Situation: The nurse supervisor of a mental health facility is reviewing ward practices to be sure they comply with the Mental Health Act (Republic Act [RA] 11036). During an earlier admission, a 19-year-old service user designated his mother as his legal representative. He is now stable and oriented and manages his own affairs. He asks that she not attend his treatment-planning meetings, but she insists, citing her role as his legal representative. Which statement BEST explains the rule the team should follow?

RA 11036 gives family members and legal representatives the right to participate in treatment planning with the consent of the service user. A legal representative acts as substitute decision maker only when decision-making capacity is impaired; every service user is presumed to have legal capacity, and nothing suggests his is impaired. His refusal therefore decides the matter, while staff keep supporting the mother in other ways.

Legal basis under RA 11036
The Philippine Mental Health Act establishes that service users retain the right to make their own treatment decisions unless there is clear evidence that decision-making capacity is impaired. A legal representative does not automatically replace the service user in all matters; the representative steps in as a substitute decision maker only when the person cannot decide for himself. In this scenario, the 19-year-old is described as stable and oriented and managing his own affairs, so the presumption of legal capacity stands.

Family members and legal representatives may participate in treatment planning only with the consent of the service user. The mother’s designation as legal representative gives her a recognized role, but it does not override the service user’s current, expressed wishes. His refusal to have her attend the meeting is the controlling factor.

Key point! Age alone is not the deciding issue. The law does not set an arbitrary cutoff such as 21 years for participation in treatment planning. What matters is the service user’s present capacity, not chronological age.

Watch out! The psychiatrist’s role is to facilitate clinical planning, not to unilaterally decide who may attend. The decision about the mother’s presence belongs to the service user when he has capacity.

Option	Why it is incorrect
1. She may attend because he is not yet 21 years old	RA 11036 does not use age 21 as a threshold for overriding a service user’s choice. Capacity, not age, governs.
2. The psychiatrist decides, as planning is a clinical matter	Treatment planning is collaborative, and the service user’s right to decide who is present is a legal right, not a clinical judgment call.
3. As his legal representative, she may attend without consent	A legal representative acts only when capacity is impaired. Here the service user is stable and oriented, so his consent is required.
4. She may attend only if he agrees to her being there	Correct. Participation of family or representatives in treatment planning requires the service user’s consent.

The team should honor the service user’s refusal while continuing to support the mother through other appropriate channels, such as family education sessions or separate communication with the service user’s permission. This approach respects both the legal framework and the therapeutic relationship.