The District Court extended an application under section 25 of the Mental Health Act that allows for the involuntary admission of a child to a mental health facility.
The girl has been diagnosed with the mental disorder, anorexia nervosa, and was detained in a mental health facility as she required treatment and ongoing monitoring. She was described as “one of the sickest children in the country”.
The solicitor for the CFA said that the girl had been admitted to the mental health facility and had made good progress in a short amount of time. Her weight on admission was 72 per cent of her target weight but had increased to 78 per cent of the target weight. The consultant psychiatrist said, “anorexia nervosa is a mental disorder but has the biggest physical impact on a young person.”
The psychiatrist outlined that due to malnutrition, anorexia nervosa can negatively impact bone structure, the endocrine system and brain function. She said that the girl was in “starvation”. The goal was to keep her hospital stay as short as possible; however, it was necessary to extend the girl’s involuntary admission by 12 weeks.
The parents were concerned that their daughter’s calories were being monitored, but that no other treatment for her eating disorder was being provided. The psychiatrist said that it was important nutrition was managed, however the girl’s inpatient treatment also included being seen by a paediatrician and attending therapy groups on the ward. The parents were also invited to family therapy. The psychiatrist said that an appointment could also be made with a dietician. After the 12 weeks in-patient treatment it was envisaged that the girl would move to community treatment.
The girl’s progress was discussed weekly at a professionals’ meeting and a care plan was prepared. The care plan was based on the girl’s progress and was updated according to her progress. It was provided to the parents, however, it was noted that the care plan did not include any input from the parents or the girl. The psychiatrist said that it could also be provided to the guardian ad litem (GAL).
The barrister for the parents said that the father did not agree with the application to extend the girl’s involuntary admittance to the mental health facility, and he was not consenting or objecting to the application.
The barrister said that the parents had welfare concerns. She said that they appreciated that given the circumstances their concerns may seem minor, but they were of huge significance to their daughter. Their daughter complained that her sleep was negatively impacted due to be woken up at night to have her blood glucose monitored. In addition, the girl was sleeping on a mattress that was designed to minimise skin tearing, but the mattress was noisy, and contributed to her waking during the night. Also, the lights were kept on in the girl’s room. The psychiatrist accepted that being woken up at night can be difficult, however it was necessary to monitor the girl’s vitals.
The parents’ barrister also said that the parents were concerned that their daughter was in discomfort, however the psychiatrist said that unfortunately physical examinations were required. The parents also reported that their daughter said that she feared the nurses and staff and was afraid to raise concerns. The psychiatrist said that she did not observe fear in the girl, nor had she reported any concerns to her.
She said that the girl did witness another young person being restrained and taken away to have medication administered and that may have upset the girl. The psychiatrist said that the hospital had a patient feedback form where the girl could ask questions or relay concerns with the key worker through that.
The barrister also said that after the girl ate she must rest for a period, however on one occasion after she had eaten she was left for a long time and wet herself. The girl was very embarrassed. It was suggested that the girl be brought to toilets before her meals.
Finally, the parents’ barrister said that the girl saw everything in black and white. The girl was given nutritional supplements, but she thought that it was wrong for the hospital to make her take the supplements. The barrister said, “she may not like some of the treatment, but it is important to raise issues with her.”
The solicitor for the guardian ad litem (GAL) asked that the case be reviewed by the court in a few weeks to monitor the girl’s progress. The GAL requested that the weekly care plan be provided to her and recommended that an email be sent to all parties so that everyone was on the same page.
The judge extended the girl’s involuntary admission. He said that she was very sick. He said that the psychiatrist agreed that the girl had limited insight into the severity of her condition. Although some progress had been made, more work was required to ensure that she reached her target weight. He said that the children before the court in s.25 applications were very sick and the treatment was necessary.