Consent of 16- and 17-year olds to admission and treatment

Sir: Parkin (Psychiatric Bulletin, October 1999, 23, 587-589) is correct in stating that current guidance on consent to treatment as set out in the 1999 Code of Practice “remains potentially confusing and is inconsistent with good practice”. Although the Mental Health Act 1983 (MHA) has built into it greater protection for patients' rights regarding consent to treatment, if the child is not under a section of the MHA, the compulsory regulations of the MHA do not apply. For the child in the community or admitted ‘informally’, that is, not under the MHA, the new Code of Practice (Department of Health & Welsh Office, 1999) seems to be undermining the competent child's rights regarding consent to treatment. In doing so it is following the judicial paternalism of recent case law, which seems to subjugate one of the Code's guiding principles, that is, that people to whom the MHA applies should “be treated and cared for in such a way as to promote to the greatest practicable degree their self-determination and personal responsibility, consistent with their own needs and wishes”, in favour of other ‘best interests’, which may be assumed to be a professional (whether judicial or medical) understanding of their physical or mental well-being. This makes the new Code internally inconsistent as well as “inconsistent with good practice”. I echo Parkin's call to the Mental Health Act Commission to investigate such inconsistencies.