Emergency Care Order for newborn baby while mother under psychiatric care, interim care order granted later – 2024vol1#4

Dublin District court granted an emergency care order for a newborn baby while the mother participated via video-link from the maternity hospital bed. Evidence was heard from the hospital psychiatrist.

The baby had been born that day by C-Section. The treating psychiatrist from the maternity hospital felt that the hospital could not manage the case without a court order being made. He said the mother could not be left with the child alone and she was under the care of both the obstetrics and gynaecology department and a psychiatrist in the maternity hospital.

The social worker went to the hospital to serve the court papers on the mother. The mother appeared via video-link to the court for the proceedings though that she had no legal representation.

The judge said he wanted to see the mother on the video-link, she participated from her hospital bed and the judge spoke directly to her. The mother was attended by a nurse and a hospital social worker. The judge congratulated her on the birth of her child and wished them both well.


First psychiatrist’s evidence

This doctor was a psychiatrist in the maternity hospital and had been involved in the mother’s care. He had spoken with her and considered she had capacity. There were no indicators that she lacked capacity. He said they had discussed the possible court proceedings with her the previous week. He had prepared a report for the court.

He said the mother had a schizophrenia diagnosis. She misused cannabis and suffered from multiple delusions which were unshakeably held, including delusions regarding the baby. He said that before she was pregnant she had delusions she was pregnant, that the hospital had taken her baby, that the State took babies and that technology interfered with them.

He went on to say that the delusions had lessened but there were elements of her behaviour that was erratic and that she would leave her residence for long periods of time and they did not know where she was. He said she had opened boxes of firelighters and set a fire in a forest. A lot of her delusions related to the baby and there was concern over safety issues. At one stage she thought the baby was the Anti-Christ. The psychiatrist noted that particularly after a birth there was a risk of post-partum psychosis. He said that the mother felt that she did not need any medications and he said the first two weeks after a baby’s birth was very high risk.

The mother interjected and said what he was saying was all lies.

The doctor said that they had been keen to facilitate access, keen to give round-the-clock maternity support and that the mental health professionals would provide round-the-clock supervision. He said his concern was what would happen if the mother decided to up and leave. He said it was not appropriate for the hospital to have to seek the Gardaí to invoke a Section 12.

She had active psychosis symptoms and active cannabis use. She had no insight, some days were good and on others she was highly distressed.

When the doctor was asked would the situation resolve within eight days of treatment, he replied that the mother did not want medications so it was unlikely to improve and may in fact disimprove.

The mother interjected again and said he had no grounds to say what he did. She said he lied to her face, she had no psychotic symptoms, she had no delusional symptoms, she was fully capable and she did not know what they were talking about. They had only met three or four times. She said where she was living there were lots of children. She had thought there might be some supervision but did not envisage them taking her baby and placing him with some random family. She said she was fully ready to mind the child and fully capable. It was very upsetting and shocking that she was led to believe something else.

The doctor said the mother had been admitted to hospital three weeks previously. She had been in for brief admissions in the past and for five days prior to the birth. The hospital could facilitate an admission for up to one week. He was happy she could care for the baby in a controlled environment but that the situation could change very quickly and could become a serious and immediate risk if the baby was removed from the hospital.

Second psychiatrist’s evidence

This psychiatrist had known the mother for five or six years and had also prepared a report for the court. He said he had engaged with the mother through the community health service except for a period of time when her whereabouts was unknown. He said she had had five inpatient admissions, the most recent in Summer 2023.

She had had a relapse of her schizophrenia and when she was unwell she exhibited hostility to others. When making a mental health decision the team weighed up the risk and treatment criteria and weighed up the benefits. The mother had had previous periods of seclusion.

There were more risks with pregnancy and the community health service decided to “watch and wait”. He said he agreed with the other doctor regarding her delusions. Her symptoms ranged from hallucinations to delusions. It could impact on her care of the baby. He explained that some of the wider issues related to planning, decision-making and her temperament and feelings which were all impacted by psychosis and she could not manage the baby by herself. He said symptoms usually deteriorated further after having a baby and it was unlikely to resolve within eight days, it would take longer.

The mother interjected and called him a liar and she said she could care for her own child. She said he “didn’t give a damn”. She again reiterated that her accommodation was one which was a “perfect place for a child”, she was in shock, there was always help available at the accommodation, it was more than perfect for someone in her situation, nothing but supports there and that it was a waste to send her child to some random family, a child should be with its mother. She said “she didn’t know what to say”.


Social worker’s evidence

The social worker said she had been assigned to the case for three months, following a referral from another Dublin acute hospital. After the mother had found out she was pregnant there was a pre-birth conference but the mother did not attend. Other professionals from the social work department and the maternity hospital did attend. There had been a concern of significant risk to the baby without the order.

She said the mother expressed delusions: about the baby not being hers, about bones being removed and that she did not feel safe and that the baby was an extra-terrestrial alien. She said the level of risk was due to her history and she did not think a supervision order would be sufficient.

The mother interjected and said she had only met the social worker four times and that the place where she was living was the perfect place for a first-time mother.

The social worker said the plan was for the mother to remain in the maternity hospital for a week, with 24-hour supervision. She said the mother could not be alone in the room with the baby.

The mother interrupted and said: “You don’t know that, how the hell can you say that, that is why people hate Tusla.” She went to say: “You are completely corrupt. There was no basis or grounds, it made no sense, they are the problem and they are lying and they had no examples.”

