Mental health legislation, capacity and consent

• Capacity is not an all-or-nothing label: it is the ability to make one specific decision at one specific time, and a person is presumed to have it unless it is established otherwise. ^{[1] [6]}
• The statutory test for lacking capacity has four parts: understanding the relevant information, retaining it, using or weighing it in the decision, and communicating the decision. ^[1]
• An unwise decision is not, by itself, proof of incapacity; all practicable steps to support the person must be tried first. ^[1]
• When an adult lacks capacity, decisions made on their behalf must be in their best interests and must be the least restrictive option available. ^[1]
• In England and Wales the Mental Health Act 1983 allows compulsory admission for assessment for up to 28 days and for treatment for up to 6 months at a time, renewable, where specific criteria are met. ^{[2] [3]}
• A competent young person can consent to treatment, but under-16s need a capacity assessment tailored to the decision, and detention or treatment of children can also rely on mental health legislation or parental consent. ^{[8] [9]}
• Confidentiality is a central duty but it is not absolute: information may be shared with consent, in the patient's best interests when they lack capacity, when required by law, and in the public interest to protect patients or others. ^[7]

By the end of this page you should be able to:

1. Define capacity as decision-specific and time-specific, and state the statutory presumption and the four abilities it requires.
2. Carry out and document a capacity assessment, including the support steps that must come before a finding of incapacity.
3. Apply the best interests checklist and the least-restrictive principle to an adult who lacks capacity.
4. Outline why and how a person can be admitted and treated compulsorily in the UK, and contrast this with the principles used in the USA.
5. Explain how consent works for children and young people, including Gillick competence, Fraser guidelines and young people's refusal of treatment.
6. Explain when and how confidentiality can be broken in mental health care, and apply safeguarding rules for young people.
7. Discuss the tension between traditional best interests and the modern human-rights approach of supported decision-making.

Mental health law sits where three different kinds of question meet. The first is clinical: does this person have a mental disorder, and what does it do to their thinking? The second is ethical: how do we respect a person's autonomy while also protecting their health and the safety of others? The third is legal: what may be done to someone without their consent, and with what safeguards? A doctor who grasps all three asks better questions, documents better, and is less likely to misuse power.

The topics of capacity, consent and confidentiality are central to everyday practice, not only psychiatry. Any patient can lose capacity through illness, injury, intoxication or distress, and every specialty uses these principles. The law differs between countries and regions, so this page gives principles and named frameworks rather than legal advice for a specific patient; always check local statute and seek legal advice in difficult cases. ^[5]

A useful habit is to separate these ideas deliberately. Capacity is about understanding and decision-making. Consent is the permission given when capacity is present. Mental illness is a clinical diagnosis. Legal authority for compulsory treatment is a power given by statute. A person can have severe mental illness yet retain capacity to refuse a particular treatment, and a person can lack capacity for a decision without any mental illness at all. ^{[1] [6]}

The Mental Capacity Act 2005 governs decision-making for people aged 16 or over in England and Wales who lack capacity. Scotland and Northern Ireland have their own legislation, but the underlying principles are similar. Section 1 sets out five principles that run through the whole Act. ^{[1] [6]}

1. A person must be assumed to have capacity unless it is established that he lacks capacity.
2. A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success.
3. A person is not to be treated as unable to make a decision merely because he makes an unwise decision.
4. An act done, or decision made, under the Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests.
5. Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person's rights and freedom of action. ^[1]

NICE NG108 cites a Care Quality Commission estimate that around 2 million people in England and Wales may lack the capacity to make certain decisions at some point in their lives because of illness, injury or disability. ^[6] In practice, many more people need their capacity supported rather than replaced.

The Act's first principle is doing a lot of work. Capacity is not proved; it is the default. The burden of showing that a person lacks capacity rests on the person asserting it, and in legal proceedings that question is decided on the balance of probabilities. ^[1] A judgement about capacity should therefore be cautious, and it should be reassessed whenever the condition that prompted the question changes, because the Act states that an impairment or disturbance may be permanent or temporary. ^[1]

Under section 2 of the Act, a person lacks capacity in relation to a specific matter if he is unable to make a decision for himself because of an impairment or disturbance in the functioning of the mind or brain. This creates two stages, and both must be satisfied. ^[1]

• Stage one: Is there an impairment or disturbance of mind or brain? (This can be a mental illness, dementia, brain injury, stroke, hypoxia, severe pain, delirium, or temporarily the effects of alcohol or other substances.)
• Stage two: Is that impairment or disturbance the reason the person is unable to make the decision?

