Amber Reynolds’ son started showing signs of depression when he was 7.

At times he was almost catatonic, refusing to rise out of bed to eat, urinate or see a psychiatrist.

When he was 15, he was hospitalized for the first time for his mental illness. He had attempted to kill himself by running into traffic, his mother said.

Nearly four years later, Reynolds said her son, almost 19, still doesn’t have a proper diagnosis for rapidly intensifying symptoms of psychosis. She blames, in part, a state law that has routinely allowed him to refuse inpatient psychiatric treatment.

In Hawaii’s inpatient mental health system, the passage from child to adult happens at 15 — the age at which a person gains the legal right to decline psychiatric treatment from a hospital or other overnight facility despite a doctor or parent’s concerns.

Inpatient care is designed for people whose psychiatric treatment needs are too intense to be adequately managed in the community.

Reynolds said her son, who she says talks to apparitions in the trees and turns violent when he feels rejected or embarrassed, has long been in need of this level of care. But the law protects his right to refuse it.

In Hawaii, involuntary commitment to a psychiatric facility is rare. State-funded inpatient beds, such as at the Hawaii State Hospital, are almost exclusively for criminals.

As a result of not receiving adequate treatment, Reynolds said her son’s symptoms have worsened. He has recently tried to manage those symptoms with street drugs, which have further exacerbated his illness, she said. 

“When he was 15, at that point he should have been committed somewhere for like six months so he could get some tools to manage his mental illness,” said Reynolds, who lives in Kaneohe and works as a restaurant manager. “If I had had the choice to keep him in a mental hospital back then, I don’t think that he would be like this today.”

Civil Beat is withholding the name of the son at the request of his mother, who has a different last name.

Consent Laws By State

State laws governing a minor’s power to refuse mental health treatment greatly vary.

In Utah, parents can admit their child to an inpatient psychiatric or substance abuse treatment facility without their consent as long as the treatment is deemed necessary by a neutral party, such as a psychiatrist, psychologist or social worker.

But in many places the practice of forcing treatment on a young person is illegal. An NBC News investigation found that 40 percent of all states grant minors the power to refuse treatment, sometimes as early as the age of 12.

In Hawaii, anyone 15 or older can turn down inpatient psychiatric treatment regardless of a parent’s wishes or a doctor’s advice. 

The exception is when a person poses an imminent danger to themselves or others. In that case, the patient’s civil right to refuse treatment can be temporarily suspended. When the person no longer poses a threat that’s imminent, or after 48 hours expire, this right is restored. 

Dr. Taryn Park, a psychiatrist at The Queen’s Medical Center, said it’s not uncommon for young people in Hawaii to refuse treatment — inpatient or otherwise.

But Park said she doesn’t think her own efforts to provide psychiatric care to minors has been significantly inconvenienced by the law that grants minors consent for inpatient treatment starting at age 15.

Achieving compliance from a young patient is often a gradual process that requires engagement from the whole family, Park said. She focuses on creating a healthy family environment and helping family members function better within their relationships as a means of indirectly treating a youth without frankly challenging their treatment refusal.

“Sometimes, I’ll be honest, we do have to utilize the other resources in our community, whether that be working closely with the legal system as a last resort or child welfare services as a last resort,” Park said.

“But all really to guide the child back onto a healthier trajectory where they just don’t have the insight or maybe even the maturity to make those healthy decisions that adults would be making on their own.”

She notes some complications that come with giving decision-making authority to youth who may not grasp the long-term consequences of their treatment refusal.

“I will say each 15-year-old has their own developmental timeline and trajectory, so how mature or insightful one 15-year-old may be might be very different from another 15-year-old, or even a 17-year-old,” she said.

Defying A Doctor’s Orders

Laws that mandate a minor’s consent for inpatient treatment are designed to protect them. But they sometimes have the opposite effect, handing decision-making authority to someone who, due to age or mental illness, may not have the capacity to make good choices about their treatment.

Up to 20 percent of youth ages 12 to 17 experience a mental disorder in any given year in the United States, according to the Center for Disease Control and Prevention.

Research shows that early intervention can help reduce the severity and persistence of many of these illnesses. Timely treatment can also help prevent secondary disorders from developing.

Reynolds said she has seen the opposite trajectory play out with her son. Instead of getting better, he has gotten worse.

She blames the law that gave him the power to refuse treatment so young for impeding his chance at recovery from his symptoms of anxiety, depression and psychosis.

On occasions when he has been hospitalized against his will upon a doctor’s determination that he poses an imminent danger, Reynolds said her son has checked himself out of treatment as soon as the doctor deemed him stable enough to regain the power to refuse services. She estimates that his longest hospital stay has been about five days.

Other times he has fled treatment on foot. According to Reynolds, Kahi Mohala Behavioral Health in Ewa Beach banned her son from its treatment facility when he was 16 after he ran away twice.

A spokesperson for Kahi Mohala, which is part of the Sutter Health network, said no one was available to comment for this story.

“If my son broke his leg and I took him to the ER, the hospital would never just send him back home without fixing it,” Reynolds said. “But it’s like they were always sending him back to me with a broken bone and they expect me to know how to fix it.”

An 18th Birthday Brings Peril

Reynolds said her son has been so uncooperative with psychiatrists over the years that he has never received a diagnosis for his paranoia and hallucinations.

She said more than one psychiatrist has suspected that her son has schizophrenia. But his official diagnosis is anxiety, depression and oppositional defiant disorder.

“When the cops come to my house, which is once a week, they ask me what’s his diagnosis and I tell them depression and anxiety because that’s what I have on paper,” Reynolds said. “But it’s much more than that. I needed a diagnosis years ago.”

Reynolds said her son’s hostile behavior has also prevented her and doctors from being able to find the right medication to help him effectively manage his symptoms. This, she said, is partly why he has turned to drugs.

“No one wants to be committed to a mental hospital unnecessarily,” Reynolds said. “There do need to be protocols, I get that. But when he was a minor, I could never force him to get help and it was really unfortunate.”

Now her son is a legal adult, drifting farther beyond her capacity to help.

Not long after his 18th birthday, Reynolds said her son started smoking methamphetamine, which has exacerbated his hallucinations and violent behavior. 

Since he started smoking meth less than a year ago, Reynolds said her son had his first bout of homelessness and his first two arrests — one for smoking meth in a public bathroom and another for violently assaulting her.

After the first arrest, Reynolds said she successfully convinced her son to voluntarily check himself into a treatment program at Poialani, a dual diagnosis treatment center in Kaneohe for people battling mental illness and substance abuse.

It was a major win. Reynolds had tried countless times to compel her son to check himself into treatment with no success. Finally, he agreed.

On his second day of treatment program, Reynolds said her son walked out because he wasn’t allowed to smoke cigarettes.

“It’s really unfortunate because we have way bigger issues with my son than him smoking cigarettes, because that’s his crutch,” Reynolds said.

Reynolds said her son’s mental illness has festered beyond her control. She fears she’ll never be able to help him regulate his symptoms.

He is currently in jail on charges of methamphetamine possession, according to public records.