Coalition still lacking joint position on minor access to psychiatric care ({{contentCtrl.commentsTotal}})

Teenage girl taking state exam. Photo is illustrative.
Teenage girl taking state exam. Photo is illustrative. Source: Priit Mürk/ERR

Allowing minors to access psychiatric help without parental consent has become an acute political issue, on one side of which is the view that minors are under the guardianship of their parents until they turn 18, and on the other the view that minors should be granted increasing, age-appropriate rights to make decisions regarding their own lives.

A seemingly innocent legislative amendment — aimed at granting minors the right to seek psychiatric help without their parent or guardian's knowledge — has become the plaything of a political dispute in which positions are shaped by worldviews. According to one, conservative view, a minor is a ward of their parents in everything until they turn 18, and without the permission of the latter should not decide or do anything of their own volition.

Another view on children's rights calls for the gradual granting to minors of increasing, age-appropriate rights to make decisions regarding matters affecting their lives. Six years ago, 16-year-olds were granted the right to get an abortion without their parent's knowledge, but to this day, a minor cannot make an appointment with a psychiatrist without their parents' permission. In a situation where a young person may need help due to their parents' harmful actions or neglect, they would not get the help they need.

The opposition is enraged by the robust blocking of the issue in the coalition: the bill introduced by the Social Democratic Party (SDE) simply collected dust for four months in the drawer of Riigikogu Social Affairs Committee chairman Tõnis Mölder (Center), who continued to put off adding the bill to the committee's agenda. Until the final week of the spring session. The committee finally began handling the bill, but it will no longer reach the Session Hall of the Riigikogu before fall.

Coalition's position unclear

The primary fear of MPs of the Conservative People's Party of Estonia (EKRE) was that by granting minors permission to see a psychiatrist without their parents' knowledge, this would open up a Pandora's box of sex reassignment. In order to help quell their fears, MPs from the SDE and Reform parliamentary groups invited a string of experts involved in children's mental health-related matters representing the positions of 36 nonprofits, including sexologist Imre Rammul, Ombudsman for Children Andres Aru, clinical psychologist and nonprofit Peaasi director Anna-Kaisa Oidermaa and Ministry of Social Affairs adviser Ingrid Ots-Vaik.

They all explained that the amendment is in young people's own interests, and that politicians' fears that children would now start independently changing genders are ungrounded as, for one thing, minors are not permitted to undergo sex reassignment, and for another, sex reassignment doesn't fall under the Mental Health Act and involves a much broader circle of specialists than just a psychiatrist.

In addition to the specialists, EKRE had also invited Varro Vooglaid to the committee meeting as a representative of the Foundation for the Protection of Family and Tradition (SAPTK), despite the fact that he is not an expert in children's mental health.

"There is a considerable number of people with conservative worldview's in society who clearly and strictly respect family values," Social Affairs Committee chairman Tõnis Mölder (Center) said in a written comment to ERR justifying Vooglaid's involvement in the meeting. "Regarding SAPTK's positions, their approach is significantly more conservative than today's bill."

Mölder's response did not clarify, however, just how many people and whom exactly SAPTK represents, which would thus make it necessary for their opinion to be taken into account.

Also unclear based on his response is what the Center Party parliamentary group's position is regarding whether minors should be allowed to see a psychiatrist without their parents being informed. His response indicated support for the bill on one hand, but also the desire to be liked by EKRE, who doesn't support the bill in its current form, on the other.

"The Center Party parliamentary group supports the idea behind the bill, but first it is crucial to find a balance between various worldviews," Mölder said, nonetheless adding that not a single worldview supports child abuse, and that everyone needs to be administered emergency medical care, including psychiatric care, if there exists a risk to their health or life. "In any case, this is a nice bill, but it is important that this bill fulfills the best possible objective."

He believes that the bill needs to be improved and clarified.

"Especially when it comes to whether and how a trusted adult (not just a parent) is involved if a child seeks psychiatric help on their own," he explained. "If a doctor believes that a child needs help but their parents for whatever reason don't provide their consent, then this is a problem that needs resolving. The worst is a situation in which trauma a child has experienced is caused by their parents' actions or neglect. Such as in a situation where a child is abused by one parent, but by law, the child needs their parent's consent to see a psychiatrist. In such a situation, the child must have the opportunity to receive help without their parent's consent."

The committee chairman also said that it is important to consider whether exceptions should be granted in difficult cases and children should be allowed to see a doctor without parental consent or whether all children should be subject to the same principle.

