Proposal to Allow Persons under 18 to Access Counselling or Screening without Parental Consent

1 Mr Ng Shi Xuan asked the Coordinating Minister for Social Policies and Minister for Health whether the Ministry will consider allowing children under the age of 18 to access Tier 2 low-intensity services such as counselling or screening by licensed practitioners, without parental consent, while retaining the requirement for parental consent for higher-risk interventions such as medication or hospitalisation.

2 Mr Ng Shi Xuan asked the Coordinating Minister for Social Policies and Minister for Health (a) whether the Ministry can provide an update regarding the study of the requirement for parental consent for children and young people below 18 or 21 to access mental health support; (b) which stakeholders have been engaged; (c) when is the study expected to be completed; and (d) whether the findings will be made public.

The Senior Minister of State for Health (Dr Koh Poh Koon) (the Coordinating Minister for Social Policies and Minister for Health): Mr Speaker, may I have your permission to answer Question Nos 1 and 2 together on today’s Order Paper?

Mr Speaker: Please proceed.

Dr Koh Poh Koon: Sir, our laws do not prescribe the permissible legal age for a young individual to seek mental health services or other medical services without parental consent. However, it is generally good practice for parents to be involved when mental health services are provided to young people. Part of the reason is that parents play a vital role in supporting their children’s well-being and their involvement in their children’s recovery journey is critical.

There has been feedback that the requirement of parental consent is one of the reasons why young people with mental health challenges hesitate to seek help. Indeed, the issue of requiring parental consent before seeking help and involving parents as part of the recovery journey, need not be conflated. The Ministry of Health (MOH) has convened an expert group to study this issue and develop guidelines on the subject. Key stakeholders including parents, youths and service providers were engaged, and their views will contribute towards shaping the guidelines.

One of the key issues we need to examine is whether for lower-level intervention that involves mostly befriending and emotional support, no parental consent may be required. However, if the objective is to encourage youths to step forward to seek help with their mental health challenges, this will need to be coupled with more proactive engagement and outreach to those who may need help.

We will provide more details when the guidelines are ready early next year.

Mr Speaker: Mr Ng Shi Xuan.

Mr Ng Shi Xuan (Sembawang): I thank the Senior Minister of State for his response. I would like to make a clarification. The Senior Minister of State spoke about emotional support. I think that is Tier 1 support. We are actually asking about the Tier 2 low-intensity services such as counselling by licensed practitioners. That is one. And then, does the Ministry have a clearer timeline on when the update will be and will the findings be made public on this review? I would also like to check with the Senior Minister of State, if there is no prescription on age, from my understanding working with the social service agencies, they also tend to feel that the requirement for this is quote opaque and wish to know what is the direction that MOH will take.

Dr Koh Poh Koon: Sir, I thank the Member for his supplementary questions. In terms of timeline, we will try to conclude the work of consulting with stakeholders and put up some framework or guidelines, hopefully, by early next year.

As Members can understand, this is a process that requires us to engage stakeholders and understand from their perspectives what would be helpful and what would be more of a deterrent. So, we will do this work seriously and put up something, hopefully, by some time early next year.

In terms of the different situations in which services need to be provided and how caregivers, including counsellors and social service agencies, can navigate this space and be clear about what kinds of roles they can play, I think what we will do is to provide these guidelines which will give a framework where the service providers be better guided in assessing the situations in which minors seek mental health support.

While I said earlier that parental support is a preferred approach for some of these services to be delivered, the guidelines do recognise that there may be specific circumstances in which requiring parental consent would deter a minor from seeking the help that they need. So, it is a balance that we need to strike. On the one hand, we want parental involvement, but sometimes, for the situation in which the minors are seeking help, it could be linked to their relationship with their parents as well. So, we do need to take a very sensitive approach to this. And I hope the guidelines and framework will give the service providers better clarity on how to navigate this space and be sensitive to the needs of both parents and children.

Mr Speaker: Mr Hoe.

Mr David Hoe (Jurong East-Bukit Batok): I thank the Senior Minister of State for his reply. I am asking this in the capacity as a member of the People's Action Party Mental Health Group. In my interactions with the social service agencies, one of them raised this concern: how do we ensure that those that are below 18, that as long as they are below 18, that this will be adopted? Meaning that if they are below 18, no parental consent will be needed. So, from the social service agencies' perspective, they do not need to reach out for parents to get their consent? Because when this is being adopted, then this will ensure higher accessibility to mental health services.

Dr Koh Poh Koon: Sir, as I said earlier in my reply, there is no legal requirement for consent even today. But what we want is to provide some guidance so that the social service agencies can be sensitive to the needs of both the child and the parents, and as good practice, to involve the parents sometime along the journey. Perhaps not right at the beginning, if it feels that it is quite sensitive for the child to even approach them for some assistance. But somewhere along the way, after a few consultations with the child, when the child has developed more confidence in the process and counsellor assesses that it is the right time to bring the parents into that recovery effort, then I think that is where the sensitivity needs to be applied and involve the parents gradually along the process and reconcile any challenges that the child may have with the parents if that is indeed the source where the mental stress is for the children. And I think this is a process where we need to rely on the expertise and experience of the counsellors to do this with sensitivity.