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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Consent, confidentiality and family involvement

Psychiatry · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

RapidFull
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Immediate danger changes the timescale, not the duty to reason

Imminent death, serious deterioration, suicide, violence, severe intoxication or medical collapse may require immediately necessary assessment or treatment before ordinary consent arrangements can be completed. If valid consent is absent or treatment is refused, do not relabel refusal as incapacity: identify the applicable emergency, court, mental-health or other lawful authority and obtain urgent senior advice.

Action: Protect life using only the immediately necessary and least restrictive intervention, obtain senior clinical and legal or safeguarding support as soon as possible, identify the applicable national law, and record the urgency, decision-making assessment, authority and alternatives. Explain what occurred afterwards and review whether continuing intervention needs a different lawful basis.

Synopsis

Make lawful, developmentally supported mental-health decisions with children and young people, preserve confidentiality without promising secrecy, involve families constructively, and recognise when emergency, safeguarding, mental-health or court authority requires senior advice.

  • Valid consent is voluntary, informed and specific to the decision at the time. The familiar understand, retain, use-or-weigh and communicate abilities are useful professional checks, but they are not one UK-wide statutory test; in England and Wales a sixteen- or seventeen-year-old lacks Mental Capacity Act capacity only when impairment or disturbance of mind or brain causes inability in one of those functions.
  • At sixteen and seventeen, presume capacity unless there is evidence otherwise. A child under sixteen may be able to consent when maturity and understanding are sufficient for that particular decision.
  • For an under-sixteen, Gillick is the common-law competence test in England, Wales and Northern Ireland. Scotland instead uses section 2(4) of the Age of Legal Capacity (Scotland) Act 1991: the attending qualified medical practitioner decides whether the child understands the nature and possible consequences of the proposed procedure or treatment.
  • Diagnosis, autism, learning disability, psychosis, self-harm, distress, family disagreement or an apparently unwise choice does not by itself establish incapacity or incompetence.
  • A competent child's or capacitous young person's valid consent is sufficient; a parent cannot veto it. If decision-making ability is absent, parental authority is limited by best interests and the scope of parental responsibility.
  • Confidentiality duties towards children and young people are as strong as for adults. Explain limits before sensitive discussion and do not promise absolute secrecy.
  • Consent to healthcare and decisions about disclosure are separate. Relevant information for direct care may ordinarily be shared on implied consent when the patient is informed, has not objected and the recipient owes confidence; otherwise identify and record the applicable basis.
  • If a child lacks sufficient maturity and understanding to decide about disclosure, necessary information may be shared for proper care or best interests. Respect a competent or capacitous objection unless law or overriding public interest justifies disclosure; information needed to protect anyone from death or serious harm should be shared promptly and proportionately.
  • Clinicians may listen to parents and carers without disclosing confidential information; receiving a concern is different from confirming the young person's diagnosis or account.
  • A competent refusal is handled differently across UK jurisdictions: never teach routine parental override, and obtain urgent legal advice for serious contested treatment.

    • Key red flags

    Never rely on parental agreement alone for an objecting young person who is restrained, confined, sedated or subjected to invasive treatment; obtain senior legal advice on authority and liberty.

    A request to keep suicidal intent, serious self-harm, abuse, exploitation or a threat to another person completely secret requires an immediate safety and information-sharing decision.

    Fluctuating consciousness, intoxication, psychosis, severe malnutrition, communication difficulty or acute distress may affect one decision now but must not be treated as proof of global incapacity.

    A parent who controls the consultation, demands records, interprets inaccurately, threatens the young person or may be the source of danger requires private assessment and safeguarding planning before disclosure.

    Disagreement about life-preserving treatment, sterilisation, abortion, prolonged restraint, deprivation of liberty or a competent refusal is not resolved by informal family consensus and needs specialist legal input.

    Investigation priorities

    01
    Decision-specific competence or capacity assessmentFirst step

    Identify age and jurisdiction, then apply the correct test: under-sixteen maturity and understanding under Gillick or Scotland's statutory rule; for sixteen- and seventeen-year-olds, the applicable national capacity framework, including the causal impairment requirement in England and Wales.

    Management branches

    Planned decisionSupport and assess the exact choice

    A child or young person is considering a non-emergency mental-health assessment, treatment or disclosure decision.

    1. Explain options, material consequences and uncertainty in an accessible format, offer private time and remove avoidable coercion.
    2. Identify the age, UK nation and exact decision, apply the relevant competence or capacity test with all practicable support, and record the test, reasoning and outcome.
    3. If consent is valid, proceed within it and agree family and information-sharing boundaries that can be revisited.
    Open full textbook →Answer 2 questions
    Sources and review status18 sources · checked 27 Aug 2026 · clinical review pending+
    Sources

    Sources and review status

    National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 27 Aug 2026; clinical approval remains outstanding.

    • GMC 0–18 years making decisionsCapacity, competence, parental responsibility, refusal and emergency decision principles.
    • GMC 0–18 years principles of confidentialityConfidentiality, serious-harm disclosure and involving children and parents.
    • GMC confidentiality for direct careProportionate information use, consent and disclosure within direct care.
    • Mental Health Act 1983 Code of Practice for EnglandEngland-specific legal and professional framework for under-eighteens and objecting care.
    • Scottish mental-health legislation code on medical treatmentScotland-specific treatment authority and safeguards under mental-health legislation.
    • Mental Health Act Code of Practice for WalesWales-specific mental-health law principles, safeguards and treatment framework.
    Mental Capacity Act 2005 section 2
    England-and-Wales causal impairment or disturbance requirement for incapacity from age sixteen.
  • Mental Capacity Act 2005 section 3England-and-Wales understand, retain, use-or-weigh and communicate functions.
  • Age of Legal Capacity (Scotland) Act 1991 section 2Scotland-specific under-sixteen authority to consent to medical treatment when the statutory understanding test is met.
  • Adults with Incapacity (Scotland) Act Part 5 codeScotland-specific treatment authority, including section 47 certification, for people aged sixteen or over who lack capacity.
  • Age of Majority Act (Northern Ireland) 1969 section 4Northern Ireland authority for consent to medical treatment at age sixteen and seventeen.
  • Northern Ireland Mental Capacity Act legislation statusOfficial confirmation that the 2016 Act is only partly commenced and that the Mental Health Order 1986 remains in use.
  • GMC access to records by children, young people and parentsProfessional rules for child-controlled access, parental requests, best interests and confidential material.
  • ICO subject access requests involving childrenChild-owned access rights and Scotland's age-twelve presumption compared with the other UK nations.
  • UK Supreme Court 2026 deprivation-of-liberty updateImmediate UK-wide replacement of the Cheshire West acid test by a multifactorial approach.
  • Mental Health Act 2025Enacted England-and-Wales reforms whose operative provisions must be checked against commencement.
  • Mental Health Act 2025 Commencement No. 1 Regulations 2026Commencement of sections 51 and 52 on 6 April 2026, with most clinical reforms not yet in force at the chapter cutoff.
  • Northern Ireland revised Mental Health Order code announcementOfficial notice that the revised code takes effect on 1 September 2026, after this chapter's cutoff.

    • Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

    Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom