Mental Health Act application granted for child in care – 2014vol3#17

The CFA brought a Section 25 application under the Mental Health Act to involuntarily admit a minor into psychiatric care. The minor (A), who was the subject of a full Care Order, was a non-national and was living in a residential centre. He wished to be admitted to hospital and was willing to take his medication, but because he was subject to a Care Order the hospital would not admit him, so the CFA was making an application to have him admitted.

His mother was a resident outside of the jurisdiction who chose not to attend any proceedings relating to her son. She had been told by telephone of the proposal to move the Section 25 application.

The court was told that voluntary consent to hospital admission excluded Section 18 (a full Care Order) which was why the CFA had to bring the Section 25 application.

The judge said that under the National Consent Policy where a young person is the subject of a statutory care order they should have separate legal representation. He acknowledged it was a policy rather than having any legal effect but it suggested A should have separate representation. The CFA solicitor told the court that it was an ex-parte application.

The judge told the CFA solicitor that he had a difficulty with the fact that A was voluntarily consenting to voluntary admission and he [the judge] was being presented with a situation where he was being asked to involuntarily admit him.

“[A] is changeable to what he agrees and disagrees to, he has been diagnosed with a specific learning difficulty which perhaps impacts on consent issues as well,” said CFA solicitor. The CFA did not think it would be lawful to admit him voluntarily as he was the subject of a Care Order.

“It may be more appropriate to bring an application for an involuntary admission when he no longer wishes to give his consent,” said the judge.

The judge raised a second observation regarding A’s capacity to consent, he said the consultant psychiatrist had not raised any concerns regarding his capacity. The judge asked about bed availability and where he would be placed.

The CFA solicitor told the court that no adolescent beds were currently available in any of the adolescent units including the privately run units. Therefore he would be placed in an adult unit. “On an exceptional basis it is permitted to place children in these units,” said the solicitor.

The judge allowed the application to proceed, he expressed his reservations as A was a young adult who had the capacity to consent and was consenting, he had concerns as to how it may sit within the parameters of the European Convention on the Rights of the Child, but said that may be beyond the scope of his remit. He also allowed the application to proceed on an ex-parte basis as he was satisfied the presence of the guardian ad litem addressed the separate representation difficulty.

The consultant child and adolescent psychiatrist told the court that A had a chart within the service since 2006. She had examined him the previous day following a request and had concerns that he had symptoms of acute psychosis. He also had a history of conduct disorder.

In the last week to 10 days he had had distorted visual experiences and believed that his thoughts were being interfered with. He also had paranoid feelings about others.
Her clinical diagnosis was of an acute psychotic illness with a past history of conduct disorder and alcohol and substance misuse. A denied this was a current difficulty. His condition fell under mental illness under the Mental Health Act. He had some partial insight into his condition and was aware that his perception had changed; he was concerned about it and was seeking help. He was taking his medication but the symptoms had not completely gone away and he was concerned.

She proposed he be admitted to the adult unit, her preference would be an adolescent inpatient unit but she could not identify one today. He should be transferred if a place because available. “He may need assistance to create that admission, he may change his mind as to whether he should be admitted, in view of that a Section 25 is needed and assisted admission should be available to him if required,” said the psychiatrist.

There was a risk of physical violence in his residential unit as he had an acute psychotic illness. If he were to attack somebody in view of his illness he could be seen as criminally insane.

Her primary concern was his risk of physical violence to others, if he did not comply with medication and advice his mental health would deteriorate. “He has stated the way to end the illness is to end it all, in other words suicide,” said the psychiatrist. She believed the treatment would benefit him, he was currently on a low dose of anti-psychotic medication, but he needed a high enough dose for his symptoms to be alleviated.

She told the court that an order for a Section 25 was required as well as an order for assisted delivery if it was necessary.

The judge told the doctor that a Section 25 was a very serious order, effectively taking away the young person’s right to self-determine, especially when that may not be absolutely required.

The doctor hoped if assisted admission was not necessary then none would be used. The judge pointed out his record would show his admission was involuntary. However the doctor said that involuntary admission was inevitable as he was a child in care.

Judge: “Notwithstanding the fact he has a learning difficulty and a mental illness he has the capacity to consent but this application is required?”

Doctor: “Yes.”

The guardian told the court that he had asked A how he would feel about a court order. A had said he wanted to get treatment and whatever the guardian thought was best he was happy to go with. The guardian felt A was very vulnerable; he did want to get into somewhere but that that consent may not last beyond meeting up with his girlfriend at the weekend.

The guardian was much more comfortable with A going to hospital voluntarily, but if this was the method they had to go for him to get treatment they had to go with that.

The judge asked the CFA solicitor about Gillick consent competency – that A may provide his own consent.

CFA solicitor: “Safeguards in the 2001 Act were not provided for children. We do not believe it is an appropriate process for a voluntary admission to take place, because he is in our care we cannot sign him over to another state body, he is in the care of the state.”

Judge: “You’re asking an organ of the state to do the same thing, the court being the third organ of the state.”

The judge granted the Section 25 application. He was satisfied A was suffering from a mental health illness as defined in the 2001 Act, that he required treatment which he was unlikely to receive unless an order was made under the section, and that he would not be admitted to a hospital notwithstanding his consent to the treatment. Under those circumstances the judge said he considered that he would not get the treatment unless the order was made, he made the order placing him under involuntary admission for two weeks.

The judge said that A was to be provided with separate legal representation on the next occasion if there was another application under Section 25, unless A specifically requested an alternative solicitor.

“If and when a bed becomes available during his involuntary detention an application would be made to the relevant court to have him placed in an adolescent unit,” said the judge. An assisted admission service order was also made.