Maryland Teenager Mental Health Consent: What Grandparents Need to Know

Mental health care for a teenager in kinship care is one of the most confusing consent areas in Maryland law. Three different rules can apply to the same child depending on the type of treatment and the teenager's age — and getting them wrong can delay care the child urgently needs.

The Age-12 Self-Consent Rule

Since October 1, 2021, Maryland law (Health-General § 20-104) allows minors aged 12 and older to consent to outpatient mental health therapy on their own. The treating clinician must determine the minor is mature and capable of informed consent. If those conditions are met, the teenager can start counseling, therapy, or outpatient treatment without your signature.

This means a 14-year-old grandchild can walk into a therapist's office, consent to treatment, and the therapist is not required to tell you about it. The minor controls the confidentiality — the provider can only share information with you if the teenager agrees, or if the clinician determines that withholding information would create a substantial risk of physical harm or deter necessary ongoing care.

The Psychotropic Medication Gap

Here is where the rules split. A minor aged 12 through 15 can consent to therapy sessions — but cannot consent to psychotropic medication. Health-General § 20-104(b)(2)(ii) explicitly excludes prescription medications for mental or emotional disorders from the self-consent rule for this age group.

So if a psychiatrist recommends an antidepressant or ADHD stimulant for a 13-year-old in your care, the teenager's consent is not enough. Someone with legal authority must sign off on the prescription.

If you hold a valid Health-General § 20-105 kinship care affidavit (Form DHS/SSA/554), you can consent to the medication. If you do not have the affidavit, and no parent or legal guardian is available to sign, the prescription stalls.

For minors under 16, the prescription-medication exclusion remains in place. At age 16 and older, that under-16 exclusion no longer applies. The gap between therapy consent and medication consent catches many families off guard.

What Your Kinship Affidavit Covers

A valid § 20-105 health consent affidavit gives you authority to consent to all routine medical care, including mental health care. You can:

• Sign intake forms for a therapist or psychiatrist
• Consent to psychotropic medication for a minor of any age
• Access the child's mental health records for treatment you authorized

But your authority does not override the teenager's own self-consent rights. If the teenager consented to therapy independently, the therapist's primary obligation is to the minor's confidentiality, not to keeping you informed.

When a Parent Objects

If the biological parent contacts the treating provider and explicitly objects to mental health treatment, the situation becomes more complicated. Under the kinship affidavit, a parent's objection overrides your consent authority for treatment you authorized. Care a minor independently consents to under § 20-104 follows separate rules, and the minor is the primary holder of confidentiality. A minor's self-consent does not include the right to refuse treatment or inpatient admission for which a parent or legal guardian has given consent.

Practical Steps

If the child in your care needs mental health support:

1. File the health consent affidavit (DHS/SSA/554) if you haven't already, signed and dated in the physical presence of a commissioned notary public — this is your baseline authority
2. For children under 12, use the affidavit for routine care; minors may still self-consent to services covered by § 20-102
3. For teenagers 12-15, they can consent to therapy but not medication — you'll need to be involved for prescriptions
4. For teenagers 16 and older, their self-consent authority is broader, but having the affidavit on file keeps your options open

Our Maryland School and Medical Consent Guide covers the full mental health consent framework, including the HIPAA implications and how to handle disagreements between the caregiver, the teenager, and a reappearing parent.

See more Maryland guides →