Care order in long-running case of girl with eating disorder extended for a further period of six months – 2023vol1#37

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A child of primary school age was involuntarily detained in a special psychiatric unit of a provincial hospital under Section 25 of the Mental Health Act as she was suffering from severe anorexia nervosa. The child was also the subject of a care order due to serious concerns about her health and welfare if she remained under her parents’ care. The parents were separated and their acrimonious relationship was a cause of acute stress to the child. The child had made improvements while under the care of the specialist psychiatrist and had progressed from a position where she had been fed by a gastric nasal tube to being able to eat small regular snacks.

The Section 25 order was extended following video-link evidence from the child’s psychiatrist where she informed the judge that the child still had “strong anorexic thinking” and was persisting in doing compensatory exercises. Following her release from hospital after improvement to her condition, the child lived with her father. The judge was very critical that the child, while remaining subject to a care order of the Child and Family Agency (CFA), was living at home.

The lawyer for the child’s guardian ad litem (GAL) told the court that the child needed a residential placement. The child moved from the father’s house and moved in with her mother and was self-harming. The child’s social worker said the child’s medical trajectory was “heading to a pre-admission level” as her weight was very low. The child’s medical professionals advised that she should live in one home with one of the parents but the parents could not agree who she should live with.

The matter came back a number of times before the court and a residential placement was sought but no residential placement was available. The CFA lawyer said the seriousness of the child’s condition was making it extremely difficult to find a residential placement. The judge criticised the CFA at a corporate level and said the social workers were doing the best they could with insufficient staff and resources. The child had been admitted to the local provincial hospital but had deteriorated and had made two attempts to take her own life.

The mother had stayed with the child in the hospital during the daytime, which meant that the father could only have more limited access in the evening time. This proved difficult for him as the couple’s other children were living with the father. The judge said it was unusual that this child’s parents could not “park their differences” for the child’s sake and that it was possible they might only realise the error of their ways at an inquest. The GAL’s lawyer stated that focus needed to be kept on sourcing an appropriate onward placement for the child as she could not be released from hospital into the care of her parents. The judge stressed that he would always be available, day or night, if there needed to be an emergency application made in relation to the child.

Current situation

The child was discharged from the provincial hospital into the care of her mother as a residential placement had not been sourced. The social worker described extremely worrying behaviour exhibited by the child since her discharge. The child had physically assaulted and hurt her mother and on one occasion had attempted to steer the mother’s car off the road. The judge listened to what each parent had to say. The mother blamed the child’s behaviour on the “enormous acrimony” between herself and the child’s father. When asked her opinion about extending the child’s care order, the mother said she thought it should be extended for a further 12 months.

Day seven of the case

The mother told the judge that the child’s specialist had recommended that the child needed to be in one house so she was staying with her mother and her meals were being supervised. The child was admitted to the accident and emergency unit of the hospital during the holiday period and was frightened she might be re-admitted. The mother reported that the child had returned to school at the start of the term and was eating at present. The lawyer for the CFA asked the mother if she was consenting to a six-month care order and the mother replied that she would prefer if a 12-month care order could be made.

The judge asked the child’s father if he believed conflict was a factor in the child’s problem and he said that there had been no contact between the parents for many months. Two of the child’s siblings lived with the father fulltime and another sibling shared his time between both parents. The father told the judge that the child had only been with him for a number of hours on Christmas Day but that she had made ten attempts to come to his home during the holiday period but that he had been advised to return her to her mother or the Gardaí would take her by force. Her siblings had not met her outside of that time. The father stated that the child had made allegations to him that her mother had hit her.

He informed the court that there were separate private family law proceedings in being in the Circuit court and that a very experienced childcare professional, who had spent hundreds of hours in his home, had completed a 60-page assessment report. The father said that the report recommended that the children should live full-time with their father.

The judge expressed her shock that the child had not had any access with her own siblings for a lengthy period. The GAL said that the child wished to spend more time with her siblings. She expressed serious concerns about the child’s behaviour, saying that she had stood in the middle of the road in traffic. The GAL was of the opinion that a residential placement would be a better place for the child regarding access to family members.

