New Hampshire Minor Mental Health Consent: Therapy, Substance Treatment, and Confidentiality Rules

The Rules Are More Complicated Than You Think

You're raising a teenager who's dealing with trauma — maybe from the same family crisis that brought them to your home. They need therapy, possibly substance treatment, and you're not sure whether you can authorize it or whether the teen can seek it on their own. In New Hampshire, the answer depends on the type of treatment and the child's age.

There's no single consent age for all mental health services. New Hampshire splits the rules by service category, and the confidentiality protections vary with each one.

Substance Abuse Treatment: Age 12 and Up

Under RSA 318-B:12-a, any minor aged 12 or older may voluntarily submit to treatment for drug dependency or a problem related to drug use. The statute permits treatment at a municipal health department, state institution or facility, public or private hospital or clinic, with a licensed physician or APRN practicing within that professional's specialty, or through another accredited state or local social welfare agency, without consent from a parent, guardian, or other person charged with the minor's care or custody.

The statute sets these protections:

• Treatment records and information are not discoverable by the State in a criminal prosecution
• Records may be used only for rehabilitation, research, statistical, or medical purposes unless the treated person gives written consent
• Parents and legal guardians are not liable for payment for treatment under this section

This means a 14-year-old can seek this treatment without consent from a parent, guardian, or other person charged with their care or custody; the statute separately limits how treatment records may be used.

STD Diagnosis and Treatment: Age 14 and Up

RSA 141-C:18, II allows a minor aged 14 or older to seek diagnosis and treatment for a sexually transmitted disease without the knowledge or consent of a parent or legal guardian. It also allows a licensed physician to diagnose, treat, or prescribe for the minor without that knowledge or consent.

General Outpatient Therapy: Parent or Guardian Consent Required

Here's where it gets complicated for kinship caregivers. General outpatient psychotherapy and mental health counseling — the bread-and-butter therapy that a trauma-affected child typically needs — requires parental or guardian consent in New Hampshire.

A 2023 legislative effort (House Bill 114) attempted to allow 16-year-olds to consent to outpatient mental health treatment without parental permission. It failed in the Senate. So the status quo stands: for general therapy, someone with legal authority over the child must consent.

If you're an informal caregiver without a court order, this creates a catch-22. The child needs therapy, you can see it every day, but you may not have the legal standing to authorize it. Your options:

• Get a written authorization from the parent specifically for mental health treatment
• Use a temporary agent appointment under RSA 461-A:19-a — if properly executed with the parent's signature, it can cover mental health consent
• File for guardianship under RSA 463 — a court-appointed guardian may consent to necessary medical or other professional care, subject to statutory and court-order limits

The In re Berg Ruling and Therapist-Client Privilege

The New Hampshire Supreme Court's decision in In re Berg, 152 N.H. 658 (2005), established that therapist-client privilege applies to minor patients. This means that during custody disputes or guardianship proceedings, a parent or guardian cannot automatically access the child's psychotherapy notes.

For kinship caregivers, this has practical implications: even if you have legal authority to consent to therapy for the child, the therapist may limit what they share with you about session content. The child's therapeutic relationship is protected, and that protection serves the child's interest in being candid with their therapist.

What About Emergency Psychiatric Care

When a child is in acute psychiatric crisis — suicidal ideation, self-harm, psychotic episode — emergency treatment follows the same emergency doctrine as physical health emergencies. Care required to prevent severe harm should not be delayed for consent paperwork. Hospital emergency departments will treat first and sort out authorization after the child is stabilized.

Putting It Together for Kinship Caregivers

The layered consent system means that a teenager in your care may be:

• Receiving substance treatment you don't know about (and legally can't be told about)
• Able to get STD care independently
• Unable to start regular therapy without consent from a parent or legal guardian

If the child needs general therapy and you don't have legal authority, prioritize getting that authority — either through a parental delegation or a guardianship petition. The School and Medical Consent Guide for New Hampshire maps every consent pathway by treatment type and age, including the specific documentation providers will ask for.

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