Decision-making about children’s mental health care: ethical challenges

Moli Paul is a senior lecturer in child and adolescent psychiatry at the University of Warwick (Division of Health in the Community, Warwick Medical School, Coventry CV4 7AL, UK. E-mail: moli.paul{at}warwick.ac.uk) and an honorary consultant with South Warwickshire Primary Care Trust. Her research interests include consent, individual and group-based health care decision-making and the comparison of adults’ and minors’ decision-making.

Children and young people are usually referred to specialist child and adolescent mental health services (CAMHS) by adults because of concerns raised by other adults. Most CAMHS consider them from a developmental perspective and as individuals in the context of their families and other relationships/systems. In this article I discuss ethical and legal challenges posed by making decisions with and about children and young people within CAMHS, with particular reference to duty of care; the rights of minors’ and parents’; capacity and consent; and disagreement between decision-makers. It is important to involve children and young people in decision-making, and I suggest ways of acheiving this.