Order extended for child detained in specialist mental health unit due to serious self-harming behaviours – 2021vol2#10

A judge in a rural town extended an involuntary detention order, under section 25 of the Mental Health Act 2001, for a child of post-primary school age for two weeks. The child had very serious self-harming behaviours and was detained involuntarily in a specialist unit. The child’s psychiatrist stated that the extension was necessary so that the child could have the therapeutic benefits and not leave abruptly. The child was also the subject of a care order under the Child Care Act 1991.

The lawyer for the HSE informed the court that the child remained a very serious risk to herself and that they were seeking an extension of the order for two weeks. The lawyer for the child’s guardian ad litem (GAL) told the judge that he supported the extension of the order. Both the child’s parents were present in court and said that they supported the extension of the order.

The psychiatrist, who gave evidence through a video link, informed the judge that she planned to continue the trial of the child’s medication. This necessitated the monitoring of her early response and the ongoing management of her social anxiety.

Psychiatrist: “We are hoping to help [child] develop more specific therapeutic goals…we want to do this in a timely way.”

The psychiatrist said that it was important that the child’s attendance in the unit not be protracted as this could add to the abandonment fears the child was experiencing. The judge asked why the child was not ready yet to be discharged. The psychiatrist explained that the child must experience the therapeutic benefits and not leave the unit too abruptly. She needed to explore occupational therapy and meet her community psychiatrist and her community psychologist. The child still had problems with emotional dysregulation.

Psychiatrist: “[Child] has adjusted and needs time to think clearly on her therapeutic goals.”

The judge asked if the GAL had had regular contact with the child and was informed that she had.

Lawyer for the GAL: “The child understands her need to remain but not become over-reliant on the unit.”

The judge decided to extend the child’s order for a further two weeks and listed the matter for a date one month later.

Day two

The matter came before the court one month later. The lawyer for the HSE made an application to extend the detention of the child in the specialist mental health unit for a period of 44 days under Section 25(10) of the Mental Health Act.

The child’s GAL was present in court to give the child’s wishes. The GAL told the judge that the child wished to remain for a longer period in the specialist unit. He said that the child was very vulnerable and had continued to express a desire to harm or kill herself at the first opportunity.

The lawyer for the HSE informed the court that the current order was expiring and that the necessary proofs under Section 25 of the Mental Health Act were met because the child required further detention due to her mental health disorder. She explained that the child had had a “very troubled couple of weeks as the expiry date loomed” and consequently needed in-patient care. She applied to the judge for an extension of the order for a further 44 days, which was less than six months in duration.

The judge considered the evidence and decided that the statutory threshold was clearly met. He said the child remained a serious risk to her own safety and granted the 44-day extension. The matter was listed for a date two months later.