If the Center Party seems to be rather in favor of supporting the bill, what does the Isamaa parliamentary group think of the issue? Their position is even more ambiguous.

"We constantly spoke of exceptions at the committee meeting, but the bill would change the general legal norm," Isamaa parliamentary group chairman Priit Sibul said in a written comment to ERR. "Isamaa and I want to work toward regulating problem areas.

Sibul's position gets even more confusing with the sentences that follow: "The role of parents and families in identifying and solving problems is important and necessary," he said. "This has also been the understanding of the specialists involved."

While the first of these two sentences rather hints at the need for parental control over minors' activities, the sentence to follow is misleading of the public. In reality, the specialists involved found that teenagers can gradually begin to be granted decision-making powers when they are sufficiently mature. The specialists didn't believe that parents' decision-making powers should prevail; rather, they supported the bill.

Sibul nonetheless recognized the need to allow for exceptions. "If a problem has been caused as a result of a parent's/parents' actions or neglect, then it's naturally a different matter and a young person must have the opportunity to receive help from a specialist," he said. "The law must regulate these exceptions and opportunities, and that is what we are working with."

SDE MP Helmen Kütt, who waited four months to discuss this bill, fears that these stalling tactics may continue in the fall, should the discussion reach the Session Hall of the Riigikogu. Sibul promised, however, that the issue would nonetheless continue to be handled in the fall.

"We hope to find a solution to the issue raised as soon as possible during the fall session this year," the Isamaa MP said. "Young people and children are our future, and maintaining their good mental health should be the goal of all Estonian political parties."

Representing EKRE at the meeting were committee member Urmas Espenberg but also Kert Kingo. While they had the opportunity to ask the specialists present about their concerns, Espenberg confirmed to ERR that their position fundamentally remained unchanged. This position is broadly justified by the need to defend family traditions.

"EKRE's position has not changed, and we will continue defending the family as a fundamental value of society, but we are prepared for certain compromises, certain specific provisions in the law for when a child has been sexually abused or domestic violence has occurred and parental consent will of course not be forthcoming," he told ERR in a written comment. "Such cases exist, but not on a massive scale, and as a rule both support networks and law enforcement are aware of them."

On the other hand, however, Espenberg stuck to his original position.

"We certainly won't agree to punishing and restricting the rights of tens of thousands of proper parents to raising their children and their desire to contribute to their child's treatment," he said. "We certainly won't start granting general legal permission for all minors to at some point start running to psychiatrists and secretly consuming antidepressants and getting involved in other risky things without their parents' knowledge. These things should be done with the support of their families, whether this support is via parents or why not also siblings or grandparents. In order to get better, a child needs the support of their loved ones."

What, then, is the coalition's common position? It seems as though one doesn't exist yet, and a tug-of-war between various worldviews yet lays ahead.

"There have been no discussions regarding this matter in the coalition recently; this will apparently be postponed until fall," Espenberg said, adding that he was sad that daily Eesti Päevaleht (EPL) has been hysterical in its coverage of the topic, according to which "EKRE eats children." "This will not benefit normal debate."

One meeting won't change worldview

An ardent supporter of the bill, Reform MP Signe Riisalo, who previously worked for years in the field of child protection at the Ministry of Social Affairs, said that after a four-month wait, it has become clear that this is a difference in values.

According to Riisalo, MPs limited themselves at the meeting to asking the experts present questions; no common position was formed, due to which it was also difficult to understand what the coalition MPs' position was.

"Both sides' sincere wish is that every child has a caring parent by their side who will help their child get through life and their worries," she said. "Vooglaid and the people who invited him to the committee [meeting] prefer the traditional approach and a parent's power over their child, but the experts, the SDE and the Reform Party prefer the modern vision of children's rights in which a parent cares for, supports and helps their child, but allows a child to make more of their own decisions regarding their own lives as their competences grow."

She also called the fear expressed by EKRE, that minors cannot be permitted to see psychiatrists on their own or else they will start switching genders, absurd.

"When it came out in the Session Hall of the Riigikogu that the fear exists over minors' sex reassignment operations, then legally speaking that is absurd; there is no connection there," Riisalo stressed. "It isn't possible to tie a child's right to see a psychiatrist to a sex change."

The positions represented are values-based, she said.

"Values have been shaped over time on the basis of one's knowledge and experiences thus far, and it isn't possible to confute them with just one meeting," Riisalo said. "I, too, cannot be convinced with one meeting that traditional positions are necessary to restrict children's right to healthcare services."

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Editor: Aili Vahtla

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