring safety exceptions such as mandated reporting or imminent danger to self/others.

Financial Responsibility and Billing

Under Family Code § 6924(e), parents or guardians are not liable for payment for services the minor consented to on their own, unless the parent participates in the treatment (and then only for services rendered with their participation). This creates a practical tension with health insurance: billing the parents' private insurance typically generates an Explanation of Benefits mailed to the parents, which would breach the minor's confidentiality by revealing the treatment. Consequently, self-consented minor services are commonly funded through Medi-Cal minor-consent programs, school-based or community-clinic funding, or out-of-pocket payment, unless the minor agrees to involve the parents in the financial arrangements.