Mental Health Legislation for those under the age of 18 Greg Richardson Consultant in Child and Adolescent Psychiatry Lime Trees CAMHS, York

What is your course of action? A 14 year old girl has run away to live with a 35 year old man she has met on the internet. Having been removed from his home and returned to the care of her mother, she has again run away and is on a bridge over a motorway threatening to throw herself off if she cannot return to the man she loves. She is brought by the police to A & E and you are asked to see her and detain her under the Mental Health Act.

What is your course of action? A 17 year old young woman suffering from anorexia nervosa for a year has a BMI of 14, bradycardia and hypotension. Her parents wish her to be admitted to hospital. The young woman, who is terrified of weight gain, when asked her view on admission says “Do not make me make the decision”.

Acts relevant to children and young people The Children Act 1989, 2004, The Human Rights Act 1998, The Mental Capacity Act 2005 although this has limited relevance to those under 16, The Mental Health Act 1983 as amended in 2007.

The Welfare Checklist Ascertainable wishes and feelings of the child, Child’s physical, emotional and educational needs. Effect on the child of any change in circumstances. Child’s age, sex, background. Any harm the child has suffered or is likely to suffer. Capability of the child’s parents to meet the child’s needs. The range of powers available to the court.

Safeguarding children is “Everybody’s business”

Mental Capacity Act 2005 Understand the information relevant to the decision To retain the information To use or weigh the information as part of the process of making the decision To communicate his decision

Background principle The Children Act is used to safeguard the child’s welfare The Mental Health Act is used to ensure that the young person or others do not come to harm as a result of the young person’s mental illness.

Considerations in relation to young people Best interests of the child or young person Keeping the young person fully informed Taking into account their wishes The least restrictive option Providing access to education. The right of young people to dignity, privacy and confidentiality The provision of facilities geared to their developmental needs

Considerations in relation to young people Who has parental responsibility and what are their views? If parents are separated, with whom does the child live, is there a Residence Order and should contact be made with both families? What is the child’s capacity for decision making, offering consent to, or refusing, treatment?

16 and 17 year olds If a young person of 16 or 17 refuses admission, they cannot be admitted under parental consent. If a young person of 16 or 17 is to be detained, i. Do they have a preference for being placed on an adolescent or adult ward? ii. Would their interests be better served by being placed on an adult ward nearer their family or an adolescent unit further from their family?

16 and 17 year olds The amendments in the 2007 Mental Health Act introduce requirements for hospital managers to provide suitable facilities for the younger patient aged 16 – 18, including guidance on segregation, staffing, routine and access to education Emergency treatment can and should always be given if delay would be dangerous.

Detention of those aged under 16 If a young person under 16 is to be detained under the Mental Health Act, a bed must be found in a facility geared to meeting their developmental needs? It is not acceptable to place them on an adult psychiatric ward.

Conclusions Under 16s cannot be placed on adult wards. 16 and 17 year olds cannot be admitted at the wish of their parents. Facilities on wards where 16 and 17 year olds are placed must meet their developmental needs A CAMHS professional should be involved in the assessment of any-one under 18 for detention under the Mental Health Act, If not possible such a professional should be consulted as soon as possible afterwards

Cullen, D. & Lane, M. (2006) Child Care Law: A summary of the law in England and Wales. British Association for Adoption and Fostering. Family and Parenting Institute (2007) Is it legal? A parents’ guide to the law. Family and Parenting Institute. Harbour, A. (2008) Children with Mental Disorder and the Law. Jessica Kingsley. HM Government (2004) Every Child Matters: Change for Children. DfES Publications. Mitchell, M., Partridge, I. & Richardson, G. (2009) CAMHS and the Law. In Child and Adolescent Mental Health Services: An Operational Handbook eds. Richardson, G., Partridge, I & Barrett, J. RCPsych publishing. In press. National Institute for Mental Health in England (NIMHE) 2009 The Legal Aspects of the Care and Treatment of Children and Young People with mental disorder: A Guide for professionals. London References