Synopsis
Conduct a developmentally appropriate consultation with a young person, explain confidentiality and its limits, assess decision-making ability for the specific choice, involve parents safely, and disclose information only when consent, law or prevention of serious harm justifies it.
- Offer part of the consultation alone routinely, present it as standard care for adolescents, and arrange an independent interpreter rather than using a parent or partner.
- Explain at the outset that information is private but may be shared if the young person or someone else faces serious harm; never promise absolute secrecy.
- Assess competence for this decision now: can the young person understand, retain, use and weigh relevant information and communicate a choice free from coercion?
- A competent person aged 16 or 17 is generally presumed able to consent; someone under 16 may consent when they have sufficient understanding and intelligence for the proposed intervention.
- Encourage supportive parental involvement when safe, while recognising that a competent young person may accept care without parental knowledge in many circumstances.
- Before disclosing without consent, seek safeguarding or information-governance advice when time permits, identify the lawful and ethical justification, use the minimum necessary information and document who received it.
- Check private contact methods, portal access, letters, prescriptions, pharmacy collection and billing because an otherwise confidential consultation can be exposed operationally.
- Finish with a shared safety plan, clear follow-up and instructions for urgent help; competence and risk can change and must be reassessed when the decision or circumstances change.
Key red flags
A controlling adult who will not allow private conversation may indicate coercion, exploitation, trafficking or abuse rather than ordinary parental concern.
A request for absolute secrecy alongside suicidal intent, escalating violence, sexual exploitation or serious neglect requires an explicit safety assessment and senior safeguarding advice.
A sudden change in consent when another person enters, rehearsed answers, unexplained gifts, missing episodes or fear about a phone or online contact can reveal exploitation.
A young person who cannot understand or retain the central information may need supported decision-making and parental or legal authority, but lack of competence must not be assumed from age or diagnosis alone.
Information about a child who may be at risk can still require sharing when certainty is incomplete; clinicians should not make the young person responsible for deciding whether protection occurs.
Investigation priorities
Identify safety, health, relationships and support needs in a structured conversation.
Management branches
An adolescent attends with or without a parent, carer or partner.
- Explain routinely that every young person is offered some time alone and outline confidentiality with its safety limits.
- Use an independent interpreter and communication adjustments, then confirm safe contact details and record-access concerns.
- Invite the adolescent's agenda before completing symptom, psychosocial, coercion and safeguarding assessment.
- Ask permission before bringing a supportive adult back, unless urgent protection makes another course necessary.