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unless there are over-riding concerns about the welfare and safety of the child concerned. Considering the needs of the child as the primary patient or client, independently of parental concerns or claims to involvement, will inevitably raise tensions and challenges to healthcare practitioners, particularly where services are provided on the basis of partnership with families. Counsellors need to be continually alert to the potential for conflict of interests between child and parents, which will require provision for a distinctly child-centred, rather than family-based, service. This tension will become increasingly difficult to operate, given the strong and mounting pressures for information sharing about children within multi-disciplinary teams such as Child and Adolescent Mental Health Service (CAMHS) teams. The proliferation of information sharing mechanisms currently at work, in terms of CAMHS, child protection teams, Connexions Services and Youth Offending Teams, all point towards the difficulties of preserving the client’s right to confidentiality, where the child or young person is the focus of concern by a range of practitioners with a common professional agenda. The right of the individual child to confidentiality needs vigilant protection, subject to the necessary limitations of a binding statutory duty on professional to disclose information, the client’s own disclosure made via informed consent, and risk of significant harm to self or others. Research carried out for the current review of the Mental Health Act illustrates, even if only anecdotally, that parents and children have contrary and conflicting expectations of what a ‘confidential’ counselling service actually means. For parents, it refers to a transparent and accessible service 8 . For children as consumers, it means protection of sensitive confidential information from access by other parties, including parents if necessary 1 . These conflicting expectations are not easily reconciled. The law concerning counselling children and young people is clearly complex. Yet it offers increased possibilities for working with the child as the client, based on the Gillick principle. This approach demands 45
of counsellors both a sound understanding of the law, and a willingness to balance a degree of risk against their own professional accountability. Dr Jenkins was one of the speakers at the NI Ethics Forum Annual Conference 2003 on the topic of Mental Health Ethics. He is a co-author, with Vincent Keter and Julie Stone, of Psychotherapy and the Law: Questions and Answers for Counsellors and Therapists. (Whurr, 2004) (Author’s note: This article is based on law applying in England, Wales and Scotland, but the broad principles described here will also relate to the law in Northern Ireland.) References 1. Baruch, G., James, C. Report from Consultation with Users of Child and Adolescent Mental Health Services. London: DoH, 2003. 2. British Medical Association. Consent, Rights and Choices in Health Care for Children and Young People. London: BMA, 2001. 3. Daniels, D., Jenkins, P. Therapy with Children: Children’s Rights, Confidentiality and the Law. London: Sage, 2000. 4. Department of Health. Reform of the Mental Health Act 1983: Proposals for Consultation. Cm 4480. London: Stationery Office, 1999. 5. Department of Health/Welsh Office. Mental Health Act 1983: Code of Practice. London: Stationery Office, 1999. 6. Department of Health. Reforming the Mental Health Act Part 1: The New Legal Framework. Cm 5016. London: Stationery Office, 2000. 7. Ford, I., Kessel, A. Feeling the way: childhood mental illness and consent to admission and treatment. British Journal of Psychiatry, 179: 384-6, 2001. 8. Lovering, K. User Views of Child and Adolescent Mental Health Services. Exeter: University of Exeter and Cornwall Social Services Department, 2003. 9. Mental Health Act Commission. Mental Health Act Commission: 8 th 46
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