Children's consent to treatmentBMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6944.1637 (Published 18 June 1994) Cite this as: BMJ 1994;308:1637
EDITOR, - In their editorial on the capacity of children and young people to consent to medical treatment J P H Shield and J D Baum make no reference to young people suffering from mental disorders.1 Children and young people may present, though not commonly, with severe mental disorders such as schizophrenia, major depression, and anorexia nervosa. Each of these disorders can be severe enough to put the patients' lives or the lives of others at risk. When a young person with such a disorder is adjudged normally to have the capacity to give or withhold consent and is actively refusing admission to hospital or treatment, use of mental health legislation should be considered.2 In England and Wales there is no lower age limit to any of its provisions for compulsory hospital treatment.3
Recent examples of such cases include a 15 year old girl who refused treatment for severe anorexia nervosa and was detained to permit nasogastric feeding and a precociously mature and intelligent 13 year old boy with a possible manic disorder who refused continued admission and was consequently datained for further assessment.
Traditionally, child psychiatrists have had little call to resort to such measures and in these rare cases have tended to rely on parental consent alone. In the light of the Children Act 1989 this practice is now almost certainly untenable.4 Both consultant child psychiatrists and senior registrars in training therefore need to be familiar with mental health legislation and, in England and Wales, should ensure that they are recognised as such by seeking the approval of the secretary of state under section 12(2) of the Mental Health Act 1983.5 Paediatricians and other doctors working with children and young people should also be aware of the need to seek psychiatric advice in such cases.