Stage two matters as much as stage one. The fact that someone's condition might make a decision unwise is never enough. Coercion, distress, a sudden avalanche of information, shock at a diagnosis, or simple disagreement with the doctor do not make a person lack capacity. ^{[1] [6]}

The Act also forbids deciding capacity on the basis of age or appearance, or on a condition or behaviour that might lead others to make unjustified assumptions. ^[1] Labelling a person as "confused" or "mentally ill" and stopping there is exactly the kind of assumption the Act prohibits.

Section 3 translates "unable to make a decision" into four functional abilities. A person lacks capacity if, because of the impairment or disturbance, he cannot do any one of the following. ^[1]

1. Understand the information relevant to the decision. Information here includes the foreseeable consequences of making the decision, of making a different decision, or of making no decision at all. An explanation suited to the person, with simple language and visual aids, must be counted; a person is not regarded as unable to understand merely because the first explanation failed. ^[1]
2. Retain that information long enough to make the decision. Retaining it for a short period only does not defeat capacity: the Act explicitly provides for this. ^[1]
3. Use or weigh that information as part of the process of making the decision. This is the ability most often in dispute, and it is the ability most directly affected by delusion, depression, mania, severe anxiety and ambivalence. A person can recite the risks and benefits and still be unable to weigh them, for example because a delusion voids the evidence.
4. Communicate the decision in any way, including speech, sign language or other means. If someone cannot speak because of a stroke or an endotracheal tube, communication support may restore capacity. ^[1]

A practical assessment should be clinical, proportionate to the complexity and importance of the decision, and carried out in the context of a trusting relationship. ^[6] It should cover what the decision is, what the person's condition is, how the condition affects understanding, retention, weighing and communication, what support was given, and what the outcome is. Using structured tools can help, but no tool replaces this judgment. ^[6]

Principle two is frequently skipped in practice, and skipping it is a common reason decisions are later overturned. Supporting capacity is the whole point of the Act. It may mean waiting for an infection or hypoxia to settle; stopping sedatives; treating pain; allowing time; giving information in shorter chunks; using familiar advocates, interpreters or communication aids; or reducing fear and coercion. ^[6]

A person also does not need to retain the information for ever. Someone with moderate dementia may understand and weigh a simple decision in the moment even if they will forget it an hour later; that person retains capacity for that decision at that time. ^[1] What is tested is whether they can retain the information long enough to decide, not whether they can remember the consultation afterwards.

Support also means avoiding covert persuasion. Providing reassurance or reducing anxiety is legitimate help; steering a person towards a particular answer is not. ^[6] If, after genuine support, the person still cannot understand, retain, weigh or communicate, only then is incapacity established.

Capacity can fluctuate within a single day in delirium, dementia with sundowning, severe mental illness, hypoglycaemia and post-ictal states. It can also be partial: a person with schizophrenia may have capacity to consent to treatment of a simple infection while lacking capacity to weigh complex financial decisions. ^{[1] [6]}

When capacity is genuinely absent, the threshold for invoking legislation is high for good reason. Once a person has been labelled incapacitous, they can lose control of decisions ranging from treatment to residence, contact and even research. The label should be applied only when the statutory test is satisfied, and it should be revisited.

Section 4 of the Mental Capacity Act 2005 does not simply say "do what you think is best". It requires the decision-maker to consider all relevant circumstances and to take specific steps. ^[1]

• Do not base the decision merely on the person's age or appearance, or on a condition or behaviour that might lead to unjustified assumptions. ^[1]
• Consider whether it is likely that the person will regain capacity in relation to this matter, and if so when. ^[1]
• Permit and encourage the person to participate, as far as reasonably practicable, in the act or decision. ^[1]
• Where the decision concerns life-sustaining treatment, the decision-maker must not be motivated by a desire to bring about the person's death. ^[1]
• Consider, so far as reasonably ascertainable, the person's past and present wishes and feelings, particularly any written statement made when they had capacity; their beliefs and values; and the other factors they would be likely to consider. ^[1]
• Take into account, if practicable and appropriate, the views of anyone named by the person, anyone caring for them or interested in their welfare, any attorney under a lasting power of attorney, and any court-appointed deputy. ^[1]
• Do what is least restrictive of the person's rights and freedom, consistent with the purpose. ^[1]

The checklist also recognises who leads the process. A decision-maker may be the treating clinician, an attorney, a court-appointed deputy, or the Court of Protection in difficult cases. An Independent Mental Capacity Advocate (IMCA) represents people who have no family or friends to speak for them when major health or accommodation decisions are being made. ^[6]

