Understanding Gillick Competence

A Guide for IEMT Practitioners

What is Gillick Competence?

Gillick competence is a legal concept used in the United Kingdom to determine whether a child under the age of 16 has the capacity to consent to their own medical or therapeutic treatment without the need for parental permission or knowledge.

The principle comes from a 1985 legal case (Gillick v West Norfolk and Wisbech Area Health Authority) in which the court ruled that a child can consent to medical treatment if they have sufficient understanding and intelligence to fully comprehend what is involved in the proposed intervention.

This principle has since been widely adopted across healthcare and therapeutic disciplines, including psychological services.

Why is Gillick Competence Important in Therapy?

IEMT practitioners working with children under 16 must ensure that the young person:

• Understands what IEMT is and how it works.
• Can weigh the benefits and potential risks or limitations.
• Is able to make an informed decision about whether to proceed.
• Understands the implications of giving or withholding consent.

If a child is Gillick competent, they can access therapy without the need for parental involvement or permission. However, the practitioner must still assess risk and ensure that safeguarding procedures are followed.

Key Criteria for Gillick Competence

When assessing Gillick competence, consider whether the young person can:

1. Understand the nature and purpose of the proposed treatment.
2. Retain the information long enough to make a decision.
3. Use or weigh the information to arrive at a choice.
4. Communicate that decision clearly.

There is no set age for competence—it depends entirely on the individual's maturity and understanding.

How to Assess Gillick Competence in Practice

You can assess competence through your initial conversations and throughout the therapeutic relationship. Questions to guide your assessment might include:

• Can they explain IEMT back to you in their own words?
• Do they understand the possible outcomes or limitations?
• Can they express their own reasons for seeking therapy?
• Do they understand their right to stop the therapy at any time?

Note: Keep a record of your assessment and the basis for your conclusion. Use supervision if you're uncertain.

Balancing Gillick Competence and Safeguarding

Even when a child is deemed Gillick competent, safeguarding responsibilities still apply. If a child discloses risk of harm or abuse, practitioners may need to override confidentiality in line with safeguarding procedures.

You should also consider:

• Whether the child has adequate support outside of therapy.
• The impact of excluding parents or guardians from the therapeutic process.
• The benefits of involving parents (when appropriate and with consent).

Working with Parents and Gillick-Competent Young People

If a young person is Gillick competent and requests confidentiality, you must respect this—unless there is a risk of serious harm. However, it's good practice to:

• Encourage openness with parents or carers (when safe and appropriate).
• Explain the limits of confidentiality clearly at the outset.
• Reassure the child that you will always act in their best interest.

Documentation and Supervision

• Document your assessment and any decisions made.
• Record the young person’s understanding and consent in their file.
• Note any conversations with parents or guardians.
• Seek supervision when in doubt, especially in complex or borderline cases.

Summary

Gillick competence helps therapists respect young people's autonomy while ensuring safe, ethical practice. It is:

• Child-centred: Focuses on the individual’s understanding, not just their age.
• Flexible: Assessed on a case-by-case basis.
• Grounded in safeguarding: Balances consent with the duty to protect.

By applying this principle carefully, IEMT practitioners can support young people ethically, confidently, and in line with professional standards.