The judge said that she was more interested in problem-solving and asked the father about the gifts he had bought the child for Christmas. The father said that he had used the child’s wish-list and had bought her all the items from it. The judge asked about birthday presents and the father said that the child had been living with him at the time of her birthday and had lived with him for a period of seven months, during which time she had improved to the point that the CFA were going to “step back” from the situation. The father’s lawyer told the court that he had followed all the guidelines and arrangements made by the child’s specialist. He had supported the plan as best he could. However, the lawyer said he was now very concerned about the child’s current reported behaviour and was seeking a short review again in one month’s time.

The father told the court that the child had attempted to come home to him almost every day during the holiday period but that he had to tell her “I can’t take you”. He told the judge that he could not understand why the medical professionals had come up with that plan.

Judge: “The child’s relationship with each parent needs to be rehabilitated.”

The lawyer for the CFA said that the child’s medical situation needed to be stabilised first but the judge said this was “the tail wagging the dog” and that the acrimony between the parents needed to be addressed. The lawyer for the CFA told the judge that a previous judge had stressed the gravity of the matter by speaking to the parents about a future possible involvement of the coroner’s court.

The father stated that a 60-page assessment report written by the very experienced childcare worker, who had spent hundreds of hours in his home, had recommended that the children should live with him in the home fulltime. The lawyer for the CFA criticised the lack of insight the father had shown when he had sought full custody of the other siblings. The father said that he was being given absolutely no information about his child and that his phone-calls were not returned.

The judge asked the social worker what the benefit of extending the care order was. The social worker said the order would give the CFA oversight of the situation; it would allow them to continue to seek an appropriate residential centre and it would facilitate an opportunity to assist the child’s mother to deal with the very challenging behaviour.

The father’s lawyer asked the social worker if the child had requested to see her father and siblings and the social worker replied that this had been facilitated on Christmas Day but that the child’s previous social worker was on sick leave. The judge stressed that the wishes of the child were very important. She said she was shocked that the child’s access with her siblings was not happening and that this would affect anybody’s health.

The lawyer for the GAL made a Section 47 application to direct the CFA to seek a residential placement. The judge asked the GAL what the child’s wishes were around access with her father and siblings and the GAL said the child would like one of her siblings to be with her at all times and that she would like to see more of her siblings.

Judge: “Are the parents listening to this? The child herself would like to see more of her siblings…it’s the parents can make that happen.”

The GAL said the child wished to see her father whenever she wanted to. The judge asked the GAL if she thought the child had a mental illness and the GAL said the child “has a diagnosis”. She said that when the child was in the first hospital the plan was structured and the professionals organised the parental and sibling access arrangements and that this “planning away from the family” worked well.

The judge asked the GAL how school was going and the GAL said the child reported it was going well but that she told hospital staff she was not happy. The GAL described the child as “flat, sad and no energy”. She said she believed a residential placement would be a better place for the child regarding access arrangements. The child had made two serious assaults on her mother. She had stood in the middle of the road in traffic and had suicidal ideation.

The judge asked what had happened in relation to the child’s bedroom and her belongings. The father informed the judge that the child had her own ensuite bedroom but that when one of her siblings had undergone recent surgery, he had used the room temporarily with her consent to avoid infection. He told the judge that the child had not had access with her grandparents for some time as she was advised to live in one house. The lawyer for the CFA said this was due to the 24-hour medical supervision she needed.

Judge: “I take the view that there’s physical and emotional health…both are important…we are in an emergency situation”.

At this time the judge rose and went to the judge’s chambers for eight minutes and then returned. The judge directed that the child’s care order be extended for six months.

Judge: “All the professionals in the world are not going to be able to solve this…she needs love. She is not seeing her siblings, her Dad, her grandparents”.

The judge listed the matter for a date two months later when the court could devote a half day to the case to address the Section 47 application and review the matter. The judge directed that the detailed report made by the childcare assessor be filed on the court’s file in advance of the next court date and that the report be made available to the court on that date. She directed that the care order be extended for a further period of six months.