No appropriate unit found for teenage “too dangerous” for secure care – 2017vol2#12

A teenager (A) whose behaviour was known to be potentially dangerous to others was refused admittance into secure care detention in Ireland because the Special Care Committee found his behaviour to be too serious for secure care.

However when the Child and Family Agency applied for his admission into a secure unit within the UK the placement declined to accept him under the false premise that he had failed to reach the agreed threshold in Ireland. It had recommended instead that the teenager stay in an open unit in Ireland with therapeutic supports.

Meanwhile A was living in a non-secure residential placement without any form of therapeutic input despite immediate and long term psychological and psychiatric therapy being recommended by a psychologist. In January, March and June of 2017 the teenager had been assessed by the child psychologist who found on all three occasions that he required a secure therapeutic residential placement outside the jurisdiction.

On first hearing of the case the High Court judge remarked that it was an “incredibly serious matter” and “an urgent” issue. A motion for a judicial review of the case was being filed by counsel for the GAL due to the lack of proper placement for the young man. Senior counsel for the GAL told the court that the case highlighted the unsuitable nature of secure care premises in really risky situations.

District Court
A week later in the District Court during a Care Order Review the court heard of the gap in therapeutic input and how secure care in this jurisdiction would be seen as “a holding placement” if he was placed there, but the risks he posed could not be meaningfully addressed within that system of care. Furthermore A required immediate psychiatric and psychological therapeutic input before any move to the UK. His presence within a secure care unit would have a destabilising effect on the other residents therefore he could not be admitted even as “a holding placement”.

The psychologist who had assessed him in January, March and June was not available to treat him, he had worked with her previously but the sessions had to be terminated due to his behaviour.

The District Court judge noted the clear position of the CFA and the psychologist, that A required therapeutic intervention in a suitable placement out of State. He requested concurrent contact with all of the units in the UK for immediate referral: “It doesn’t mean next week, it doesn’t mean the day before we’re back in, it has to be done urgently.”

He also remarked that it had been 10 months since the Care Order hearing and he was constantly saying the same things. The case was put back in for Review in two weeks’ time.

Return to High Court
Two weeks’ later in the High Court at the Minors’ Review List the judge heard that two of the three suggested placements in England had been found unsuitable therefore the CFA might have to look to other jurisdictions. A was currently stabilised but did not appear to be returning to his open residential unit within his curfew hours and was still using drugs. Therefore there were still concerns about his well-being and the well-being of society at large.

Senior counsel for the CFA assured the court that the matter was being progressed. Two of the units in the UK that had been recommended by A’s assessing psychologist were not secure units and the third option was a psychiatric hospital. A did not fall within that remit therefore other options now had to be looked at, possibly with the US.

Counsel informed the judge that a unit had been newly created within the auspices of the CFA for children with the harmful behaviours in question and a referral to that unit would now also be looked at. Counsel for the GAL remarked that “the cranking up of the CFA came after the judicial review was initiated and also came after three letters and after eight months.” “There is a 60 page affidavit of what we have done on this case,” replied counsel for the CFA, “I wouldn’t like the court to think things didn’t happen, things did happen.”

Return to District Court
In the District Court the following week the court heard that the newly formed unit for children with the harmful behaviours in question had said that A did not meet their criteria due to age. Further private therapeutic supports would be recommended when his assessing psychologist met with A in December.

Counsel for the GAL told the court that the National Secure Welfare Commission in England had informed him that placements were extremely limited there at the moment. “Therefore you can’t cherry pick, it’s a case of you’ll get given what you get given and then shoe horning it into a therapeutic placement for [A].”

For example there was a UK organisation that would provide a wraparound service for children with A’s presentation and provide that service within a secure unit there. However this was still at the exploration stage and there was no certainty around it as yet.

The judge remarked: “The reality would appear with the situation with regard to placement in the UK is as bad as here, if that’s the number of beds available then they’re in pretty poor shape.”

From what he could read in the social work report high support was no longer being considered, only secure care. He asked if services for children with this type of presentation all took young people up to the age of 17 rather than 18 and was it because they would not take someone beyond a certain age as they felt there was nothing they could do. He said that this was something that had come up in a variety of cases before.

“The placement he’s in is a temporary placement, a put-together placement,” said the judge. “It’s been described as a holding placement. There is no therapeutic input, he is not going to CAMHS, the proposed solution in the UK hasn’t come much closer and this State and the combination of states would appear not to be in a position to meet his needs.

“The CFA obligation is clear under Section 3 [Functions of Health Boards, Promotion of Welfare of Children] and Section 36 1B [Children in the Care of Health Boards, Accommodation and Maintenance of Children in Care] specifically of the Child Care Act 1991, the child’s needs are not being met. Given the matter is before this court and the High Court I’m hesitant as to where else it can go, there has to be a recognition there is a failure to deal with this, this is not the first time a judge has said this over the years.

“Over the last 25 years it is constant and children with a particular presentation have no facilities in this State to meet their needs, resources are an issue, a bespoke solution for every children is perhaps not available.

“There is a brief reference [in the social work report] to units beyond the UK, everything has to be explored.”

Counsel for the GAL told the court that it was listed in the Minors’ List to consider papers for the judicial review and a time limit would be set down for submissions and it would be open to hearing. A range of declarations in relation to a secure residential appropriate placement to meet his needs would be included.

When the case came back to the High Court in late January no further progress was reported and the youth was still in an insecure placement with no therapeutic support.