33.21 - Consent for mental health treatment of minors.

§ 33.21 Consent for mental health treatment of minors.    (a) For the purposes of this section:    (1) "minor" shall mean a person under eighteen years of age, but shall  not  include  a  person  who  is the parent of a child, emancipated, has  married or is on voluntary status on his or her own application pursuant  to section 9.13 of this chapter;    (2) "mental health practitioner" shall mean a  physician,  a  licensed  psychologist,  or  persons providing services under the supervision of a  physician in a facility operated or licensed by  the  office  of  mental  health;    (3) "outpatient  mental  health  services"  shall  mean those services  provided in an outpatient program licensed or operated pursuant  to  the  regulations of the commissioner of mental health;    (4) "reasonably  available"  shall  mean  a  parent or guardian can be  contacted with diligent efforts by a mental health practitioner; and    (5) "capacity" shall  mean  the  minor's  ability  to  understand  and  appreciate  the  nature  and  consequences  of  the  proposed treatment,  including the benefits and risks of, and alternatives to, such  proposed  treatment, and to reach an informed decision.    (b)  In  providing  outpatient  mental  health services to a minor, or  psychotropic  medications  to  a  minor  residing  in  a  hospital,  the  important  role  of  the  parents  or  guardians shall be recognized. As  clinically appropriate, steps shall be taken  to  actively  involve  the  parents  or guardians, and the consent of such persons shall be required  for such treatment in non-emergency situations, except  as  provided  in  subdivisions  (c),  (d)  and (e) of this section or section two thousand  five hundred four of the public health law.    (c) A mental health practitioner may provide outpatient mental  health  services,  other  than those treatments and procedures for which consent  is specifically required by section 33.03 of this article,  to  a  minor  voluntarily  seeking  such services without parental or guardian consent  if the mental health practitioner determines that:    (1) the minor is knowingly and voluntarily seeking such services; and    (2) provision of such services is clinically indicated  and  necessary  to the minor's well-being; and    (3) (i) a parent or guardian is not reasonably available; or    (ii)  requiring parental or guardian consent or involvement would have  a detrimental effect on the course of outpatient treatment; or    (iii) a parent or guardian has refused to  give  such  consent  and  a  physician  determines  that  treatment  is  necessary  and  in  the best  interests of the minor.    The mental health practitioner shall fully document  the  reasons  for  his  or  her determinations. Such documentation shall be included in the  minor's clinical record, along with a written statement  signed  by  the  minor  indicating  that  he  or  she is voluntarily seeking services. As  clinically appropriate, notice  of  a  determination  made  pursuant  to  subparagraph  (iii)  of  paragraph  three  of  this subdivision shall be  provided to the parent or guardian.    (d) A mental health  practitioner  may  provide  a  minor  voluntarily  seeking  outpatient  services  an  initial interview without parental or  guardian consent or involvement to determine  whether  the  criteria  of  subdivision (c) of this section are present.    (e)  (1)  Subject  to  the  regulations  of the commissioner of mental  health governing the patient's right to object to treatment, subdivision  (b) of this section and paragraph two of this subdivision,  the  consent  of  a  parent  or  guardian  or  the  authorization  of a court shall be  required  for   the   non-emergency   administration   of   psychotropic  medications to a minor residing in a hospital.(2)  A  minor  sixteen  years  of  age  or  older  who consents may be  administered psychotropic medications without the consent of a parent or  guardian or the authorization of a court where:    (i)  a  parent  or  guardian is not reasonably available, provided the  treating physician determines that (A) the minor has capacity;  and  (B)  such medications are in the minor's best interests; or    (ii)   requiring  consent  of  a  parent  or  guardian  would  have  a  detrimental effect on the minor, provided the treating physician  and  a  second physician who specializes in psychiatry and is not an employee of  the hospital determine that (A) such detrimental effect would occur; (B)  the minor has capacity; and (C) such medications are in the minor's best  interests; or    (iii)  the  parent  or  guardian  has  refused  to  give such consent,  provided the treating physician and a second physician  who  specializes  in  psychiatry and is not an employee of the hospital determine that (A)  the minor has capacity; and (B) such medications are in the minor's best  interests. Notice of the decision to administer psychotropic medications  pursuant to this  subparagraph  shall  be  provided  to  the  parent  or  guardian.    (3)  The reasons for an exception authorized pursuant to paragraph two  of this subdivision shall be fully  documented  and  such  documentation  shall be included in the minor's clinical record.