When is a child not a child?
When John Taylor Partridge was admitted to Derriford Hospital in Plymouth on Friday 14 March 2014 after an episode of significant self harm, he was 17 years old. He had a history of self harm, he had previously been diagnosed with an Autistic Spectrum Disorder, had mild learning difficulties and was taking prescription medication for depression. When he sought to take his own discharge against medical advice, a mental capacity assessment was undertaken to establish whether he had the requisite capacity to refuse treatment; it was determined that he did possess the necessary capacity to understand the consequences of his actions by those assessing him, and he was allowed to leave hospital, only to be found two days later in woodland near his home. Sadly, John had taken his own life.
The UN Convention on the Rights of the Child defines a child as everyone under 18 unless, "under the law applicable to the child, majority is attained earlier" (Office of the High Commissioner for Human Rights, 1989). The UK has ratified this convention. However there are a number of different laws across the UK that specify different age limits in different circumstances. These include child protection, age of consent, and age of criminal responsibility.
England, Wales, Northern Ireland and Scotland each have their own guidance for organisations to keep children safe. They all agree that a child is anyone who is under the age of 18 and The Children Act 1989, which allocates duties to local authorities, courts, parents and other agencies in the United Kingdom to ensure children are safeguarded and their welfare is promoted, also applies the same age limit. However, in order to assess his capacity to make decisions, the practitioners involved in John’s care carried out a mental capacity assessment, and as the Mental Capacity Act 2005 applies to people aged 16 years and over, John was effectively treated as if he was an adult, with all the powers of autonomy and self determination enjoyed by “competent” adults.
The Coroner recognised that, at the age of 17 years, John occupied a “grey area” between childhood and adulthood, and whilst a young person aged 17 has to be considered to have capacity to make his own decisions, including the decision to discharge himself, unless he was assessed not to have capacity under the Mental Capacity Act 2005. He also recognised that the Plymouth teenager had been particularly vulnerable due to his underlying history and condition, and the acute crises in which he found himself that weekend. The overlap between the Mental Capacity Act and the Children Act for 16 and 17 year olds had put the practitioners in an invidious position, and it was a situation described by his mother Sandy Partridge as a “crack in the healthcare system” through which her son fell.
In his conclusions, the Coroner made a number of recommendations including the provision of adolescent mental health services at weekends, which sadly was lacking at the time of John’s admission, and confirmed his intention to write to the Secretary of State for Health to highlight the “disconnect” between the competing legislation when applied to children between the ages of 16 and 18 years. What is clear from this case is that young people in this age group are vulnerable to falling in to gaps in service provision, and as this group is statistically at greater risk of completed suicide, any steps that can be taken to safeguard and protect their welfare has to be regarded as being an utmost priority.
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