The mother apologised to the court for the way she was speaking but she said she was in shock and she was crying. She said it was “all lies” and that she had only met the psychiatrist five or six times. She said the baby was moving alright and eating well.

The judge said it was a serious case and acknowledged it was a difficult case for the mother. He said the doctor had assessed the mother as having capacity and he said the court was mindful of the fact that it was day one of the child’s life and that the mother had not had the benefit of legal representation.

He referred to the evidence of the doctor and his professional concerns and the outline of the treatment since the mother’s admission. He said that the doctor had given evidence that there was active psychosis, active cannabis use and a lack of insight.

In relation to the second doctor he said that the doctor had known the mother for five to six years and she had a spell of voluntary admission. He said she was psychiatrically very unwell and was therefore unable to care for the child. He said he had heard evidence that women with a pre-existing mental health illness can deteriorate after giving birth.

The judge said the mother should remain in the hospital with the nursing staff with her and he would encourage access. He said without the order there was a concern the mother would leave the hospital with the baby. The mother was unable to look after the child outside of the controlled environment and he would proceed with an abundance of caution as the nuclear option was to take a newborn into care.

He said the professionals believed that neither a supervision order nor a mother and baby unit would be sufficient to manage the risk and he said the doctor wanted to avoid having to call the Gardaí to the hospital to invoke a section 12.

In all of the circumstances the judge said he would accede to the emergency care order. He said the mother should be appointed legal representation, access should be meaningful and advised an abundance of caution. The mother and child were to remain in the hospital.

Interim care order

The case came back before the court with the Child and Family Agency (CFA) making an application for an interim care order. Both parents were present in court along with a maternity nurse who supported the mother. The court was told that the parents had both applied for legal aid that day and solicitors for both parents were in court. The CFA informed the court that they were adjourning their initial interim care order application as the mother and father consented to a voluntary care arrangement being put in place.

At a subsequent hearing an interim care order was granted. A reporter from the Child Law Project was not in attendance at this hearing.

The case then came back to court for an extension of the interim care order and to hear an application from the CFA to dispense with the parents’ consent to allow the child to travel abroad with his foster parents on a holiday that had been booked before the child was received into care. The father was in court but the mother was not present as she was in hospital receiving care.

The court was informed by the CFA solicitor that both parents were consenting to the extension of the interim care order on a without-prejudice basis.

The father was objecting to the application to dispense with his permission for a passport for the child on the basis that there was no need for the baby to travel outside of the jurisdiction and also that he had built a bond with the baby which would be disrupted as he was having access three times a week which would not happen if the child was allowed to travel.

The social worker outlined the dates of the proposed holiday. She said the foster carers wanted to bring the baby with them. The child had settled with them and had forged an attachment to them. The application for the child’s passport was underway and his birth had been registered. In addition, a previous application to dispense with parental consent to allow the baby to receive his vaccines had been made. She said to deny the child the holiday would be disruptive to his routine and to the relationship forged and there was no need to separate him from his primary carers.

She went on to say that a reunification plan and a Parental Capacity Assessment (PCA) were to commence in the coming months, but the social work team did not have enough information currently.

She referred to an incident at access where she said that the father had brought bleach with him to the access centre as he wanted to clean the floor so that he could teach the child to walk. The child was two and a half months old at the time.

She said access was currently fully supervised and that no unsupervised access would occur before the PCA. She acknowledged that the father had access three times a week for one and a half hours. Generally access went well, however there had been feedback from the social work student who supervised access indicating the father said to her, “don’t tell me what to do.” She accepted that the social work team were not at the point of reducing his access.

The solicitor for the father said that the father’s position was that the holiday was not a necessity, it would interrupt his bond and access with the child and the child was very young to be going away.

The guardian ad litem (GAL) said that it would be beneficial for the child to travel with the foster carers and re-emphasised the fact that the holiday had been booked before the child was received into care. She said it was more appropriate for the child to go on the holiday than to move the child to another new house. The GAL said that access could be facilitated through voice calls/video calls and this was in the child’s best interests.


Father’s evidence

The father said he thought the child was very young to be travelling, maybe after one year. He confirmed he was having regular access and it was very positive. He agreed that the child was calm and settled and slept. The father said during access he fed and played with the child and the child slept. He said he exercised the child’s legs, he was not sure that he was getting exercise in his legs. The father said it was wipes he was using and not a bottle of bleach. He wanted to clean the floor with the wipes before putting the child on the floor.

He was asked about his living arrangements and he confirmed he had secured a permanent tenancy which was available from that day. He said he wanted to mind the child and he would prefer that the foster carers delayed their holiday.

The judge said he had some familiarity with the case and he noted the consent of the parents to the extension of the ICO. He noted that the GAL was supporting the ICO extension and was glad that the mother’s presentation was improving and that the baby was thriving.

He said he was satisfied to extend the ICO for a period of 28 days.

In relation to the application by the CFA to dispense with the parent’s consent to allow the baby to travel he said he had heard the father’s concerns and that he understood them. He said it was not ideal that the child was travelling but he was a child in care and the foster carers had booked the holiday before the child was received into care. He said the child had formed a strong bond with his carers and he was concerned about the impact if the child was moved. He said the child should be allowed to travel but that arrangements should be made for access via photos or video calls. He said contact was not to be removed altogether for the period of the holiday.

He made orders extending the interim care order and dispensing with consent to allow the child to travel.