Child suffering from anorexia nervosa living at home under care order; judge critical of CFA’s lack of social workers and foster parents- 2022vol2#17

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A child of primary school age ended up living at home despite being under a care order. She had been detained in a special psychiatric unit of a provincial city hospital under Section 25 of the Mental Health Act 2001 as she was suffering from the eating disorder anorexia nervosa. The child was subject to the care order as there was a very serious risk to her health and welfare. The child had made improvements while under the care of her psychiatrist and progressed from a position where she had been fed through a nasal gastric tube to being able to eat small meals regularly.

During a hearing of an application to extend the care order the court heard she had written a personal letter from her hospital bed to the judge asking to be released from hospital but the judge decided, on the advice of the psychiatrist, that the child should continue to remain in hospital as she was still presenting with “strong anorexic thinking” and was attempting compensatory exercises in the bathroom.

On the next date in court the judge extended the care order and decided that residential care was the best option for the child, who had recently been released from the psychiatric unit of the provincial hospital. The child had undergone treatment for anorexia nervosa and had spent a number of months at the hospital. The child had been due to live with her mother following her release from the hospital but she had returned to her father. The mother’s lawyer said that the child was now hostile towards her mother but the father’s lawyer said he was not opposing access and would give evidence of his encouragement of access. The judge directed that a bespoke residential placement be found for the child and directed that an update be given after one month.

At the next hearing of the case the lawyer for the CFA told the court that the child, who had a serious eating disorder, was living with her father although she was the subject of a care order. The judge asked the lawyer how the CFA could possibly be fulfilling its obligations if this were the case. He said he was seriously concerned.

Lawyer for the CFA: “It’s a thin line… she’s a vulnerable child, who was subject to a Section 25 Order.”

The judge stated that he was not blaming the lawyer for the CFA but that he believed the CFA, who had “corporate responsibility” was failing in its duty. The lawyer for the CFA reported that there was now a national crisis regarding residential placements and that social workers were doing their very best to deal with things.

The judge said that the court had to make it known that the child’s mother may have proceedings under the European Convention on Human Rights against the CFA. He described the CFA as “not fit for purpose” as it did not have sufficient numbers of social workers, foster carers or residential placements. He pointed out that there had never before been such a sad state of affairs as the present time with the number of placements breaking down. He said that social workers were spending so much of their time on bureaucracy and finding placements that they could not do what they were trained to do.

The lawyer for the child’s guardian ad litem (GAL) informed the court that the child was not safe at her home and that the child was contacting the Gardaí out of hours.

Judge: “The social workers are trying but CFA corporate is not complying.”

The judge decided to direct the CFA to make a written response to the child’s GAL, which response was to be copied to the solicitors for the mother and father. He stated that he was not satisfied and was deeply concerned that the CFA was not fulfilling its obligations under Section 18 of the Child Care Act.

Judge: “This child is in care but is not in care.”

The lawyer for the CFA reminded the judge that the court had been previously told that the child was living with her father while subject to a care order. The judge replied that such a situation challenged the integrity of the proceedings and that it was a practice that was “coming up, over and over”. He repeated that he was very concerned for the child.

The lawyer for the GAL said that things for this child were now at a crisis point and that she needed a placement. The judge referred to a line from the child’s letter to him where she wrote that she did not see the point of a care order as it made no difference to her.

When the case came up again it was adjourned to a date one month later as the child’s father was not present in court. The lawyer for the CFA told the judge, who had not been involved at any earlier hearing of this matter, that this was a very serious matter as the child was suffering from a serious eating disorder. She advised the judge that the child was being very closely monitored.

When the case resumed a month later the lawyer for the CFA told the court that the girl was now living with her mother. The CFA lawyer said that the “toxic parental relationship” was a cause of stress and anxiety for the child and that she had been very distressed in recent weeks and had moved in with her mother.

Judge: “Who is in charge of this situation? The whole point of a care order is taking responsibility from the parents. Now the child is deciding. She is confused, desperate, emotional, volatile and vulnerable. How sustainable is a care order if the child is in charge?”

The lawyer for the CFA informed the court that an application had been made for a residential placement and that the child was on the priority list. The judge replied that every child who got on a list was on that priority list. The judge added that it was easy to find out the child’s priority placing on the list on a weekly basis. He said he was not satisfied to rule that the review of the child’s care order was satisfactory.

Judge: “[The child] is not receiving the care and attention that she needs.”

The child’s social worker reported that she had been self-harming, which was described as impulsive behaviour and cutting with a scissors. The judge asked the parents if they had any questions. The mother replied that she had no questions and the father asked if the CFA had now achieved the goals they had set out to achieve.

The social worker told the judge that the child’s medical trajectory was “heading to a pre-admission level” as her weight was too low. The judge said the problem in this case was not a matter of funding but of finding a suitable residential placement. He stated that it was the management of CFA and not social workers who did not plan in advance. He was also critical of the planning which was based on the belief that centres had to be operating always at full capacity.

The child’s mother told the court that she had engaged with the services but that the child’s father had not engaged. The judge said that the child’s problems had very little chance of resolution while her parents were not in a position to co-parent. The mother suggested that one of the child’s parents should withdraw if another solution could not be found.

Judge: “If people make decisions at the wrong time, it could have significant or fatal consequences.”

The child’s father said that the CFA were brought in on the matter because the parents could not agree which home the child should live in. He stated that the child had not had one minute of therapy and had not seen a dietician. The judge said for the dietician to be engaged, there must be a period of stability and that the chaos had to be gone.