Traditional best interests focuses on what is good for the person. The modern, rights-based approach asks what the person would have valued, and what support they need to express it. The World Health Organization and the Office of the High Commissioner for Human Rights emphasise the legal-capacity focus of the Convention on the Rights of Persons with Disabilities: legal capacity cannot simply be removed on the basis of a mental condition, and substitute decision-making should be replaced by supported decision-making wherever possible. ^[5]

This is a genuine tension that good clinicians and good law try to hold rather than resolve. When a person has clearly expressed prior wishes in a written advance statement, those wishes should carry substantial weight, even where they differ from what the clinical team would choose. When there is no guidance, the team falls back to the objective factors of the checklist, with careful consultation of those who know the person. ^{[1] [5]}

The Mental Capacity Act framework applies to decisions that have not yet arisen. Advance care planning lets a person set out future preferences, appoint an attorney, or record written wishes while they still have capacity. It is particularly suited to progressive illness (such as dementia), severe mental illness with fluctuating capacity, and situations in which some capacity may be lost suddenly. NICE recommends that advance care planning be part of supporting decision-making, with regular review. ^[6]

The Mental Capacity Act does not cover every decision. Some decisions (such as marriage, voting, consenting to sexual activity) may be subject to their own capacity tests. Treatment that is entirely unconnected with a mental disorder, or the needs of physical illness, can be provided to an incapacitous patient in their best interests, but treatment under the Mental Capacity Act cannot be used as a way of treating mental disorder itself when the Mental Health Act applies. ^{[2] [6]} Where deprivation of liberty is involved, separate safeguards apply, and the NICE guideline does not cover Deprivation of Liberty Safeguards processes. ^[6]

Most legal systems that permit compulsory psychiatric care share a set of principles, even though the statutes differ in detail. ^{[5] [10]}

• Mental disorder as the starting point. A diagnosis or clinical picture of mental disorder is required, on grounds of nature (the type of disorder, its course, prognosis and past response to treatment) and degree (how it presents now). ^{[2] [3]}
• A seriousness threshold. The disorder must warrant hospital assessment or treatment, not merely its existence.
• Necessity and appropriateness. There must be a defined purpose (the person's health or safety, or the protection of others) and, for treatment detention, treatment that is appropriate and actually available. ^{[2] [3]}
• Least restrictive alternative. Detention is not justified if the person's needs can be met in a less restrictive way. ^[10]
• Procedural safeguards. Independent assessment, written reasons, a right to appeal to a court or tribunal, and a regular review of whether the criteria still hold. ^{[2] [10]}
• Equivalence of treatment. The person should receive good care; legislation is increasingly framed so that care cannot be given involuntarily unless suitable treatment is actually available. ^[3]

Coercion in mental health care is a major focus of modern human-rights frameworks. The WHO and OHCHR 2023 guidance calls for laws that eliminate coercion in favour of free and informed consent, supported decision-making, advance planning and crisis support. ^[5] At the same time, that document accepts that most countries still authorise deprivation of liberty on the basis of mental health diagnoses, usually combined with an alleged risk to self or others or a need for care; its aim is to move practice toward the rights-based end of the spectrum. ^[5]

The Mental Health Act 1983, as amended by the Mental Health Act 2007, is the statute that authorises compulsory admission and treatment in England and Wales. (Scotland and Northern Ireland have separate Acts.) It is a medical, not purely welfare, statute: the criteria are clinical, and the powers are conditional. ^{[2] [3]}

Admission for assessment, section 2. A person may be detained for up to 28 days, on two medical recommendations (one from a doctor approved under section 12), on the grounds that he is suffering from mental disorder of a nature or degree warranting detention in hospital for assessment, and that he ought to be detained in the interests of his own health or safety or for the protection of other persons. Two doctors must have examined the patient separately no more than five days apart; where possible one doctor should know the patient. The application is usually made by an Approved Mental Health Professional, who must consider whether hospital detention is the most appropriate way of providing the care needed. ^[2]

Section 2 is not renewable. At the end of 28 days the person must be discharged, detained on another section, or remain informally. If a nearest relative unreasonably blocks an application for treatment (section 3) while a section 2 is running, the section 2 can be extended during proceedings to displace the nearest relative; this is an exception, not the rule. ^[2]

