“Clearly it’s a success story” – High Court judge – 2017vol2#10

See also Case Histories 2017 Vol 1, No.6

The High Court heard that a significant intervention sending an adolescent [A] to an out-of-State low level secure therapeutic mental health unit in order to obtain treatment unavailable in Ireland resulted in a very successful outcome for the teenager. He had suffered from attenuated psychosis and his life was at risk. On reaching his majority A returned to Ireland in 2017 to a placement with a private service provider in an adult psychiatric unit. It was noted by counsel for the Child and Family Agency that the young man was a vulnerable adult.

In 2014 Y had left home and gone to live with his grandfather following an allegation of physical abuse by his stepfather. However in early 2015 the placement with his grandfather broke down and the teenager was received into the voluntary care of the Child and Family Agency. After a short-term placement in foster care he was placed in residential care in 2015.

During 2015 problems arose with his residential placements due to his developing aggressive behaviour and serious multiple attempts at self-harm. He engaged in risk-taking behaviours in his placements, damaged property and threatened staff.

The teenager was admitted to an adult psychiatric unit for 48 hours in 2015 after a suicide attempt, he was assessed by a consultant at the time who found that A was not detainable under the Mental Health. He then waited for 20 weeks before going into secure care during which time he engaged in self-harm, property damage, threats of harm to others and reported criminal activity. He had limited engagement with services such as ACTS (therapy service) and the Child and Adolescent Mental Health Service (CAMHS).

Before his transfer out of the jurisdiction he had been an involuntary patient in an adult high dependency psychiatric ward, under single occupancy. A psychiatrist from CAMHS who worked with adolescents in secure care had confirmed that secure care had now been ruled out for the child as it was not a mental health care facility and therefore could not manage his medication.

History of the case prior to transfer out of state
During a court hearing for an Article 56, Brussels II bis order sought from the court to use its inherent jurisdiction to transfer the teenager out of the state, the clinical director of the Central Mental Hospital, a consultant forensic psychiatrist, told the court that he had assessed the teenager in Autumn 2016 and it was his opinion that he met the diagnostic criteria for attenuated psychosis.

He said the boy as in the “at risk” category with an increased risk of a severe mental illness in the next year with a typical progression to schizophrenia or bi-polar disorder.

In the next six to 12 months his life was at risk and any risk assessment would show that there was a high imminent risk of serious harm, including death, because of the nature of his behaviour in recent months. Furthermore, when at liberty he repeatedly engaged in impulsive, unpremeditated, reckless behaviour and engaged in acts which were dangerous to himself. He had attempted to hang himself and jump off certain locations and these attempts had not been superficial.

“I don’t know of a facility in the State that can meet his needs,” he told the court. “To protect his life, in my opinion he needs a period of sustained treatment in a therapeutic, safe and secure setting. It’s likely to be at least for a year, it cannot be found within the State. [The institute] in the other jurisdiction is the one most likely to meet his needs.”

The teenage boy was at the time of the hearing in an adult high dependency psychiatric ward. The psychiatrist described the boy’s room as being big enough to fit in a single bed and two other people. He had limited fresh air and exercise.

Senior counsel for the CFA submitted that the finding of fact was a mental disorder which warranted detention in hospital. The formulation of a treatment plan and a mental health treatment plan would take place.

The teenager wished to remain in Ireland and did not wish to partake of therapy in the proposed institution in the UK. His view was different to that of the GAL who felt it was in his best interests to be admitted to the low secure psychiatric child and adolescent therapeutic centre.

After three days of hearing, including from five psychiatrists, the judge concluded that it was in the young person’s best interests to receive the appropriate treatment and therapeutic benefits available at [the UK unit] and that he should be detained for that purpose. The full written judgment was published on the Court Service website.

Within four months of the admission to the UK hospital the teenager was reported to be engaging at a meaningful level not done for a number of years and was in the best place ever regarding family relations.

The adolescent underwent medical tests that he had refused for a long time and moved from the psychotic aspect of his diagnosis going from a risk of proximate risk to his life.
Within six months A was no longer secluded and had been granted some leave from the grounds. A change in his medication had worked positively and he had attended a conference in relation to his own welfare as well as engaging in psychology.

There was a concrete improvement in his behaviour and he “was doing his level best” the court heard. A HSE psychiatrist would review his case in August and his progress was quite remarkable.

By mid-summer the GAL was seeking a precise care plan for the proposed return of the teenager and suggested a conference call between the parties. A private service provider had been identified and the issue of funding was to be dealt with.

The court heard that the young man was anxious about being detained in the out-of-state institution and was considering legal representation. Senior counsel for the HSE told the court that it was never the case the minor would be detained out of state after the age of 18 and on a legal basis there had never been a reason for such an application.

Ultimately A returned home on reaching his majority to a privately funded placement in an adult psychiatric unit. The transfer home was successful and the court heard from counsel for the HSE that A was now an adult, he had capacity and that it could not have been imagined how well it would turn out and this was in no small part due to the Court itself.

This was echoed by the guardian ad litem who also felt that the period in the out-of-state psychiatric hospital had been a significant intervention that nobody could have envisaged. His mother and grandfather were very grateful to all of the parties involved and to the Court.

Six weeks later when the case came to the Minors’ Review List for the last time counsel for the CFA made an application to terminate proceedings. He told the court that A’s social worker and guardian ad litem had paid him a visit on the previous days at his new accommodation where A had greeted them warmly and they had found his demeanour to be calm and bright. He had lost weight and was attending a gym and eating appropriate food, he had also bought himself a new bike which he was very happy with.

The young man had chatted to the social worker and GAL while cleaning up, sweeping the floors and wiping down the kitchen. He had told them how happy and grateful he was for everything that had been done and was insistent that the wanted his appreciation to the judge mentioned. “He had feared returning to [a Dublin] hospital and did not quite believe he’d have an aftercare plan like the one he has,” said counsel for the CFA.

He planned to do a course, take up boxing and spoke of his future plans. His social worker reported him to have demonstrated calm, joked freely with them and spoke highly of staff and his aftercare agreement.

The judge terminated the proceedings. “Clearly it’s a success story,” she remarked. All parties were in agreement.