A judge in a provincial city directed that the CFA should provide funding so that a teenage boy could receive treatment for his ADHD. This followed a section 47 application from the boy’s guardian ad litem seeking the direction.
The teenage youth had entered care at 12 years of age and was due to age out within the coming months. He had originally been placed in long term foster care with his sister. That placement had lasted approximately six or seven years, but it had subsequently broken down due to a deterioration in his relationship with his sister. The youth had been moved to a new placement and it was hoped that he would be able to stay there after he had turned 18 years of age, to allow him complete his final year in secondary school.
The solicitor for the Child and Family Agency (CFA) told the court that the existing aftercare plan required amendment to reflect youth’s changed circumstances. The youth had been assessed for ADHD and his need to access adult psychiatric services in the future was included in his existing aftercare plan.
However, she said that there was a long wait list for these services (approximately 18 months) and as a result, the youth’s guardian ad litem (GAL) intended to make a section 47 application seeking the court’s direction for the CFA to fund privately sourced psychiatric services to allow treatment of the youth’s newly diagnosed ADHD to commence without delay.
She said that the youth was not legally permitted to consent to receiving mental health treatment prior to turning 18 years of age. The amount of funding being requested for the private mental health service would be in the region of €1,300. However, she added that there would be a need for oversight in the event that public funding was to be allocated to pay for private medical treatment.
In making the section 47 application to the court, the GAL’s solicitor said that the youth would be going into his Leaving Cert year at the next school term and that his ADHD condition was having a big impact on him. He was very keen to avoid any delay in receiving treatment. He said that the amount of funding being requested from the CFA was a finite once off payment.
The GAL told the court that the youth had been experiencing difficulties for a long time and that now they knew that these difficulties were related to his ADHD condition. The youth wanted to trial the ADHD medication to see how he responded to it. She said that untreated ADHD had a cascade of impacts including difficulties with placements and schooling. The international guidelines indicated that pharmacological intervention was the first line of treatment for ADHD.
However, there were several different types of medication which needed to be trialled. The treatment needed to be consultant led. She said that it was unfortunate that the diagnosis had come so close to the youth’s aging out of care, but it had taken a year in order to obtain the diagnosis. She had spoken to a psychiatrist in the public adult mental health service who had explained to her that adult patients were being referred by a GP to community services in the first instance and that only patients with moderately severe ADHD or more serious ADHD were being referred on to the public mental health service. The waiting time for treatment was in the region of 18 months.
She said that the private treatment was needed to get the youth through his Leaving Cert year and would carry him through until he was able to access the public adult mental health services. The youth had repeatedly told the GAL of his desire to receive early treatment. She said that the youth’s sister had also been diagnosed with ADHD and she had been treated with great success. The youth had already had a cardiac assessment which was normal and which was required prior to any treatment commencing.
She said that she could not overstate the need for this treatment and she was asking the court to direct the CFA to pay €1,300 to an identified private service provider as part of the youth’s aftercare plan. She said that she did not feel that there was any appreciable risk to the money. She said that the €1,300 would cover assessment, prescription, titration, and monitoring by the private service provider. The youth’s GP had agreed to oversee the interim period between the youth transferring from the paediatric to the adult services as long as the medication had been titrated correctly.
The social worker told the court that she regretted that there had been so much upheaval in the youth’s life. She agreed that he wanted to be treated for his ADHD. However, she said that the therapist at the local Child and Adolescent Mental Health Service (CAMHS) did not feel that the youth met the criteria for ADHD.
She also said that normally if the CFA procured a service for a person in its care, it monitored the provision of the service thereafter. She was concerned about the aftercare team being able to provide the necessary monitoring and support the youth in respect of his treatment plan. His treatment would require the youth to attend his GP for ongoing monitoring and he would need ongoing engagement with the psychiatrist also to determine the right type of medication and to titrate the right amount to be administered.
She said that she had not yet had the time to engage with the aftercare team to ensure that the required monitoring would be put in place. The aftercare plan still needed to be finalised and agreed to take into account some changes that had occurred.
The judge observed that the youth would age out of care in the very near future, that he had been assessed by a psychiatrist as being ADHD positive and that medication was required to treat his condition. She said that it was in the youth’s best interests that he receive the treatment and that as a result, she was inclined to make the directions sought in the section 47 application and this treatment should be part and parcel of the youth’s aftercare plan when it was finalised. She noted that the youth was in agreement with the treatment and that his sister had already made progress following her treatment for ADHD.
She directed that the CFA provide the sum of €1,300 to the private mental health service provider for medication, oversight of the titration and monitoring of the youth’s ADHD treatment.
The matter was put in to return to court a week later for finalisation of the aftercare plan.