Admission for treatment, section 3. A person may be detained for up to 6 months initially, with further renewals, on the grounds that he is suffering from mental disorder of a nature or degree making hospital treatment appropriate; that it is necessary for the health or safety of the patient or the protection of others that he receive treatment and that it cannot be provided unless he is detained; and that appropriate medical treatment is available. The "appropriate medical treatment" test requires that suitable treatment is actually available, not merely that it exists in theory. ^{[2] [3] [4]}

Who applies. An Approved Mental Health Professional or, in principle, the nearest relative (extremely rarely in practice) makes the application. The nearest relative has a right to be informed and can apply for the patient's discharge; disputes about the nearest relative go to the County Court. ^[2]

Consent to treatment, Part 4. For patients detained on treatment sections, the Act sets out when treatment can be given without the patient's consent. ^[4]

• For most treatments, including medicines given within the first three months, consent is not required and treatment can be given if it is directed by the approved clinician in charge. ^[4]
• After three months of medication, a second, independent, medical opinion (from a "Second Opinion Appointed Doctor", usually a psychiatrist appointed by the regulator) must certify that the patient either has capacity and consents, or that treatment is appropriate despite refusal or incapacity, before medicines can continue to be given without consent. ^[4]
• Certain treatments, notably psychosurgery and other specified procedures, require the patient's own consent plus certification. ^[4]
• Electroconvulsive therapy (ECT) calls for separate safeguards: it cannot be given to a patient who has the capacity to refuse and does refuse, and special certification applies. ^[4]
• Urgent treatment is exempt from these certification rules when it is immediately necessary to save life, to prevent serious deterioration, to alleviate serious suffering (provided it is not irreversible or hazardous), or to prevent violence or danger (provided it is not irreversible or hazardous and is the minimum interference necessary). In addition, treatment under an existing authority can be continued, if discontinuance would cause serious suffering, while waiting for certification. ^[4]

Tribunals are the appeal route. A detained patient can apply to the Mental Health Tribunal, and hospitals also have automatic referral duties. ^[2]

The US approach grew from the constitutional protection of liberty. Early twentieth-century commitment laws allowed confinement simply for mental illness; the civil-rights era shifted the focus to dangerousness. Two leading principles come from decisions of the Supreme Court: a person who is not dangerous and can survive safely with help cannot be detained (O'Connor v Donaldson), and the government may not confine simply because of disability (O'Connor v Donaldson, as reviewed in the literature). The minimum burden of proof for civil commitment is "clear and convincing evidence", though some states require proof "beyond a reasonable doubt" (Addington v Texas). ^[10]

In most US states, the criteria are a mixture of: ^[10]

• a mental illness, generally a serious one, and not merely a diagnosis in isolation;
• danger to self (in all states), defined to include some forms of grave disability (inability to meet basic needs such as food, clothing and shelter) in many states;
• danger to others;
• need for treatment, often framed as lack of insight coupled with likely deterioration;
• and sometimes serious deterioration as a distinct criterion.

Most states also provide some form of least-restrictive requirement, so that a person who can be managed in the community is not confined as an in-patient. Outpatient commitment is an alternative to inpatient commitment in many states. ^[10] The due process layer includes notice, a hearing, legal representation, a medical opinion, and Judicial or administrative review; many states allow any adult to petition. Law enforcement is often the first point of contact in a crisis, which makes police-and-crisis training an important public-health responsibility. ^[10]

The US system thus trades precision and liberty protection for complexity: statutes differ between states, evidentiary standards vary, and connecting people to care that is often community-based and under-resourced remains difficult. Neither the US nor the UK model resolves the underlying dilemma; they weight it differently. ^{[5] [10]}

Many countries have ratified the Convention on the Rights of Persons with Disabilities, which calls for a shift away from substitute decision-making and coercion toward equality, non-discrimination, supported decision-making, free and informed consent, participation and community inclusion. ^[5] Many national laws still permit guardianship, forced treatment or detention on the basis of disability, practice that the CRPD Committee has criticised. The WHO 2023 guidance responds by recommending that mental health be integrated into general legislation rather than siloed in mental-health-specific acts, with explicit protections for consent and supported decision-making. ^[5]

Low-resource settings face a particular problem: legislation often exists on paper while forensic psychiatric services, independent tribunals and community alternatives do not. In such countries, a sensible working approach is to use the general principles above as the floor of good practice: identify whether the person has a treatable mental disorder, whether they have capacity, whether the proposed treatment would serve their health or safety or protect others, and whether less restrictive options have been tried, while working with the legal and professional bodies that govern local practice.

