“Are You Going to Tell My Parents?” Confidentiality in Child and Adolescent Psychiatry

If you're a teenager seeing a psychiatric provider, there's a good chance you've wondered:

“Are you going to tell my parents everything I say?”

And if you're a parent, you may be wondering:

“Wait…you're not going to tell me everything my child says?”

Welcome to one of the trickier parts of child and adolescent psychiatry.

The short answer is: some conversations can stay private, while other things may need to be shared.

Exactly what stays confidential depends on your age, the situation, the type of care you're receiving, and the laws in your state.

Why are you asking my parent to leave the room?

Don't worry — you're not in trouble.

It's normal for psychiatric providers to spend some time talking with teenagers privately.

Teenagers may be more comfortable discussing depression, anxiety, relationships, bullying, substance use, sexuality, trauma, or what's happening at home when a parent isn't sitting next to them.

And, let's be real, sometimes the answer changes when Mom or Dad leaves the room.

Private time gives teenagers a chance to learn how to talk about their own health and gives us a better picture of what's actually going on.

So…what will you tell my parents?

We don't need to give your parents a play-by-play of every conversation.

If you tell me you had an argument with your best friend, you're stressed about school, or you're embarrassed about something that happened on a date, that doesn't necessarily mean I'm going to repeat the entire conversation to your parents.

But confidentiality has limits — especially when safety becomes a concern.

If you tell me something that makes me seriously concerned that you could hurt yourself or someone else, I may need to involve your parent or guardian so we can keep you safe.

That doesn't mean you're in trouble.

It means we're going to work together to figure out what you need.

“What if I'm having suicidal thoughts?”

Please tell us.

Having suicidal thoughts does not automatically mean you're going to the hospital.

We're going to ask more questions: Do you actually want to die? Have you thought about how you would do it? Do you intend to act on it? Do you have access to what you would use? Do you feel like you can keep yourself safe?

Those answers help us understand how serious the situation is.

If I'm concerned about your safety, I may need to involve your parent or guardian. That might mean making a safety plan together, increasing supervision, securing medications or other potentially dangerous items, arranging closer follow-up, or getting emergency help when necessary.

The goal isn't to get you in trouble.

The goal is to keep you safe.

“What if I drink or use drugs?”

Tell us.

We're psychiatric providers, not undercover detectives.

We're much more interested in whether alcohol or drugs are affecting your mood, medications, judgment, or safety than in getting you in trouble.

But if your substance use is putting you in serious danger, we may need to involve a responsible adult.

The exact confidentiality rules for substance-use treatment can also vary depending on your age, the type of treatment, and state and federal law.

“What if someone is hurting me?”

This is an important exception to confidentiality.

Healthcare professionals are mandated reporters. If we reasonably suspect that a child is being abused or neglected, we may be legally required to make a report.

If you're nervous about telling us something, you can ask first:

“Before I tell you, is this something you would have to report?”

That's always a reasonable question.

What about sex and relationships?

This one depends heavily on state law and the circumstances.

Different states have different rules about minors and confidential services involving sexual health, pregnancy, contraception, and sexually transmitted infections. Age differences, coercion, exploitation, or abuse can also change what a provider is required to do.

If you're unsure, ask us what the rules are before you share the details.

A note for parents

If your child's psychiatric provider asks you to leave for part of the appointment, we're not trying to cut you out.

Parents and caregivers are incredibly important in child and adolescent mental healthcare.

But giving teenagers some appropriate privacy can make them more willing to talk honestly about what's happening.

The goal is to balance both: giving teenagers a safe place to talk while involving parents when their support is needed — especially when safety is at risk.

The bottom line

Teenagers deserve a place where they can talk honestly about their mental health.

Parents deserve to know when something is happening that seriously affects their child's health or safety.

And psychiatric providers have to balance both.

Sometimes a conversation can stay private. Sometimes we have to say:

“This is something we need to bring your parent into.”

When that happens, whenever possible, I like to involve the teenager in deciding how we're going to have that conversation, rather than surprising them.

Because confidentiality isn't about keeping secrets from parents.

It's about creating enough trust for teenagers to tell us what's really going on — while making sure that when they need help staying safe, they get it.

This article is for general educational purposes and is not legal advice. Laws regarding minor consent, parental access to health information, confidentiality, and mandatory reporting vary by state and individual circumstances. Ask your healthcare provider about the rules that apply where you receive care.