Child admitted to child and adolescent mental health unit – 2019vol1#10

An order for the involuntary admission of a child into a child and adolescent mental health (CAMHS) in-patient unit was granted under section 25.6 of the Mental Health Act 2001 in a Dublin District Court. The teenager’s mother was consenting to the order.

The teenager (A) who was already under a full care order since 2012 had been living with his foster parents before his admission into the CAMHS in-patient unit. He had called An Garda Siochana from his foster home in a stressed and agitated state and they had brought him to A&E. The hospital had then contact the CAMHS unit where a bed was available facilitating his admission.

The clinical director of the CAMHS in-patient unit, a professor and a consultant child and adolescent psychiatrist, told the court that he had met with the teenager since his admission into the unit the day before the court hearing.

A had been previously referred to CAMHS within the community health service, there the consultant psychologist had reported A to be suffering from an anxiety disorder. It was now felt by the staff of the in-patient unit that his condition had deteriorated since that earlier diagnosis, he had not slept for three days and was in an agitated state. He distrusted his foster mother and reported that the medication he was taking was interfering with his thinking and his thoughts were increasingly preoccupied with the interventions he was receiving.

The local community services consultant had prescribed an SSRI (selective serotonin reuptake inhibitor) for the primary problem of an anxiety disorder. Currently the teenager was expressing increasing distrust as to the motivation of his treating consultant within the community services.

The clinical director of the CAMHS in-patient unit told the court that A had expressed a wish not to return to live with his foster parents and that A’s thinking in relation to them and his treating consultant in the community was quite paranoid. The clinical director told the court that he had a treatment plan for A if the court was to grant the order under section 25.6 of the Mental Health Act.

He said a number of stressors had been identified in relation to the teenager. He had moved to the foster placement six months ago, initially it had been a respite placement and then after two months it became confirmed as a long-term placement. Four months into his new foster placement, A started in a new school, this was subsequent to a three-month period of non-attendance at school. The young person had found school to be a stressful environment in the past therefore starting a new school would be very stressful for him.

There were concerns in the foster family’s home that he bore some responsibility for the death of their two dogs. This was denied by the teenager. The clinical director said that it would take time to establish a rapport with the young person, currently he was finding it difficult to trust people but felt he was developing a relationship with the nursing staff in the in-patient unit.

For now A would be in the assessment phase and in a safe environment. Young people of his age were also in the unit, it was a brand new facility and designed to be conducive to relieving stress. Each bedroom had its own ensuite and there were lots of space and facilities.

The director remarked that A’s response to the new environment was part of the assessment phase. “Once he is taken out of the situation he has found stressful then how he responds to being in a calm environment, that’s part of the assessment phase. We also look at the use of medication and how it will be helpful in this process, it’s not similar to the medication he had been on. He said he understood how such medication could be helpful and did agree to give the matter further consideration and to discuss it further with members of staff,” he said.

“He is suffering from a mental disorder, it will take time for us to be clear as to the exact nature of this disorder, the next 78 hours is very informative of the true nature of that disorder. I get a sense from the reports there is a background of an anxiety disorder, an acute stress reaction with almost psychotic-like features. He reports hearing voices and seeing things, symptoms that he himself is finding very stressing. These can happen in acute stressful situations but such phenomena can arise in acute mental illness. It’s a wait and see, we have to be clear as to the true nature of these symptoms.”

The judge granted the order noting the mother’s agreement and consent. She said she was satisfied there was a mental disorder for the purposes of the treatment at the centre and that this was not a treatment he could receive anywhere else. The case was due to return in three months’ time.

Section 25.6 of the Mental Health Act 2001 states:

Where it appears to a health board with respect to a child who resides or is found in its functional area that—

(6) Where the court is satisfied having considered the report of the consultant psychiatrist referred to in subsection (1) or the report of the consultant psychiatrist referred to in subsection (5), as the case may be, and any other evidence that may be adduced before it that the child is suffering from a mental disorder, the court shall make an order that the child be admitted and detained for treatment in a specified approved centre for a period not exceeding 21 days.