Children's rights and best-interests principles shape this area as much as clinical judgment. A key point for clinicians is that the Mental Capacity Act 2005 does not apply to those under 16, and NICE NG108 excludes assessment and support of decision-making in children under 16. ^{[6] [8]} Capacity work with under-16s therefore relies on common law (Gillick), on the Children Acts, and, where mental disorder is present, on mental health legislation. ^{[8] [9]}

Who can consent. ^{[8] [9]}

• At 18, a person has adult autonomy.
• At 16 or 17, there is a presumption of capacity to consent to medical treatment; consent may be overridden when a refusal would risk death, severe permanent injury or irreversible harm.
• Under 16, a child may be Gillick competent: that is, able to consent to a particular intervention if they have sufficient understanding and intelligence to fully understand its nature, purpose, likely effects and risks, chance of success and the alternatives. Competence is specific to the intervention and can fluctuate, for example with stress or mental disorder. ^[8][9]
• Fraser guidelines are a distinct set of criteria that apply specifically to contraception and sexual health (and, since 2006, to treatment of sexually transmitted infection and termination of pregnancy): sufficient maturity and intelligence; cannot be persuaded to involve parents; likely to continue sexual activity; physical or mental health likely to suffer without treatment; and treatment in the young person's best interests. ^[9]

Parental consent and best interests. If a child lacks the capacity to consent, consent from a person with parental responsibility is usually sufficient, and one parent's consent is normally enough. Where parents disagree and cannot be reconciled informally, legal advice (and sometimes the court) is needed. The child should be involved in the decision as far as possible. ^[8]

Refusal of treatment by young people. A competent young person's consent cannot be overruled by parents, but refusal is different, particularly where the decision risks death or serious deterioration. In England, Wales and Northern Ireland the law around overriding a competent young person's refusal is complex, and legal advice should be sought. ^[8]

Mental health legislation and children. The Mental Health Act 1983 can apply to children and young people, and provides a separate legal basis for assessment and treatment of a mental disorder in that group; the phrase "mental disorder of a nature or degree" applies without an age threshold. Informal admission on the basis of parental consent may be used, but it requires care where a young person objects, and the deprivation of a child's liberty for treatment requires proper legal authority and regular review. ^{[2] [8]}

Confidentiality with young people. A young person who is competent can expect confidentiality. Information can be shared without consent in the public interest to protect the young person or others, where required by law, or where information sharing is in the best interests of a child who lacks maturity to decide. Safeguarding concerns (such as abuse or serious self-harm) should be escalated through local safeguarding processes. ^{[7] [8]}

No fixed bottom age. There is no minimum age at which Gillick competence or Fraser guidelines can be applied, but competence in a child under 13 is unusual to find, and children under 13 who disclose sexual activity trigger safeguarding obligations regardless of competence. ^[9]

Confidentiality is one of the central duties of the doctor-patient relationship, and professional guidance treats it as a duty that is ethical as well as legal. Patients may avoid seeking care entirely if they believe information will be disclosed without consent. ^[7]

The framework also holds that appropriate information sharing is part of safe, effective care, and that confidentiality is not absolute. ^[7] A doctor is under duty to protect patients' personal information from improper disclosure while keeping disclosures to the minimum necessary. The commonly cited principles are: use the minimum necessary information and anonymised data when possible; manage and protect the data; be aware of the relevant governance responsibilities; comply with the law; share relevant information for direct care unless the patient has objected; seek explicit consent for identifiable disclosure for purposes other than care (unless disclosure is required by law or justified in the public interest); tell patients about unexpected disclosures and record the decision; and support patients to exercise their rights to see their records. ^[7]

Information may be disclosed without breaching confidentiality in circumstances such as these: ^[7]

• The patient consents, implicitly for their own care or explicitly for other purposes.
• The disclosure is of overall benefit to a patient who lacks capacity to consent, in line with capacity legislation.
• The disclosure is required by law, including by order of a court.
• The disclosure can be justified in the public interest.

