Children and Young People and Mental Health

Mental health issues affect many children and young people around the UK; the figures for those being diagnosed are increasing every year. Children are extremely vulnerable to mental disorders because they are aware of their abnormal feelings or behaviour but are unfamiliar with the causes, commonness or help available. As children progress into young adults, their feelings or behaviour will not change but they will be aware of what a mental illness is and hopefully take the first steps to seeking help.

The Mental Health Act (1983)

There is no lower age limit to the Mental Health Act (1983) and there are no specific provisions in the Act relating to children. In theory, children and young people may be treated or compulsorily detained under it, but in practice very young children are not detained under the Act, with the majority being admitted as ‘informal’ patients by their parents.

YoungMinds believes that the needs of children should be addressed in any proposed new mental health legislation.[15]

Consent to treatment

A parent has the right to give consent to treatment for a child under 18, provided it is in the child's interests. In cases where a parent refuses to consent to treatment that doctors consider to be in the child's best interests, the child may be made a ward of court. The court can then overrule the parent's refusal.

In the Gillick case in 1985 the House of Lords established the principle that a doctor could give contraceptives to a girl under 16 without her parents’ consent, provided she had sufficient intelligence and understanding to fully comprehend what was proposed. They did not specify an age at which children become competent. Since this case, the concept of ‘Gillick competence’ has been extended to other treatments.

For children aged 16 and 17 the provisions of the Family Law Reform Act 1969, section eight apply. This states that: "…the consent of a minor who has attained the age of 16 years, to any surgical, medical, or dental treatment, which in the absence of consent would constitute a trespass to the person, shall be as effective as it would be if he were of full age; and where a minor has by virtue of this section given an effective consent to any treatment it shall not be necessary to obtain any consent for it from his parent or guardian". Perversely, the same law does not give the child the same right to refuse treatment.[13]

Many paediatricians feel children should have treatments explained to them and their consent sought whenever possible. There is evidence that even young children can often understand quite complicated medical issues. A study of children undergoing orthopaedic surgery found that relevant experience of illness, treatment or disability was far more important than age for acquiring competence.[14] YoungMinds considers that children should be considered competent to make decisions from the age of 12.

(Statistics from Mind.org.uk)

This information shows just how difficult a mental health experience can be for an individual under the age of 18. Not only must they suffer with a disorder they usually know little about, but also their parents must know about it for them to receive any professional treatment. If the parent and child have a poor relationship, the experience can be even harder for the child and in some cases treatment may be refused in order to keep the illness from their parents.

The National Service Framework for Children

The National Service Framework for Children, Young People and Maternity Services (NSF), which was published in September 2004 by the Department for Education and Skills, sets out national standards for children’s health and social services. It proposes the following standards for the care of children and adolescents.

The promotion of health and wellbeing, identifying needs and early intervention, led by the NHS in partnership with local authorities.

Supporting parenting, by providing information and support for parents to help them care for their children and equip them for life.

The provision of child-, young person- and family-centred services, tailored to individual needs and taking account of their views.

The development of age-appropriate services responsive to need.

Safeguarding and promoting the welfare of children and young people, preventing harm, promoting welfare and addressing needs.

Implementing timely access to appropriate and effective services to meet the health, social, educational and emotional needs of children and young people who are ill, throughout their period of illness.

The provision of high quality, evidence-based hospital care for children and young people in hospital, developed through clinical governance in appropriate settings.

The development of coordinated, high quality family-centred services for disabled children and young people and for those with complex health needs, promoting social inclusion, enabling them to live ordinary lives.

Promoting the mental health and psychological wellbeing of children and young people, by providing access to timely, integrated, high quality multidisciplinary mental health services to ensure effective assessment, treatment and support.

Making sure children, young people, their parents or carers, and health care professionals in all settings can make decisions about medicines based on sound information about risk and benefit.

The National Service Framework stipulates that services must be developed to meet the needs of young people aged 16 to 17, who often fall between child and adult services. A flexible approach is suggested, so that young people receive care and treatment most appropriate to them as individuals, which might be in either child or adult services.

The National Service Framework highlights the need for appropriate services for young people and children with learning disabilities, who often have mental heath problems. The Framework also acknowledges the need for more staff, new ways of working, new roles, and additional training.

(Statistics from Mind.org.uk)