Managing Health/Mental Health Independently and Communication Parameters for Families

Key points:

• Start talking with your student in early high school about going to college.
• Remember that young adults should become independent in managing their time and their health care.
• It is normal for parents to feel all kinds of emotions as they let go and encourage their student to become more independent.
• If your student needs health care services it is important for them to trust their health care providers. Knowing that they can talk to their providers confidentially helps them trust the system.
  • Be aware of the different types of consent that a student can agree to sign to allow communication
  • Consent to talk with the home doctor or counselor is useful
• Individual health information is confidential and is protected by a federal law called HIPAA.
• Information about your student’s actions or behavior on campus may be observed by non-health care administrative leaders, housing staff, or teachers. These are individuals that you might contact if you have concerns about your student’s behavior.

Learning to manage self-care and health
It is important to begin talking about personal responsibility during the early teenage years. You should encourage your child to manage time appropriately. This could include taking responsibility for activities such as homework schedules, sleep schedules, and participating in managing appointments with doctors, and taking medicine (if one is taking medicines). Some students are more responsible than others, and some students make more appropriate choices than others when given independence. It is important for parents to give opportunities for their student to be increasingly responsible during high school so that they can learn from their mistakes while they are still living at home and under family supervision.

Managing private health information
How can parents support their students while respecting their confidentiality? We encourage parents to talk with their young adult children prior to leaving home for college about how to take care of their health. There should be conversations about confidentiality laws and about the possible usefulness of parental input in relation to medical or mental health care. The conversation should include a discussion around the importance of encouraging the young adult to take charge of their own health care. Parents of students with known mental health issues should talk with their student about a joint meeting with the health care team at the college prior to the start of school. This can help to make certain that there is a realistic plan in place for ongoing care and that everyone agrees on how problems will be handled if and when they arise.

Young adults, which in the US means anyone over 18, have privacy protection for their health care information. This means that any sharing of information between a clinician and family member must be approved in writing by the young adult unless there is an emergency situation that justifies overriding the laws of confidentiality. Therefore, parents should talk with their student about signing consent for campus clinicians to talk with parents. Students should also be encouraged to sign consent for the doctor or counselor at college to talk with the doctor or counselor at home. This step increases the likelihood that treatment will be well coordinated and everyone who needs to be involved in major decisions will be part of the conversation.

When students sign a consent form allowing communication with parents or other important individuals, the release forms may give a list of choices for what a doctor or counselor may discuss and under what circumstances these discussion may happen.

Examples include:

• May call parents to obtain collateral (information about the student’s past health history or family history) information
• May give information to parents if they call asking for information
• May only tell the parent whether or not their student is attending appointments
• May only talk with parents on specific dates
• May only talk with parents about certain topics (such as not allowing any discussion of substance use)

It is important to keep in mind though that a student may change his or her mind and take away the consent to talk with others.

It is also important to be aware that even when there is no consent from the student a parent may still call the campus doctor or counselor to provide information or discuss a concern; the provider should accept the information but will very likely inform the parent that they “can neither confirm nor deny that the young adult is a patient at the clinic”. If a parent is concerned, they may reach out to counseling or health services to discuss their concern. Also, parents may contact the university Dean of Students or, on a residential campus, the University Housing Director, to discuss a concern about their student’s safety or well-being. These university representatives will not have direct access to medical or counseling information. They may be aware, however, that a student is struggling and can help parents find ways to help their student.

There may be situations in which there is a concern about safety or a hospitalization. The student needs to sign consent for the providers to inform parents of hospitalization. Typically hospitals encourage the student to allow contact with parents.

For more information on consent and helping your student manage their mental health in college read: Starting the Conversation: College and Your Student’s Mental Health

Written by, D. Catherine Fuchs, MD
Director Psychological and Counseling Center
Professor of Psychiatry
Child and Adolescent Psychiatry
Department of Psychiatry and Behavioral Science
Vanderbilt University