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Feeling Shut Out: Staying Involved in Your Young Adult’s Behavioral Health Treatment after Age 18

Beth Hess - Monday, May 28, 2018

The transition to adulthood can be lengthy and difficult for young adults. Data shows that in 2014, 32.1% of 18–34 year-olds lived in their parents’ homes (Pew Research Center). This is the highest point in 75 years, and likely due to a variety of social and economic reasons.

For young adults with behavioral health challenges, the transition to adulthood can be longer and more difficult than for other young adults. The social and emotional delays often experienced by youth with behavioral health needs can interfere with the development of skills and capacities that are needed to successfully transition to adulthood and succeed in critical life activities, such as completing post-secondary education, holding down a job, and forming healthy and stable relationships.

Many families remain actively involved in the care of their young adult with behavioral health needs after their child turns 18. Along with providing room and board, caregivers are often the ones who take their young adult to the emergency department when needed, deal with legal issues, arrange for behavioral health treatment, and pay co-pays and other treatment costs. They may help their young adult complete forms such as college applications, job applications, taxes, and applying for Medicaid.

Nonetheless, when your child turns 18, they become a legal adult, regardless of whether you feel they are ready for this status. Your young adult must act for themselves in all legal matters. They have the right to exclude you from receiving medical or financial information about them, and the right to exclude you from participating in decision-making processes. This can be a scary prospect for caregivers of young adults with behavioral health challenges. Their young adult may seem especially vulnerable.

There are ways for young adults to consent to the disclosure of confidential information and include caregivers in decision making. You may want to discuss these with your child and their providers before your child turns 18. Some options are:

Consent to share information: If your child agrees to allow their doctor or treating professionals to share information with you, they can simply write a statement to this effect, and, if they want, specify which information cannot be shared. They can revoke their consent at any time. It is hoped that providers encourage young adults to sign a consent, and revisit the topic periodically.

Advance Directive for Mental Health Services: Creating an Advance Directive for Mental Health Services is an empowering and proactive step for a person with mental health needs. In an Advance Directive, a person may:

  • Issue a treatment directive, in which they state their wishes regarding treatments or medications they do or do not want, providers they do or do not want, and who providers have permission to speak with. A treatment directive goes into effect when two physicians determine that the individual is mentally incompetent
  • Name a health care agent to receive and share medical information about them, and/or to make treatment decisions for them. This can go into effect whenever the individual chooses – either immediately after being witnessed, or when the person is declared medically incompetent by two physicians
You should know, however, that an individual may revoke their mental health advance directive at any time – even in the event that they are found incompetent to make decisions. Click for the Maryland form for an advance directive.
Guardianship is an extreme measure that is unlikely to be the best option in most situations. In guardianship proceedings, a petitioner (usually a family member or friend) asks the court to find that a person is unable to manage their own affairs because of a disability. If the court agrees, it appoints someone to act for that person and make decisions for them. There are a number of reasons not to seek guardianship of a young adult with behavioral health needs. Guardianship:
  • Deprives the person of the right to make virtually all personal and/or financial decisions
  • Can only be granted after all less restrictive measures can be shown to have been tried and failed
  • Must be determined in a court by a judge. Laws differ by state and Maryland has very restrictive laws; it is quite difficult to be granted guardianship, especially for a person with behavioral health challenges 
  • Is costly and time-consuming
  • Potentially sets up an adversarial relationship with your child, who will have a court-appointed attorney represent them during the court hearing
Being shut out of your young adult’s behavioral health treatment after they turn 18 need not be inevitable. Consents to share information and Mental Health Advance Directives are both tools that can be used to facilitate communication between you and your young adult’s providers and enable you to participate in their treatment.


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