Interim care order extended for baby of mentally ill mother – 2018vol2#19

See follow up Vol 1 of 2019: Interim care order extended where mother suffering from mental illness

An extension of an interim care order was granted in the District Court for a young baby. The mother, who had contested the extension of the order, had been diagnosed with a serious mental illness as a young adult, and as an adult her behaviour was described as “highly persecuted, erratic and unpredictable.”

The baby boy, who had been born in early 2018, had been living with a foster family since he was two months’ old. Initially he had been discharged from the maternity hospital with his mother who had been engaged in family support planning by her social worker. The mother had been referred to the social work department two weeks before the baby’s birth.

The social worker told the court that following the birth it had quickly become evident that there were risks to the baby, particular around feeding as the mother could not prepare the bottles in line with the guidelines. This included having poured boiling water over the formula instead of cooled boiled water and a lack of willingness or ability to do things differently.

Feeding had quickly become a significant concern as feeds were not prepared in advance and the mother would wait until the baby was hysterical before preparing a bottle which would then need to cool down. As well as this, she declined all medical intervention for her child including the heel prick test and a hearing test and no reasons were given for these decisions.

The social worker had noticed that the mother did not make eye contact with her baby and treated him as a possession, carrying him around from room to room in his Moses basket and not allowing anyone to intervene or support her in his care. Due to the risks and concerns involved the baby had been placed on the child protection registrar.

The mother had relied very heavily on intervention from day one, the social worker explained to the court, and had put forward a private arrangement that she would move in with family friends. These family friends had made sure that the baby was fed and safe.
Within a few months his mother had accessed psychiatric services and had admitted herself into a psychiatric hospital, leaving the baby with her family friends. Three weeks later those friends had to leave the country for the weekend and the baby was then taken into care and placed with a foster family. The mother spent three months in total in the psychiatric hospital, discharging herself after two months and readmitting herself the following month for another short period.

The social work team had planned to place the mother and her child in a residential mother and baby support unit as soon as a placement there had become available. The mother and child were to live together in the unit for a 12-week assessment period while the mother was provided with family support services. However, the placement had become available while the mother was still unwell in the psychiatric hospital and this meant she had been unable to accept it.

On being discharged from hospital the social worker had organised a placement in an apartment for the mother in a low support service connected to the mother and baby residential support unit that would provide a three-month tenancy. She would engage in support there and have access to her baby three times a week in her apartment.

The social worker told the court that the goal of the three-month tenancy was to engage the mother in parenting support services to progress her ability to take responsibility for her child and manage the subsequent 12-week assessment in the residential support unit. A psychologist would form part of the decision-making process as to whether it would be appropriate for the mother to move to the residential support unit with her child for a 12-week assessment. Subsequently, if that assessment went well, they could move back to the apartment together and accommodation would be provided there for them for a further year.

While it was very clear that the mother loved her child and was very committed to attending access it was also clear that it was difficult for her to take part in the accesses. The most significant risk factor was the mother’s mental health, over the last eight months she had been frequently unwell and feeling highly persecuted making her behaviour unpredictable. It also meant that she could not partake of the supports offered to her or engage with the social work department. The mother was struggling to make eye contact with her child at access, understand his needs and follow the support and guidance of the access worker.

“She is very suspicious and hostile towards the social work department,” said the social worker, “she can’t move things forward, she finds it difficult to come back with answers and it’s difficult to make joined up plans for that reason. There have been times when we’ve had to discontinue access as she’s been so heightened and there is so little progression in her ability to learn the things the access worker is trying to teach her; how to do a bottle, what his routine should be, that he needs to nap and feed. There is no incorporation of the learning from previous accesses so every access is like the first one.”

So while the mother was very committed to attending all of her access visits her capacity to change was lacking, she also had a lot of difficulty in reading the baby’s cues, understanding when he was tired and preparing bottles in advance. Sometimes she did seek advice but other times when she was being guided or directed her response was that she was his mother and she knew better. The last three accesses had to be cut short as the mother was incredibly heightened, she had been very noisy and hostile and had woken up the baby on the last access.

The social worker had brought the baby for his vaccinations and the mother had also attended the appointment but did not hold him or lift him up for the doctor. “He was looking for eye contact and engagement and she wasn’t capable of giving it to him, she wouldn’t grip him properly when the nurse gave him the injection and she [the mother] gave him to the support worker. She also didn’t respond to his upset and became fixated on getting the vaccination card stamped. She didn’t greet him on arrival or say goodbye to him. When she’s very heightened she doesn’t acknowledge him, I’m not sure she hears him when she’s in that state,” said the social worker.

