High schools, doctor-patient confidentiality, and mental health

DancingMaenid · Sep 19, 2011

I've tried to look into this, but I'm having a hard time even knowing where to look. Basically, to what extent do American public schools tend to involve themselves in the private health matters of students, in this case mental health? How much can they involve themselves?

My MC is a seventeen-year-old high school student who's being treated for depression. He recently spent a brief time in the hospital following a suicide threat. All this happened mainly over the summer, so he didn't have to take any time off school and his school wasn't involved.

But now that he's going back to school in the fall, would his school know anything about his hospitalization and current treatment? If he and his family don't tell them, they wouldn't know, right? But would they want to be informed, and would they be able to do anything, like make him see a counselor at school?

If they found out through "unofficial" channels, like students finding out and talking about it, would they want to talk to the MC about it?

Or would they just ignore it as long his behavior and performance at school is okay?

The plot can work either way, but I had some ideas that hinge on this, and I'm not really sure what's plausible. Thank you so much!

Wiskel · Sep 20, 2011

I can't answer for the USA but in England they wouldn't be told through official channels unless the family, and in particular the young person wanted them to be.

The main reason for choosing to tell them would be so that they could support the young person going back. Depression effects concentration and energy, so if the YP was struggling over the holiday one might assume they'd need a little support in a situation where more was expected of them.

In England all schools have a school nurse who could offer some support. English schools don't have anyone who'd call themselves a counsellor but they often have enthusiastic teachers. The most likely support for us to set up would be a named teacher who was liked and trusted by the YP, we'd tell them as much as the YP wanted them to know and arrange it so that the YP could approach them any time they wanted to. We might set up the same deal with the school nurse. Sometimes we set up a card system where we give the YP a card that allows them to leave the class by showing it to the teacher, then makes sure they won't be stopped and questioned on their way to see their support.

For increasingly more severe depression we might negotiate a staged return to school through a part time timetable

How much support the school offer, and whether they handle it well or badly, or are pushy or relaxed about it depends on the school's culture, which usually depends on the personality of the head.

It's increasingly common for people to find out about this even if they aren't told through offical channels. You'd be stunned how many people put these sort of things on facebook or twitter and later regret it. They may put up a goodbye message, or post about going to hospital, or even just spill their thoughts. Once one person at school knows then rumours usually spread.

Craig

Maryn · Sep 20, 2011

The US high school and middle school our kids attended had a child psychologist on staff, dividing his time between the two and occasionally working at the lower grades as well.

If teachers or counselors heard the gossip of your student hospitalized following a suicide attempt, they would have sought to involve the psychologist. The student would be considered 'fragile' (my word), in need of a place to turn during the school day when the emotional load was heavy.

The first step would probably be contacting the parents for permission to talk to him. Once that's given, whatever they discuss is entirely confidential, and no amount of parental pressure will make the psychologist violate that trust.

If the parents refuse permission, I'm pretty sure state law would determine whether the psychologist can approach a 17-year-old to make himself available if the student wants to talk, or if that's forbidden.

Maryn, not a lawyer

DancingMaenid · Sep 20, 2011

Thanks for the responses! It sounds like my assumptions are probably fairly close.

I had an idea about my MC meeting his love interest while waiting to talk to the school counselor/psychologist. But I'm not sure about that because 1) I don't think my MC would willingly talk to someone and 2) his father would definitely not grant permission.

Maryn · Sep 21, 2011

In the school district where our kids were educated, school counselors only deal with minor behavioral issues which are fully within the student's control. (Student talking back to the teacher, disrupting class, failing to attend, blowing off homework, like that.) The majority of the counselor's workday deals with such issues and with making sure each student in his or her caseload has the right classes and the proper number of credits to pass to the next grade, and information on the college application process, trade schools, etc. Here, they wouldn't be involved in the day-to-day dealing with a fragile student's emotional needs.

I'm lucky enough to live where there's a good school system reasonably well-funded, though, so if your plot needs the school counselor to do the best she or he can to help your depressed student, I suppose it could happen. The counseling might well be ineffective, though, with useless advice like "Snap out of it" which might help a moody teen but not a depressed one.

You'd have to determine the law for the state where your story is set to see if parental permission is required for age 17 to talk to a psychologist without parental permission. I think it's 16 here to make their own decision on such matters. And that would be for the psychologist only; no permission would be required to see the school counselor, regardless of the student's age.

Maryn, hoping to help

High schools, doctor-patient confidentiality, and mental health

DancingMaenid

New kid...seven years ago!

Wiskel

practical experience, FTW

Maryn

At Sea

DancingMaenid

New kid...seven years ago!

Maryn

At Sea