Judge directs immediate assessment for deeply troubled child not permitted onto CAMHS waiting list – 2021vol2#11

Following a two-day hearing, a judge in a provincial city directed the Child and Family Agency (CFA) to arrange for the immediate assessment of a child in care, who was of secondary school age. The child, who had previously been referred by her GP to the Child and Adolescents Mental Health Services (CAMHS), was deemed by them not to be of sufficiently high priority to be placed on their waiting list.

She was self-harming and depressed and deeply affected by trauma in her earlier childhood as a result of domestic violence, neglect and abandonment. The judge was not satisfied at the way this child had seemed to “slip through the cracks” in services and directed an immediate assessment.


Day one

The lawyer for the guardian ad litem (GAL) told the court that the girl had suffered early trauma in her life. He described an incident when she was a young child and had witnessed her mother at a riverbank threatening to jump in. She had suffered nightmares as a result. Her father was described as a “very challenging” man. She had had no contact with her mother for four years but recently the mother had commenced contact with her through social media and started to hang around her school.

The judge noted from the CFA’s report that the girl was getting on well with her GAL but asked whether there was a need now for a trauma-informed psychological assessment. The GAL’s lawyer confirmed that the GAL had gone through all of the girl’s files but could find no evidence of any therapy ever having taken place and it appeared as if she had “slipped through the cracks”. She had told the GAL she preferred face-to-face therapy and was not comfortable with online therapy.

The lawyer for the CFA said that the girl had been referred to CAMHS during the previous year but that CAMHS had suggested that Jigsaw would be a more suitable service. Consequently, her GP had referred her to Jigsaw. The judge asked if CAMHS had written a reply regarding the referral made to them and said that the court expected to know what the results were from her referral, she was self-harming at the time of the referral.

Judge: “We have a situation here where there was a referral made but no letter back except to say that Jigsaw was more appropriate.”

The lawyer for the CFA told the court that the girl’s self-harming was superficial, that the services were very over-stretched and that consequently A had not come high enough on their priority list. The judge asked for clarity about the Jigsaw referral and the letter from CAMHS suggesting that service.

Judge: “This needs full oversight urgently. I’d like to see the paper-trail.”

The judge decided to list the matter for a full review on a date four weeks later. She directed that the social worker and the girl’s GAL be present in court for the review. She also directed that the mother be notified of the review to allow her sufficient time to have representation in court.

Day two

The girl’s social worker told the court that she had spoken with the child’s GP and that the locum GP had sent a referral in this matter to CAMHS. CAMHS had not met her but had recommended Jigsaw.

Judge: “Not good enough…[the girl] was self-harming and depressed…how serious does it have to be when [the girl] is self-harming and depressed?”

When the lawyer for the CFA said that the girl had chosen not to engage by phone, the judge replied that it cannot go back on the child but must be a decision in the best interests of the child. The judge enquired about the proposed assessment under the National Educational Psychological Service (NEPS) and the social worker said the school principal had noted that it was during times of stress in the girl’s life that her focus and organisation was no longer on her schoolwork. When the judge pointed out how appalling her school results were, the lawyer for the CFA replied that her mother had disrupted her life by coming back into it. The judge asked if it was possible the school staff were making assumptions and that the girl’s foster-parents had also expressed concern at her decline in school results.

The social worker informed the judge that she had tracked down the refusal from CAMHS and also a phone contact for Jigsaw, where face-to-face services were due to re-commence in six weeks. The GAL informed the judge that she had formed a view that there was a significant change in the girl’s behaviour since she had contact with her mother. It was as if something had been triggered in her mind and her self-care had disimproved. As a very young child, she had witnessed domestic violence in the home, had suffered neglect and had been abandoned. The incident where she had witnessed her mother threatening to take her own life in the river had affected her deeply, leading to continuing nightmares about fish eating her mother’s body in the river.

The GAL said that there had been drug misuse in the home and that the girl had experienced a “chaotic, unpredictable home life”. She had struggled with relationships with peers in school and play-therapy had been suggested for her, but there was no record of this therapy ever having taken place. The GAL’s lawyer said that a clinical and neuropsychologist had been identified locally and was an appropriate person to carry out an assessment. This assessment would encompass the assessment elements of a NEPS assessment. The GAL pointed out that time was passing fast and that there was a “window of opportunity” for this assessment to be completed before the girl started the new school year. The school year-head had spoken very positively about her and said that her problem was really one of lack of motivation.

The lawyer for the CFA told the judge that it had not been possible to contact the girl’s mother to inform her about the review taking place and the social worker said that the child told her that she was not ready to meet her mother. The GAL described the mother’s attitude to the social work department as one of palpable anger. The mother had also denied giving the child disturbing information about her father, which had been deeply troubling for her. The GAL said that the girl had expressed a wish to meet her mother but she did not wish to meet her on her own and was very concerned that her mother might not turn up and that it would only lead to disappointment. The GAL informed the court that the mother was in receipt of methadone treatment.

The lawyer for the CFA said that it needed three quotations in order to apply for funding for the assessment and was short two quotations. The recent hacking of the information technology services was causing additional delays.

The judge said that an explanation was needed for the court as to why CAMHS had not met with the child at all. If they never spoke to the child, this needed to be explained. She asked the GAL’s lawyer to write to CAMHS to enquire when they had seen the child.

The judge made a direction that the girl’s assessment, including the NEPS element, was to commence immediately and to be completed before the start of the following school year. She also directed that the mother had to produce her doctor’s update about her addiction issues before any access could take place.

The matter was listed for a review on a date five months later.