AB 665 California: Teen Mental Health Consent Without Parent or Caregiver

What AB 665 Changed

Before Assembly Bill 665 took effect on July 1, 2024, California had two different standards for minors seeking outpatient mental health care. Medi-Cal-covered youth had to demonstrate they were in "serious danger of physical or mental harm" or were an alleged victim of abuse or incest under Family Code Section 6924. Privately insured youth only needed a clinician to find them mature enough to participate — a much lower bar under Health and Safety Code Section 124260.

AB 665 eliminated that disparity. Under current law, any minor aged 12 or older can consent to outpatient mental health treatment or counseling if the attending professional determines they are mature enough to participate intelligently. The insurance source no longer matters.

What This Means for Kinship Caregivers

If you are a grandparent, aunt, or other relative raising a teenager in California, AB 665 creates a situation where the child can access therapy independently — and you might not be told about it.

Here is how it works in practice:

The teenager can start therapy on their own. A 14-year-old seeking outpatient mental health treatment can consent without your signature if the treating professional finds them mature enough to participate intelligently. The clinician makes the maturity determination, not you.

The therapist must try to involve you — usually. Both Family Code Section 6924 and Health and Safety Code Section 124260 require the treating professional to involve the minor's parent, guardian, or relative caregiver in the treatment plan. The exception: if the clinician determines that involving you would be "clinically inappropriate" — for example, if the teen reports abuse, severe family conflict, or if disclosure could worsen their condition.

You may not see the therapy records. California's insurance privacy law (AB 1184, Insurance Code Section 791.29) prohibits health plans from sending Explanation of Benefits statements to the policyholder for "sensitive services" including mental health therapy. Digital patient portals like MyChart automatically restrict caregiver access when a minor turns 12, creating a "Teen Proxy Access" tier that blocks sensitive records.

What AB 665 Does Not Allow

Minor self-consent under AB 665 has hard limits:

• No psychotropic medications under AB 665. Psychotropic drugs require adult parental or guardian consent or a court order.
• Outpatient treatment or counseling. AB 665 does not authorize inpatient mental health treatment.
• Residential shelter services are separate. Family Code Section 6924 also lets a minor who meets the maturity standard consent to residential shelter services; that does not authorize inpatient mental health treatment.

How the Caregiver Affidavit Interacts With AB 665

The Caregiver's Authorization Affidavit (Family Code Sections 6550–6552) gives qualified relatives the authority to consent to routine medical and dental care. For a teen who needs therapy but is younger than 12, or who does not meet the maturity threshold, your affidavit is what authorizes the counseling.

For teens 12 and older who do meet the maturity standard, AB 665 creates a parallel path. The teen can consent independently; your affidavit may authorize other medical care within its scope. Where the tension appears is in records access: your affidavit gives you the right to discuss general care with providers, but the teen's self-consent to confidential therapy creates a privacy wall around those specific records.

Practical Steps for Caregivers

If you are raising a teenager and want to support their mental health access:

1. Talk to the teen directly. Let them know therapy is available and that you support it. If they know you are on their side, they are less likely to seek it behind a privacy wall.
2. Know the Medi-Cal pathway. Teens covered by Medi-Cal can seek outpatient care through their managed care plan. DHCS Behavioral Health Information Notice 24-046 requires plans to reimburse visits authorized under AB 665.
3. Do not demand portal access to therapy records. Pushing against AB 1184's privacy protections creates conflict and may cause the teen to disengage from treatment.
4. Distinguish between consent categories. You still consent to routine medical checkups, dental visits, immunizations, and non-mental-health prescriptions through your affidavit. AB 665 carves out only outpatient mental health.

Our California school and medical consent guide includes a detailed breakdown of how AB 665 interacts with the caregiver affidavit, what records you can and cannot access, and how to navigate the privacy boundaries without damaging your relationship with the teen.

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