He said the CFA could sometimes have an impossible task. They are sometimes brought in to retrieve a situation that is “too far along to retrieve”. He added that the CFA had never got the allocation of support and resources that they needed, which meant they were “blindfolded and had their hands tied”.

The child’s father said that he did not think she would do well in a residential placement as she had deteriorated greatly on her second stay in a local hospital, she had made two attempts to take her own life and had suicidal ideation. The judge replied that the parents needed to give the residential placement a chance as it would allow the child to maintain a relationship with both her parents.

Judge: “I would be very concerned about your daughter surviving if something is not changed.”

The lawyer for the CFA told the father that the child’s mother had engaged with the services but that he had not. The father replied that some appointments were missed by him through illness and also that he did not have the time. The judge told him that if this was important to him, he would make the time. He needed to take some responsibility.

The judge decided to adjourn the case for one month and said he wanted weekly updates on the child’s place on the priority list for the residential placement. The lawyer for the CFA said it was extremely difficult to get a suitable placement for a child with such a serious condition. The judge replied that any possible solution which could make things better should be tried.

The matter has been listed for a date one month later.

When the case resumed, now on its sixth adjourned hearing, the court was told that the child was now back in hospital, having deteriorated and lost significant weight. The lawyer for the guardian ad litem (GAL) made an application seeking the sourcing and funding of a residential placement. The father’s lawyer made an application for an improvement for the father’s access to the child in hospital.

The lawyer for the Child and Family Agency (CFA) informed the court that, due to the deterioration in the child’s condition in hospital, a Section 25 application to have the child detained for her own safety was pending. The judge made no order but said the matter was very serious and that he was available, day or night, to deal with any emergency application which might arise in relation to the child.

The child’s father was present and was represented. The mother was not present. The GAL was not present but was represented. The lawyer for the CFA informed the court that the child was now an in-patient at a local provincial hospital and that her condition had deteriorated seriously. She said the child had significant weight loss, she was not fit for discharge from the hospital and could not return to her parents’ care. The CFA lawyer said that a Section 25 order, which would allow for the child to be detained involuntarily for her own health, safety and welfare, was pending, but that she did not have instructions on that.

The lawyer for the GAL made a section 47 application seeking to source and fund a placement at a residential facility. The judge replied that the funding for the residential placement was not the problem but he questioned whether a residential care facility was suitable for the child as the problem was one of mental disorder.

The lawyer for the CFA recounted an incident that had occurred with the child at the hospital, where it necessitated the assistance of three security personnel and two nurses. The judge described this as a very serious matter. The CFA lawyer stated that the child was in the right place at present but the judge was very concerned that the child had to be restrained.

Judge: “She had to be restrained. Effectively she is detained.”

The social worker said the child was confined to bed rest. The judge said he was worried about judges’ availability over the following days and that the child could not be detained without a legal basis. The father’s lawyer informed the judge that the father was very disappointed that the child had been moved back to her mother’s care. She had lost 15 kilograms in weight and 11 of those kilograms were lost while she was in the care of her mother.

Judge: “It is not a blame game… [it’s] impossible to get the parents to agree anything… that’s why she’s in care”.

The father’s lawyer explained that things had stabilised for the child during the summer when she was in her father’s care. The judge asked whether the child’s mother was present and the lawyer for the CFA replied that the child’s mother was in the hospital with the child. The mother’s solicitor was not present either.

The father’s lawyer said that two of the three children of the family were living with the father. It would be better for him to be facilitated to visit the child in hospital during the day rather than in the evening. She stated that the father only had evening access. The lawyer for the CFA reported that the child was calmer in the evenings. The social worker said that the mother was in the hospital from 9am until 4pm and that the child was very dependent on the mother during the snack times. The mother was able to carry out her own work from the hospital.

The social worker said that the child had said that she did not want to see her father but that she regularly texted him. The judge asked if everything that was being said was said “through the filter of anorexia” and that the child did not want to see a parent who would make her eat.

The father informed the court that the child started texting him daily from the hospital at 8.30am. He said that the other two siblings left for school daily at 8am and he could visit during the day. Her siblings had not seen her in over a month. The judge said that if he were in the same situation, he would organise for a babysitter to take the two siblings to an evening activity during the evening as they might have found visiting her upsetting. The judge said he was querying alienation as things had not improved.

Judge: “[It is] unusual this pair can’t park their differences, even with this critical issue of [child’s] illness. This child is not getting any better. Maybe it will be at an inquest they’ll see the error of their ways.”

The GAL’s lawyer asked the social worker if the meeting of the professionals involved in the child’s care had taken place and the social worker replied that it had. They had concluded that the child was compliant and had gained two kilograms but that she also had tried vomiting in the bathroom. The social worker added that the child was on bed rest, was panicked about going into Section 25 care and was teary. The judge said he hoped the two kilograms was progress.

The GAL’s solicitor stated that there needed to be a focus on the forward placement as the child could not return to the care of her parents. She had absconded some weeks earlier and had been found hanging out a window. The judge asked how the “voice of the child” was going to be dealt with when the child was so worried. The GAL’s lawyer stated that the child did not want to go to residential care as the staff were “not nice to her”. The judge said that was typical of an anorexic child’s reaction as “they want to do as much as possible to starve themselves to death”.

The judge made no order in relation to the Section 47 application. He said he would deal with any emergency application, day or night, that might arise in relation to the child.