SINGAPORE: Mental health practitioners are calling for younger teenagers to be allowed to seek counselling without parental consent, saying some youths who approach them for help ultimately walk away because they are unwilling or unable to involve their parents.
Some practitioners want the threshold lowered to as young as 13 or 14, as the government works on guidelines on parental consent for mental health services.
Current practices vary depending on where young people seek help.
Callers to the national mental health helpline 1771 can remain anonymous, while community-based providers generally do not insist on parental consent before providing counselling and support.
But schools are more likely to require parental consent before formal counselling begins, reflecting their approach of maintaining a strong partnership with families.
General mental health providers also typically seek parental consent before treating those under 18, in line with professional guidelines.
Practitioners say the issue has become more pressing as more young people independently seek professional help, amid greater awareness of mental health and reduced stigma around counselling.
Dr John Lim, chief well-being officer at the Singapore Counselling Centre, said the centre recently had to turn away two teenagers, aged 14 and 15, because they did not want to obtain parental consent.
“When we highlighted the need for parental consent, they were most reluctant. Hence, we couldn't proceed and they did not come back again with the parental consent form,” he told CNA.
While the centre has seen more parents bringing their teenagers for counselling, it has also seen an increase in young people turning up on their own, he added.
Dr Lim wants youths from the age of 13 to be able to seek counselling without parental consent, saying many at that age are capable of recognising when they need professional support.
"A lot of them actually know what they want. They see the need to speak to a professional counsellor, they want a human to confide in … and not just talk to ChatGPT as a form of support,” he said.
Some may be reluctant to seek parental consent because of stigma or because they do not want their parents to know about the problems they are facing. In some cases, the difficulties may involve one or both parents, Dr Lim said.
“There are cases where counsellors … realise it's not so much the youth that needs counselling, it's actually the parents,” he said.
Some parents are receptive when this is raised and counselling can develop into family therapy, which Dr Lim said has been constructive.
Allowing youths to get help early could also prevent emerging mental health problems from becoming more serious, he said.
“Many youths experience a lot of anxiety. We do not want it to be developed into a clinical issue, like clinical depression or generalised anxiety disorder,” he said.
“The key is we need to mitigate it, especially on the onset of those mental health challenges. So professional counselling, thought therapy, psychotherapy, can be very helpful.”
“AN EXTRA PAIR OF LISTENING EARS”
Counselling psychologist Geraldine Tan, director of The Therapy Room, has similarly had to turn away clients under 18 who refused to obtain parental consent.
She said she has noticed a shift in how young people view counselling, including youths approaching her on behalf of friends.
“They say, ‘I think my friend needs it. Can they come to you?’ This is a very heartening change from before, when it was taboo and they feel that the resources are out of reach,” she said.
Young clients approach her with concerns ranging from family and friendship problems to academic stress and existential crises.
Dr Tan said 14 is the age typically suggested by mental health professionals for youths to be able to seek counselling independently.
“At 14, there’s a little bit more maturation. They’ve moved to a different developmental age group. There's a lot of hormonal changes,” she said. “A lot of changes in their friendships, their understanding of things. So that's quite a turbulent time for them.”
But she hopes the upcoming guidelines will not impose age restrictions, so children of any age can approach mental health professionals for help.
“I would say that anybody can walk into the doctor's office, right? So why can't anybody walk into a mental health (facility) or to a psychologist, who's your emotional doctor?” She asked.
CONSENT ONLY PART OF THE ISSUE
For many young people, however, getting through the counselling room door is only the first step. What happens to the information they disclose can be just as important.
Ms Roseanne Yeong began seeing her school counsellor at 13, mainly about problems she was experiencing at home.
But her sense that counselling was a safe and confidential space was later damaged when the counsellor spoke to her parents about what she had disclosed without first informing her.
“When I found out that the counsellor had contacted my parents and did not let me know beforehand, it really shattered that trust I had in the counsellor,” she said.
Afterwards, she became more selective about what she discussed.
“After I knew what were certain things that would get me reported to my parents, I tended to not touch on those topics anymore because I was not ready to share that part of myself with my parents, especially because we were not on great terms,” she recalled.
Ms Yeong, who is now a psychologist working with people with intellectual disabilities, said allowing children greater access to mental health services would be a positive step, but decisions over parental involvement should be made case by case.
Parents or another family member may need to be informed if a child is at risk of suicide, self-harm or harming others, for example.
“Let's say a child is actively dealing with suicidal ideation, then in that case, it would be good for a family member to know,” she said, as that person could keep a closer watch on the child.
But the considerations would be different if, for instance, the child was experiencing abuse at home, she said.
She suggested such decisions could be reviewed by a professional such as a case manager.
TOWARDS CLEARER CONSENT GUIDELINES
Health Minister Ong Ye Kung said last week that there needs to be a balanced approach that acts in a young person's best interests while safeguarding their well-being.
“The right system is one that lets a young person enter through a safe door, and then involve the family appropriately as the care journey progresses,” he said.
The Singapore Medical Council is revising its ethical guidelines to provide doctors with clearer guidance on parental consent. The Ministry of Health is also developing guidelines on parental consent for various service providers. Public views will be sought in the coming weeks.
Mr Ong encouraged young people who are struggling to continue to seek help.
“It is important to know that asking for help is an act of responsibility, and not a disappointment to your family. You do not need to work everything out by yourself. Start by speaking to someone you trust and are most comfortable with,” he said.
He also urged parents to give their children time and space if they are not immediately ready to confide in them.
“When they do speak, you can’t judge too early. When it comes to mental health, patience is often the most important support we can give them,” he said.