Admission to adult mental health wards for under 18's - adaptation for Scotland: guidance
Best practice guidance to aid implementation of s23 of the Mental Health (Care & Treatment)( Scotland) Act 2003 which places a duty on health boards to provide sufficient services and accommodation to meet the needs of young people under 18 when they are admitted to hospital for treatment of a mental disorder.
Section 7: Consent and Confidentiality
Consent
Note: Even if patients are detained (and therefore some treatments for mental disorder could be given without their consent), the patient's capacity to consent to particular treatments should be kept under review. Even where they lack capacity to make a decision about treatment, their views should always be sought and they should be facilitated to participate in decisions as far as possible.
Authority to treat children and young people must be established. For young people with capacity to give consent, the relevant authority may be derived from the young person themselves or from a legal framework such as the Mental Health (Care and Treatment) (Scotland) Act or the Adults with Incapacity (Scotland) Act. For children under the age of 16 years, authority to treat may derive from the child if they have capacity to consent to treatment, or from an individual with parental authority if they are incapable of consenting or from legal frameworks such as the Mental Health (Care and Treatment) (Scotland) Act.
The Code of Practice to the Mental Health (Care and Treatment) (Scotland) Act suggests that the definition of incapacity for patients treated under the Act involved factors similar to those defined in Adults with Incapacity (Scotland) Act 2000.
7.1 All examination and treatment is conducted with the appropriate consent, as specified for young people under 18 years (QNIC 36).
| No. |
Type |
Standard |
|---|---|---|
| 7.1.1 |
1 |
The ward staff can access a Board policy or protocol that provides guidance on the legal framework for decision making on care and treatment for under 18s. |
| 7.1.2 |
1 |
Staff inform young people, both verbally and in writing, of their right to agree or refuse treatment and the limits of this. |
| 7.1.3 |
1 |
Staff are proficient in assessing a young person's capacity to consent. |
| 7.1.4 |
1 |
Young person's capacity to consent to treatment is assessed in accordance with the definitions described in the Adults with Incapacity (Scotland) Act 2000. |
| 7.1.4.1 |
1 |
All assessments of an individual's capacity should be fully recorded in the patient's medical notes. |
| 7.1.5 |
1 |
The young person's consent or refusal is recorded in their notes, as well as the treating clinician's assessment of the young person's capacity to consent to the treatment in question. |
| 7.1.6 |
1 |
Where young people are not detained, and are assessed as not having capacity, the basis for providing treatment without the young person's consent is recorded, and the views of the young person are ascertained and taken into account. |
| 7.1.7 |
1 |
Staff should inform informal young people with capacity that their consent to treatment can be withdrawn at any time and that fresh authority to treat is required before further treatment can be given or reinstated. |
| 7.1.8 |
1 |
Interventions are only conducted without the consent of young people in line with the principles of the Mental Health (Care and Treatment) (Scotland) Act 2003. |
| 7.1.9 |
1 |
When a young person who is assessed as having capacity is treated without consent, this is conducted within the appropriate legal framework, such as the Mental Health (Care and Treatment) (Scotland) Act 2003. |
| 7.1.10 |
1 |
Staff are clear on who has parental rights and responsibilities. |
| 7.1.11 |
1 |
Young people and their parents/carers are informed about the procedures for obtaining consent where the parental responsibility is held by a third party. For example, parental responsibility may be shared with others if the young person is subject to a care order (where the local authority may have parental responsibility). |
Confidentiality
7.2 Mental Health (Care and Treatment) (Scotland) Act 2003 principles suggest sharing information with carers, however when considering what information to share with carers, it is best practice to consider the patient's right to confidentiality about their private medical details (QNIC 35).
| No. |
Type |
Standard |
|---|---|---|
| 7.2.1 |
1 |
Ward staff receive clear guidance on young people's rights to confidentiality and the circumstances in which information can be shared with third parties, including those with parental responsibilities. |
| 7.2.2 |
1 |
Young people and their parents/carers are informed of their right to confidentiality and the limits of this, and receive written information on this right. |
| 7.2.3 |
1 |
Young people who are assessed as able to make such decisions are asked whether they wish to give or withhold their consent to information about their care and treatment being disclosed to their parents or carers. Note: It is good practice for staff to explain the reasons why it might be helpful for their parents to be given this information. |
| 7.2.4 |
1 |
Young people are informed when confidential information about them is to be passed on to other services and agencies, and the reasons why this is important to their continuing care is explained. |
| 7.2.5 |
1 |
Audio and visual material is kept confidential and secure and young people and their parents or carers are assured about this and any limitations to this. |
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