Mother with mental health difficulties considers adoption – 2013vol2#22

A full care order was granted in the Dublin District Court for a baby whose mother was bi-polar and had a neurocognitive deficit. She had consented to the order.

Her solicitor said that his client was accepting the order due to her mental state, which meant she was not in a position to offer the child a home to meet his needs. His client was happy that access should be once a fortnight but was considering adoption. She was very upset at the moment.

The judge said she knew how upset the mother was, she had seen the soft toys she had brought the child at Christmas time. The solicitor said: “Yes, she was thinking of her son ahead of her own desires”. He said it was not envisaged that she would come out of her mental illness. The judge said that if the mother did come out of her illness there was a facility within the Act to dispense with the care order.

The social worker, who had been allocated since last summer, told the court that the department had received a referral from the maternity hospital with regards to the mother’s pregnancy. The mother had initially wanted to give the baby up for adoption but she had changed her mind and placed the child in the care of the HSE.

The consultant psychiatrist had diagnosed the mother as being bi-polar and having a neurocognitive deficit as a result of long term medication and drug and alcohol abuse.  He felt the mother would be unable to care for her baby after the birth, as she did not have the ability to make decisions which were rational for herself or her child.

The mother engaged with the social worker. She was very clear she would not be able to care for the child, she had no home and no money, she did not seem to understand the depth of care the child would need.

After the baby was born last summer, the ward social worker contacted the HSE as the mother had changed her mind about placing her child in the care of the HSE and wanted to keep the baby. She said she would be helped by a friend. The social worker said she was very unrealistic, but this was due to her cognitive ability. However her friend did not meet the fostering criteria required, one of which was an age gap of less than 40 years. The friend could not offer accommodation to either the mother or the child.

The mother’s family were not in a position to take on the baby. She had fallen out with the relative who had put herself forward to adopt the child. Another could not take the baby on because he could not take the risk of jeopardising his own family by exposing them to her volatile behaviour.

In the two months after the birth, she had only attended two access visits, after this she did not turn up to some of them. The mother felt she could not attend access three times a week, so she had requested its reduction to once a week.

The social worker said the mother had a lack of ability to organise herself to attend events such as access or child-In-care reviews due to her cognitive ability.

Her solicitor asked how her mental health deficits were impacting on her. The social worker said that after her mother had died she had become more institutionalised and more unstable. She was difficult during an access and did not want to take guidance or instructions. The social worker said that while normally the mother was very compliant, she had become very oppositional. She was not in tune with the baby’s needs and would not burp him during feeding although he needed it due to reflux.

Furthermore, she had jumped into the canal and also ended up in hospital with a lot of medication in her system. She displayed sexual promiscuity and was found in another ward in bed with a patient. The social worker told the court that losing her child and her mother had had a huge impact on her.

As she missed more access visits, a distance had grown between the mother and child. The social worker visited her and found the mother was very dishevelled, she had not been complying with her oral medication.

At the last access however, she was very warm towards the baby; she sang to him and cuddled him. He had enjoyed her singing. She was very compliant, she commented on how well he looked and how lucky he was to be cared for so well by his foster family and have foster siblings.
The social worker said she had self-discharged from the hospital, but she attended the doctor there once a week. The mother was in the process of working with an organisation that secures accommodation for people with mental health difficulties.

The baby was doing very well and reaching all his milestones. He had very good attachments with his foster parents who were approved for long-term fostering. So permanency planning was needed now in terms of the match. “It’s the last piece of the jig-saw,” said the social worker. The foster parents had developed a photo file of the baby as a Christmas present for the mother, which had been well received.

The solicitor for the HSE asked about the mother’s capacity to meet the baby’s needs. The social worker said she did not have the capacity due to her frontal brain damage. “I would like to emphasise that she loves him very, very much, she tries her best, however her capacity to stimulate him and provide for his day to day care is very limited,” she said. The prognosis was very poor for her.

Returning the child to her care would place him in risk of neglect and emotional harm. He would suffer avoidable neglect.

The mother’s solicitor asked if access would be once a fortnight. He said: “She was very saddened that the child cried, and she was very saddened as though she in some way was bad for him, so I think she may need a lot of reassurance, she is feeling quite bad.” The mother had said to the social worker, “he likes you more than he likes me.” The social worker felt she struggled with handling him and managing him.

The GAL told his solicitor that access should not be moved to once a month as the bond between the parent and child needed to be preserved. He said however that it was possible the mother might not be able to attend fortnightly access and then the HSE would need to see if it should be moved to monthly.

The solicitor for the GAL asked how the clinical presentation translated into a risk for the child. He answered that in his view she would have a massive difficulty even providing basic safety for the baby. He pictured him being on her knee and her simply getting up and walking to the door, forgetting the baby was on her knee. He had put this to the consultant psychologist who had agreed that scenario could happen. His solicitor confirmed, however, that it would be an unintentional exposure to harm.

The mother’s solicitor asked if the mother had become more lucid since moving to private accommodation. The GAL confirmed this and said she was able to engage more than when she had been in hospital.

The judge granted the full care order. She said: “Given the unfortunate constellation of mental health and mental capacity difficulties, they could together cascade into a series of potential harms, albeit that they would be unintentional. The diagnosis and prognosis are bleak.”

She directed that the placement committee consider the outcome of the fostering assessment process at the earliest opportunity but within three months and that the mother should be given assistance at access, with for example instructions on how to hold a baby. She ordered that the HSE provide all appropriate needs to the mother. For example, in the event she required an advocate to accompany her so she could engage in access, perhaps somebody from her existing mental health team could act in this capacity.