Dr. Brendan Doody:

Under the Act, we have been able to initiate and deliver nasogastric, NG, feeding for seriously unwell people with eating disorders in our inpatient services and where restraint has been necessary. We have a colleague working with us in the inpatient unit who has long experience of working in inpatient services in the UK. He is able to compare and contrast the Act's provisions that apply to under-18s. He says that the system here, which goes through the courts, is a far superior mechanism than what he experienced in the UK. The oversight by a court provides protection, in that we are going to court to vindicate and protect the rights of the young person. It provides oversight, even where parents are consenting. There is also the important guardian ad litemrole. In a sense, the Act and the amendments to it as they pertain to children make it clear that it is a separate Act. Most of those provisions were in the Act initially but were just seen as references to sections of the Child Care Act.

The rules and regulations that come with the Mental Health Act and apply to children and adolescents need to be separate from those that apply to adults. The initiation and use of NG feeding and, if necessary, the use of restraint constitute a form of restrictive practice, but one that delivers a necessary and life-saving treatment. It is important to remember that, until three years ago, children who required such treatment were being sent abroad. That is no longer happening. We have the legal framework. The amendments to the Act clarify and build on the experience that we have gained in the use of the Act over the past number of years.

It also clarifies the anomaly in respect of 16- and 17-year-olds, even though in practice we would not have been admitting 16- and 17-year-olds or even younger, if they did not consent to admission, solely on consent of parents. In a sense, it is bringing the status of 16- and 17-year-olds in line with that for other treatments. It is important that 16- and 17-year-olds have that capacity to consent.

There are lots of positives with regard to the Act. I have been in court many times, explaining to the a judge that we are here, even though the parents are consenting - and this may be for a young person who is only 11 or 12 - because it is important that we vindicate and safeguard the rights of the child. It is important that they are properly safeguarded and vindicated and are appointed a guardian ad litem. There are many positive aspects to the legislation. The safeguards with regard to children who are subject to care orders have been omitted from the amendment in the Act but there is a very good reason they should be there. They have been omitted without a recommendation of the expert group for them to be so omitted.