Full Care Order for African boy – 2013vol2#28

A full Care Order was granted in the Dublin District Court for a boy born in Ireland of African parents. The mother, who had had eight admissions into a psychiatric hospital in four years, attended the hearing.

The respondent father was in Africa, he had been advised to seek legal representation and was served to participate in the proceedings but did not do so. The parties were legally married in Africa and got divorced there, the mother had custody of the boy.

A Garda told the HSE solicitor that in early November his assistance was required by a doctor and social worker at the mother’s house due to her unfit mental state. There were three children in the house, an infant, a toddler and the little boy.

“The only emotion she was showing at the time was anger and aggressiveness, she showed no emotion when the children were being taken away by the father … one of the children was crawling on a glass table,” said the Garda. The father was the father of the two youngest children.

At one point she grabbed one of the children by the arm and the child got distressed. In his opinion the mother “was in an unfit state of mind … there was a serious risk for that child’s welfare to stay in the house.” The Garda and a colleague then brought the mother to a psychiatric hospital.

“The reason that [the mother] displayed restlessness and anger was that her children were going to be taken away from her,” said the mother’s solicitor. “That’s feasible,” replied the Garda, “but she didn’t really have any interaction with the children, she was more in on herself, pacing up and down.”

The GP told the court she had dealt with the mother directly for five years due to mental health issues. On the day of the last Section 12, when the Gardai intervened, “issues had arisen, [the psychiatrist] had not been allowed into the house, and two social workers… were not allowed beyond the hallway into the house.” She realised a doctor’s intervention was needed.

The GP said: “When I went in initially she didn’t really react appropriately, she lay on the couch with her back to me, the TV was up loud, she said she wasn’t going to speak to me … I did establish from her that she had not been taking her medication … she was a little bit hypo-manic which would be part of the bi-polar spectrum.”

“Were you aware there should be full and complete compliance with [her medication]?” asked the HSE solicitor. “It would be a common part of her condition of a lack of insight into the importance of taking her medication,” said the GP. She went to the pharmacy to get the medication (a starting dose for two days).

“Did she present as aggressive at any stage?” asked the HSE solicitor. “She wasn’t at all aggressive towards me. Her language got loud when the ex-partner was coming for the girls. We were basically taking over her whole life, all of us together and she became detached. My assessment was that she had had an acute exacerbation of a long-standing mental illness.”

Recently at the GP practice the mother had told her quite a number of times: “I am not unwell,” but said that if the GP insisted she was unwell and needed medication she would take it. There had been eight admissions to mental hospital in four years, all precipitated by lack of compliance with medication.

The mother’s solicitor asked: “Are you aware she didn’t want to take it due to unpleasant side-effects, depressed mood and loneliness?” She could not recall her saying that, she agreed that all psychotropic medication could have unpleasant side effects, but the benefits outweighed them. The GP told the GAL barrister she had not considered alternative medication or got advice on the day because it became clear that she was “suffering illness to an extent she needed hospitalisation and in the event she was admitted for 16 days.” It was not possible the mother was not psychotic but just upset that her children were going to be taken into care.

The school principal told the court in the second half of the junior infants’ year there was a history of the mother being unwell, and they had concerns about the child’s safety. When she picked him up she was distant and disengaged.

The principal said while out of care the child “acts in”, becoming quiet and withdrawn, the teachers said he was listless, his enthusiasm was low. He became wary and anxious if anyone came to the classroom door, he was worried it was his mother. When in care he was more relaxed.

She met with him three weeks ago and asked him to think of the good times with his mother. He said: “I don’t remember, not really. I don’t remember the good times, she’s been sick for so long.” The boy had said to her: “I didn’t like it at all when I was with her, she was getting sicker every second, every hour, once she hit me with a coat hanger, once she hit me and made my nose bleed, when she hits me I close my eyes so I don’t know what’s going to happen.” Once he was worried his mother was not taking her medication and about going back to her.

The principal was concerned about his thinness when the mother was unwell – he was fitting into clothes for six-year-olds when he was eight. However, he was always well presented at school, and had his books and pencils. The HSE solicitor asked her if he had indicated his wishes. “He told me he doesn’t want to go home,” she replied. He told her his foster mother was “the best thing that has happened to me.”

She witnessed the child crying once when the mother’s car was parked half up on the foot path outside the school. The mother was agitated and upset, the principal was at the passenger door to see if everything was ok, but the mother drove off with the car door open, so she phoned the guards and the social worker.

There was a good period two years ago when the father of the two youngest children was there. However, in the times she saw the mother she was in “abnormally high spirits, not with-it, detached,” She felt the school had a responsible role, as there “was no responsible adult in the house.”  Her illness had prevented the mother from showing an insight into the boy’s emotional needs.

She told the GAL barrister she would phone the social services when the mother was unwell and “things had to deteriorate to a certain degree until there was intervention, this was a great trial for the child … her pre-admittance period was very challenging for [him].”

The psychiatrist told the HSE solicitor she first met the mother in a psychiatric hospital in 2008. She had come in voluntarily, but wanted to leave and her admission became involuntary. She had smashed the windscreen of her neighbour’s car because she thought she was a witch, she thought her son had become possessed by the magic of genies.

