Judge extends order for child detained in a specialist mental health centre for her own safety – 2021vol2#9

See follow up Vol 1 of 2022: Bespoke residential placement directed for a child with serious mental health issues

A judge in a rural court extended an involuntary detention order for a child of primary school age for two months due to the risk to the child’s own health and safety from the mental health disorder anorexia nervosa. The child had written to the judge asking to be allowed to return home but the judge, having listened to the psychiatrist’s evidence, decided that the child should be detained as an in-patient for a further two months for her own safety. The child was also the subject of a care order under the Child Care Act 1991.

The child’s psychiatrist gave her evidence to the court through a video link from a provincial city hospital. This was the first time a video link had ever been used in this rural town court. The lawyer for the HSE informed the judge that it was seeking to extend the child’s order for two months as there was a serious risk to her health due to anorexia nervosa.

The psychiatrist informed the court that the child continued to have “strong features of anorexia nervosa”. Some worthwhile progress had been made since the child became an in-patient at the specialist residential unit three months earlier. The child was fully compliant with the health plan, eating three meals and three snacks per day. The psychiatrist stressed that this was significant progress as there had been no food consumption prior to admission and the child had required a nasal gastric tube and intravenous fluids.

The child’s psychiatrist reported that she was now in attendance at the group programme in the residential unit. She was also attending the in-patient school lessons and was enjoying visits with her parents and overnight stays with her parents in the parents’ flat at the centre. She had also been able to meet up with her siblings recently in a nearby park.

However, the child’s psychiatrist continued to have ongoing health and safety concerns for her. She described her as a child with “strong anorexic thinking”, who was still vomiting and questioning the nurses frequently about her feeds. She continued to attempt to do “compensatory exercises” when she went to the bathroom and had subsequently challenged the need for her to be supervised by a member of staff in the bathroom.

The lawyer for the HSE asked the psychiatrist if she was of the view that the child was in need of additional in-patient care and the psychiatrist replied that she was now urging the court to extend the order for that reason. She added that “close co-ordination between Tusla and the parents” was necessary.

Judge: “The child wrote me a personal letter saying she’s ready to go home now.”

The psychiatrist stated that the child was not yet ready to be allowed return home. She said she had considered the option of allowing the child home for Christmas Eve and Christmas Day, but after seeing the vomiting behaviour and the very distressed behaviour following a pre-Christmas family visit, it was her professional opinion that the move home should be done gradually. The psychiatrist said that she was hopeful that the child would be able to transition home in about two months’ time.

The judge said she was satisfied with the psychiatrist’s evidence, despite the child’s letter to her, and extended the child’s detention order for two months. While the child expressed the wish in her letter that she was most anxious to go home, the judge said that she was obliged to do what was in the child’s own best interests.

The detention order under section 25 of the Mental Health Act 2001 was extended for two months and the matter was listed for a date one month later.