At the centre of the application was the child and he was generally a happy and very sociable little boy said the social worker. He had settled very well into his foster placement and had developed a close bond with his foster parents and although he did engage well with his mother when she responded to him he was becoming increasingly confused by her lack of response.

Access was currently three times a week for three hours at a time in the mother’s apartment at the low support service. The social worker told the court that the plan in place was proportionate and fair and the goal was reunification. The opportunity for a full parenting capacity assessment in the residential support unit would be made on a comprehensive assessment in the low support service of the mother’s ability to care for her baby on a 24-hour basis.

The mother gave evidence to the court detailing a number of occasions that she said she had nearly lost the baby while pregnant, these included due to her friend putting chilli on her steak and her mother making her a tuna fish salad. She described the birth of her baby as “horrific” and that the doctor had put “a test tube up me and broke the waters in that manner”. She told the court that she had moved in with family friends who had made her buy very expensive organic food and who were “mentally unwell”. She also said that a social worker had banged the baby’s head when putting him in a car and had not put a seat belt over the baby seat, “she didn’t fasten him in”.

She said that at the last access the social worker had not let her interact with her baby and had put a Lego brick in his mouth. The mother also told the court that the social worker had tried to break the baby’s neck with the car seat while he was on the examination table at the doctor’s appointment, afterwards she had gone to the Garda Station and filed a formal complaint.

The mother then spoke about the psychologist, who wanted to carry out the assessment in the low support unit, “I do not believe anything that comes out of [her] mouth, I’m not staying there, I’m getting out.” Regarding her own solicitor, she told the court that he had a picture of a sportsman playing hurling and two pictures of a past politician on the wall and that he was trying to inform her on his political opinions. She told the court she questioned her diagnosis of serious mental illness [she was diagnosed in early adulthood].

She did not want to stay in the low support unit but she did not know how she was going to get out of there, “I was totally fooled,” she told the court, regarding her move into the unit. “These people have me under their thumb now, including my solicitor and social worker.” She told the court that her buggy had been taken off her by her brother and she had had to ring the Gardai.

The judge asked her what did she think was in the best interests of her child, he was there to understand what was in the child’s best interests and why. “What about the welfare of me?” replied the mother, “what about what the social work department are doing to me, they’re saying I have a psychiatric condition which I don’t.”

Her solicitor intervened to tell the mother that there was a huge waiting list to get into the low support unit and it was a wonderful opportunity but she replied that she wanted to move out, a relative was willing to take her son and TUSLA “are a very dishonest, corrupt organisation, my long term wishes for my son is that he resides with me, hopefully we will get a house from the council, neither of my parents will give me money, they [the council] did offer me a flat on [X] street, a two bed, my mother wouldn’t let me take it. If I had taken it I would have a place to live.”

The guardian ad litem (GAL) told the court that when it was put to the mother that the low support unit was available to her, she had been elated and that when she went to visit the service she said she that was delighted to move in and had expressed her happiness to the staff. “From the very beginning it was a very positive decision from [the mother],” the GAL said.

The GAL described the placement as a “wonderful opportunity for the mother and child to bond, access is three times a week, I would recommend strongly that she engage in the process, she needs to listen to the advice of others, being a mother is a difficult task and the workers are advising her on the child’s best welfare. It’s a wonderful opportunity with a very long waiting list, I would ask her to re-evaluate matters, the professionals have her child’s best interests at heart.”

The judge decided to extend the interim care order. He spoke to the mother telling her: “My current consideration is the welfare of your child, that’s the paramount consideration of this court, having heard all the evidence, I believe that you do lack a certain amount of insight into this case. I’m satisfied that the threshold for the ICO has been met, the intervention is proportionate, circumstances haven’t changed since the initial ICO was made. If you choose to leave [the low support unit] there is nothing I can do about it but you will effectively be denying the opportunity of the parenting capacity assessment to see if it’s possible for reunification to take place,” he told the mother.

“I want you to have every opportunity possible for reunification with your child for that to happen you need to cooperate.” He asked her if she would reconsider her position and stay in the unit.

The mother replied that she wanted the social worker to step down from the case. The judge said that he found her evidence had been very good however the mother said she would prefer someone a “little more mature” and that yesterday her social worker had put her leg up on a bench.

The judge repeated that he was asking her to consider what the social workers were saying to her and to consider the parental assessment. The interim care order was granted.