In mental health practice this covers the everyday dilemma: a patient who is depressed, threatening self-harm and refuses contact with family; a person with psychosis who asks you not to tell the partner who is also the victim of his paranoid beliefs; a patient whose delusional beliefs involve a specific named person. The route is to use the minimum necessary information, to tell the patient where practicable and safe, to seek their consent if they have capacity, and to document the reasoning. ^[7]

Disclosures in the public interest must be "necessary and proportionate": the benefits of disclosure must outweigh the patient's interest in confidentiality and society's interest in trust between doctors and patients, decided case by case. Where doubt exists, senior advice and, where appropriate, a Caldicott or legal view should be sought before disclosing. ^[7]

Where a patient lacks capacity, disclosure is justified where it is of overall benefit to them, again taking capacity legislation into account. Where the incapacity is temporary, it may be reasonable to wait until the patient regains capacity before making a decision that is not urgent. ^[7]

Confidentiality continues after death: there are provisions for disclosure to those with legitimate interests after the patient has died. ^[7]

Health professionals must also be aware of statutory duties, such as reporting certain communicable diseases, reporting gunshot or knife wounds, or making safeguarding referrals; statutory duty takes precedence over the duty of confidentiality. ^[7]

Ethics and law overlap but are not the same thing. Professional ethical standards commonly draw on four principles: respect for autonomy (the patient's right to choose, including the right to refuse), beneficence (acting in the patient's best interests), non-maleficence (avoiding harm) and justice (fairness in access and treatment). ^{[7] [8]} These principles are easy to state and hard to balance.

The law sets the minimum standard that must be met; ethical expectation goes further. Capacity and consent are where the tension is sharpest. A patient can clearly lack the wisdom to refuse a life-saving treatment, yet have the legal capacity to do so; the ethical pull is toward persuasion and further offer, while the legal pull is toward respect. Equally, a patient can lack the capacity to consent despite being sure they wish to accept treatment; acting without proper assessment and best-interests reasoning is unethical even if the outcome looks sensible.

Coercion raises a further ethical point. Legal powers to treat compulsorily are sometimes, in political debate, presented as protecting the public. The more defensible justification is therapeutic: the Mental Health Act 1983 criteria in England and Wales require both a definable disorder and a genuine clinical need, and ask whether treatment can be provided in any less restrictive way; the "appropriate medical treatment" test requires that the treatment is actually suitable and available, not merely theoretical. ^{[2] [3]} The US sources make the same argument: the purpose of commitment is to provide treatment, not simply to remove people seen as risky from the community. ^[10]

Ethical tools for difficult cases include seeking a second opinion, involving senior colleagues and, in the UK, Independent Mental Capacity Advocates or Independent Mental Health Advocates, and referring to the Court of Protection or the Mental Health Tribunal for resolution.

Related MedGrasp topics (plain text, pending verified links): psychiatric history and mental state examination; perinatal mental health; autism, ADHD and developmental delay; intellectual developmental disorder; concepts of decision-making and mental capacity; medical ethics and confidentiality; safeguarding children and young people; working with mentally unwell patients; general medical ethics; end-of-life care and advance decisions.

• Capacity is presumed; it is specific to a decision and to the time at which it is made. ^[1]
• Incapacity requires an impairment or disturbance of mind or brain that is the actual reason for being unable to decide. ^[1]
• The four functional abilities are understanding, retaining, using or weighing, and communicating. ^[1]
• All practicable support must be attempted before a finding of incapacity; an unwise decision alone is never enough. ^[1]
• For adults lacking capacity, decisions must be in their best interests and be the least restrictive option. ^[1]
• Best interests means consultation, taking wishes and beliefs seriously, encouraging participation, and considering likely capacity recovery. ^[1]
• In England and Wales, compulsory admission for assessment lasts up to 28 days, and for treatment up to 6 months initially, renewable. ^[2]
• Treatment powers under the Mental Health Act 1983 include three months of medication without consent, then a requirement for consent or independent certification, with special rules for certain procedures and exemptions for urgent treatment. ^[4]
• The "appropriate medical treatment" test introduced by the 2007 Act requires that suitable treatment is actually available before detention can continue. ^[3]
• The USA justifies commitment on dangerousness, including grave disability, need for treatment and deterioration, with due process and a least-restrictive requirement. ^[10]
• Children under 16 can consent if Gillick competent; Fraser guidelines apply to contraception and sexual health; refusal by a competent young person may require court involvement. ^{[8] [9]}
• Mental health legislation provides a separate basis for assessing and treating children with mental disorder. ^{[2] [8]}
• Confidentiality is an ethical and legal duty but not absolute; sharing may be justified by consent, best interests when capacity is absent, statutory or court requirement, or public interest. ^[7]
• Only the minimum necessary information should be shared, and safeguarding concerns, including in children under 13, must be escalated. ^{[7] [9]}
• The human-rights framework asks states to move from substitute decisions and coercion toward supported decision-making and free, informed consent, while recognising that most legal systems still permit involuntary care with safeguards. ^[5]