BILL ANALYSIS                                                                                                                                                                                                    



                                                                  SB 543
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          SENATE THIRD READING
          SB 543 (Leno)
          As Amended  September 3, 2009
          Majority vote 

           SENATE VOTE  :22-12  
           
           JUDICIARY           7-3                                         
           
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          |Ayes:|Feuer, Brownley, Evans,   |     |                          |
          |     |Jones, Krekorian, Lieu,   |     |                          |
          |     |Monning                   |     |                          |
          |     |                          |     |                          |
          |-----+--------------------------+-----+--------------------------|
          |Nays:|Tran, Knight, Silva       |     |                          |
          |     |                          |     |                          |
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          SUMMARY  :  Expands the rights of minors to receive outpatient  
          mental health treatment or counseling services.  Specifically,  
           this bill :    

          1)Defines "professional person" who can provide mental health  
            treatment or counseling services to a minor age 12 or over  
            pursuant to this legislation to include:

             a)   A designated mental health professional under specified  
               regulations;

             b)   A marriage and family therapist, as defined;

             c)   A licensed educational psychologist, as defined;

             d)   A credentialed school psychologist, as defined;

             e)   A clinical psychologist, as defined; 

             f)   A licensed clinical social worker, as defined; 

             g)   A marriage and family therapist registered intern, as  
               defined, working under the supervision of a licensed  
               professional, as defined; and,

             h)   A board certified, or board eligible, psychiatrist.









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          2)Notwithstanding any other provision of law, authorizes a minor  
            who is 12 years of age or older to consent to outpatient  
            mental health treatment or counseling, if the minor, in the  
            opinion of the attending professional person, is mature enough  
            to participate intelligently in the mental health treatment or  
            counseling services.

          3)Provides that the mental health treatment or counseling  
            authorized by this bill shall include involvement of the  
            minor's parent or guardian, unless the professional person,  
            who is treating the minor, after consulting with the minor,  
            determines that such involvement would be inappropriate.   
            Requires the professional person to state in the client's  
            record about the contacts with the parent or guardian or why  
            such contact is inappropriate.

          4)Provides that the minor's parent or guardian is not liable of  
            payment for the mental health treatment or counseling provided  
            by this bill, unless the parent or guardian participates in  
            the treatment or counseling and then only for such services  
            rendered with that participation.

          5)Specifies that this bill does not authorize a minor to receive  
            convulsive therapy or psychosurgery, as defined, or  
            psychotropic drugs without the consent of the minor's parent  
            or guardian.   

           EXISTING LAW  :

          1)Authorizes a minor who is 12 years of age or older to consent  
            to mental health treatment or counseling, except as specified,  
            on an outpatient basis, or to residential shelter services, if  
            the following two conditions are satisfied:

             a)   The minor, in the opinion of the attending professional  
               person, is mature enough to participate intelligently in  
               the outpatient services or residential shelter services;  
               and,  

             b)   The minor presents a danger of serious physical or  
               mental harm to himself or herself, or others, without the  
               treatment, counseling, or residential shelter services, or  
               the minor is an alleged victim of incest or child abuse.  

          2)Requires that a professional person offering residential  








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            shelter services make his or her best efforts to notify the  
            parent or guardian of the provision of those services.  

          3)Provides that the mental health treatment or counseling of a  
            minor must include the involvement of the minor's parent or  
            guardian unless, in the opinion of the professional person who  
            is treating or counseling the minor, the involvement would be  
            inappropriate.  

          4)Defines "professional person" who may provide mental health  
            treatment or counseling to minors.  

           FISCAL EFFECT  :  None
           
          COMMENTS  :  In 2004, California voters passed Proposition 63, the  
          Mental Health Services Act (MHSA), which provides increased  
          funding, personnel, and other resources to support county mental  
          health programs and monitor progress toward statewide goals for  
          children, adolescents, adults, and families.  Community  
          stakeholder groups consisting of consumers, families, and  
          service organizations identified various barriers to various  
          populations accessing not only for MHSA programs, but for all  
          mental health services.  The groups identified that, among other  
          things, requiring parental consent when a youth seeks mental  
          health counsel or treatment is a barrier to the youth getting  
          needed assistance.  This bill, sponsored by the National  
          Association of Social Workers, California Chapter, Mental Health  
          America of Northern California, GSA Network and Equality  
          California, seeks to address that barrier to needed services.

          According to the author, parental consent for mental health  
          services can create a barrier, especially in prevention and  
          early intervention programs where the youth may not be  
          experiencing serious physical or mental harm.  The author  
          asserts that this barrier is especially harmful to certain  
          populations of youth from abusive or neglectful homes, lesbian,  
          gay, bisexual, and transgender youth, youth from immigrant  
          families, homeless youth, and youth whose cultural backgrounds  
          do not condone mental health services.  The author states that  
          this bill will help ensure that youth do not have to wait until  
          their mental health deteriorates and their safety is compromised  
          by suicide, substance abuse, or violence to receive needed  
          services.
          Under existing law, minors age 12-17 may consent to mental  
          health treatment or counseling without parental involvement in  








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          particular instances.  The minor must be mature enough to  
          participate intelligently in the treatment or counseling, and  
          present a danger of serious physical or mental harm to self or  
          others, or be the alleged victim of incest or child abuse.  This  
          exception to the general requirement of parental consent is  
          fairly narrow in scope.   

          This bill expands the existing precedent in current law slightly  
          to allow youth to consent to outpatient mental health treatment  
          if the attending professional believes the youth is mature  
          enough to participate intelligently in the services.   
          Accessibility to mental health treatment or counseling can be  
          critical to youth who are struggling with difficult,  
          emotionally-damaging life circumstances.  Early intervention,  
          evaluation, and counseling can make a crucial difference in the  
          mental well-being of a minor.  It seems at odds with the public  
          policy of the state to require minors to reach a state of crisis  
          before allowing them to seek treatment without the consent of  
          their parents, especially when the parents themselves may be  
          contributing to the minor's mental distress.  Allowing minors  
          who are mature enough to engage intelligently in treatment and  
          counseling seems consistent with the other exceptions the  
          Legislature has already made in statute for minors to seek  
          services vital to maintaining their health and well-being.    

          Regardless of the maturity of the youth, this bill specifically  
          provides that the youth may not, without the consent of his or  
          her parent or guardian, receive convulsive therapy (electroshock  
          therapy), psychosurgery (which has historically included  
          prefrontal lobotomies, but more recently includes less invasive  
          techniques) or psychotropic medication (any medication capable  
          of affecting the mind, emotions, or behavior).  This limitation  
          ensures that while youth are able to receive necessary treatment  
          or services, there are clear and very reasonable restrictions as  
          to what may be done in the absence of parental consent.  

          Under current law, the mental health treatment or counseling of  
          a minor must include involvement of the minor's parent or  
          guardian unless, in the opinion of the treating professional,  
          that involvement would be inappropriate.  This bill requires  
          that the professional person, when considering the  
          appropriateness of the involvement of the child's parent or  
          guardian, must consult with the youth.  This will help ensure  
          that the professional has the necessary information from the  
          youth on which to base the decision.  This bill still favors  








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          parental involvement unless the involvement would be  
          inappropriate.  However, by knowing that the professional must  
          consult with them before seeking parental involvement, this bill  
          should help more youth be comfortable seeking needed mental  
          health services.  This bill also provides, like existing law,  
          that a parent or guardian is not liable for any costs of the  
          treatment or counseling, except to the extent that the parent or  
          guardian participates in the treatment or counseling.
           

          Analysis Prepared by  :    Leora Gershenzon / JUD. / (916)  
          319-2334 


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