On discharge she was on an anti-psychotic drug, but had a difficulty with it so it was changed. She had missed some appointments, and at times was not there when homecare nurses called. The following year when she was unwell, “she felt she was being controlled by a man, he was able to interfere with her thoughts and her son, she was worried her son was possessed with an evil spirit.” Did you ever feel she could hurt her son, asked the HSE solicitor. “Only on one occasion,” she replied.

There was concern early the following year, when her medication was reduced and she stopped attending the clinic. When she saw the mother that summer she said she had stopped taking her medication for a few months. A pattern of illness evolved: admission, coming back out, becoming ill again and then re-admission.

She described at length the pattern of illness that continued in 2012 with missed appointments followed by emergency care orders, and a history of non-compliance with medication as well as Depo medication.

“Could her schizophrenia be cured?” asked the HSE solicitor. The psychiatrist said the mother kept relapsing, and did not believe she had schizophrenia, but as she had recurrent episodes they would recommend medication on an on-going basis. She had responded to medication well initially, the issue was non-compliance afterwards.

The GAL barrister asked her about the issue of insight. “She does not believe herself to be ill, is that itself a product of the illness?” “Yes, some people would believe it’s a neurological deficit… we don’t know why some people have an insight and some don’t … you can’t change it, I think she has very poor insight.”

The judge asked her if she ever engaged a cultural mediator. She said she had had “a tiny bit of assistance but not very much.”

The social worker told the HSE solicitor that the child was placed with the same foster family since his first emergency placement in 2009. The boy had told her his mother hated him, never played with him and would not let him play outside. She had called to the foster home recently and the child hid under the bed. He seemed anxious, he was incredibly clingy to the foster mother and constantly scared to leave the foster family. He had been received into care six times since he was six years old, three times through the courts.

He was refusing contact with his mother at the moment. It appeared the mother did not provide the boy with stimulation, he had watched television for long periods. She did not let him have friends over or go to friends. He had told her that his mum would hit him and made his mouth bleed. “I beat him but I never make his mouth bleed,” interjected the mother.

“Our concern is that she isn’t well, she shouts at him, hits him, roars at him, makes him babysit,” said the social worker. “He is attention seeker, I have to train my son,” interjected the mother. There had been consistent reports since 2009 about this type of behaviour from the mother. “That’s what they call tough love, tough love,” interrupted the mother.

When the hearing resumed on the second day the mother told her solicitor she had had a lot of stress around her relationship with her partner in 2008 which had triggered a mental illness. When she was pregnant she spent three months in [a psychiatric hospital]. “It was a very tough pregnancy, I always suffer an hormonal imbalance when I am pregnant.” She had suffered unpleasant side-effects from the medication she was previously taking, so she stopped taking it before she was pregnant. The medication she was on now was working better.

The solicitor said it was stated in evidence that the child did not want to live with her. The mother said it was the social worker’s fault. She said she “gave him a light smack in the bum, a smack in the back” because he was out for four hours and she had not known where he was, she had been scared. He had helped her to make cupcakes, she helped him make breakfast by himself in the morning, when he woke up he made his own breakfast and got dressed by himself. He had enough food.

“I never told my son that I hate him, I told him I hate things that you do that are not appropriate,” she told her solicitor. It was suggested that she might inappropriately send him to the shops. She explained she sent him for fruit when they ran out, that the shop was only “two minutes from the house, I want him to have some sense of responsibility.” He had never missed school, he reports were ok, his character was ok, she said.

She would agree to a Supervision Order, but they would have to treat her like an adult. Her relationship with the psychiatrist was very good, she had seen her that morning for the Depo injection.

“Why are you so desperate to have the child back in your care?” asked her solicitor. “What I really want is my son, I love him and I want him to have family values, I want him to understand life is not a bed of roses.”

HSE solicitor: “Did you ever harm your child?”

Mother: “No, I never harmed my child and I couldn’t.”

“Do you know why he made those statements?”

“I threaten him with a clothes hanger … I can do that, I’m his mother, I don’t want my child to be on the streets, I want him to get a good job.”

The solicitor spoke to her about her lack of compliance and engagement, why was she not engaging with the support services. “Because it was a taboo, it was a disgrace for me,” she told him.
There was a pattern of engagement and non-engagement, he said. The mother replied: “I was stopping the medication because I wasn’t able to take care of my children properly, but this one has anti-depressant and doesn’t make me feel tired.”

Did she accept she had a mental health illness? She did, but it was not a big issue. She did feel she should be on medication, she said she could take care of her children now.  She was happy to continue it as long as required. “I don’t have any reason to stop the medication,” she said.

The barrister for the GAL asked her if she had been in hospital eight times in four years, she said people go on holidays, she went to the hospital. When she was pregnant she had a hormonal imbalance, it affected her towards her spouse, so she went to the mental health clinic to rest, they gave her a well-balanced diet there.

The GAL told his barrister that clearly the child had been in situations that were dangerous, when his mother had “been in an acute phase of psychosis … it has had a serious emotional impact … his mum blamed him for everything, if something went wrong he was hit for that, called names and put down, it hasn’t been deliberate on the mother’s part, it is a product of her illness,” he said.

During the time he had known her he had not seen any sustained period of stability and she was emotionally unregulated. The concerns for the GAL arose from the illness, the lack of compliance with medication and the mother’s inability to protect the child. He felt the child needed the security and stability of a long-term placement.

The judge granted the full Care Order.

(See also Volume 1, case-history 4)