Paediatric mental health in the emergency department - Fraser and Gillick competence
Introduction
Children and young people frequently present to the ED with mental health problems, self‑harm or suspected intoxication.
Safe management requires parallel attention to immediate physical needs and a structured psychosocial assessment, clear application of consent and confidentiality law, timely safeguarding, and escalation to specialist mental health services when required.
This section summarises practical ED‑focused principles (legal baseline, assessment frameworks, documentation and escalation) aligned with RCEM, GOV.UK and NICE NG225.
Legal framework - quick rules for ED practice
- 16-17 years: presumed able to consent to treatment and to decide about confidentiality; treat as capable unless there is clear evidence of incapacity (GOV.UK). Parents do not automatically override a competent 16-17‑year‑old.
- Under 16 years: may be Gillick competent for specific decisions. Competence is decision‑specific and depends on whether the child understands the nature, purpose, risks and alternatives of the proposed intervention.
- Fraser competence: an application of Gillick principles commonly cited for contraception and sexual health decisions; use it as an example of issue‑specific assessment of maturity and understanding.
- Under 13 years: parental involvement is usually appropriate, but some younger children can demonstrate sufficient understanding for limited decisions-assess carefully on a case‑by‑case basis.
- Emergency exception: life‑saving or immediately necessary treatment may be given in a child’s best interests without consent...
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