Pandemic restrictions on access a concern after girl admitted to psychiatric unit under Mental Health Act – 2020vol1#4

Access was raised as a concern by the parents of a girl of primary school age who had been admitted to a psychiatric unit because of a serious eating disorder. The parents were concerned because no face-to-face contact was permitted in the inpatient unit during the Covid-19 pandemic and the parents had only had Skype access for the month since the child was admitted.

The issue arose when the Health Service Executive (HSE) applied to the District Court for the extension of an order made for her involuntary admission to hospital under section 25 of the Mental Health Act 2001. The parents of the child were present in court but were not legally represented.

The report of the GAL was handed in to court indicating the GAL was supportive of the extension of her detention in the unit. The report of a consultant psychiatrist from the approved inpatient unit was handed in to court with an affidavit stating that the contents were true and accurate.

The court was told that the matter first came before the District Court in May this year and the judge had made an order pursuant to section 25(6) for involuntary detention of the child in an approved inpatient unit as she had been admitted in a compromised state from the children’s hospital due to anorexia nervosa. On that date the parents had attended court and consented to the order and the directions made. The HSE sought an extension of the order to the end of July prior to the courts summer recess.

The solicitor for the HSE summarised the report of the consultant psychiatrist and confirmed that the consultant psychiatrist was not related to the child or the family. The report indicated that the child had a diagnosis of anorexia nervosa and that she had had an “exceptionally serious rapid loss of body weight in March and April”. The report said that the issue was not that the young girl’s admission weight was so low but that “the trajectory of weight loss was so rapid”.

The court was told that the young girl required three nasal gastric feedings daily and she was obtaining no other nutrition other than that feeding. The report stated that this was a necessity to ensure the brain sufficiently hydrated and had sufficient nutrition. The report stated that although the child had engaged in a feeding programme she had no motivation to change. The report confirmed a diagnosis of anorexia nervosa, a disorder under section 3(1)(a) of the Mental Health Act, and the consultant psychiatrist expressed the opinion that the child may also have other feeding disorders.

The court was told that the child was a serious harm to herself and “if left to her own devices she would starve”. The court was told that there was an immediate and significant risk to her health, the child had a lack of insight and no motivation to change. The report stated that the child’s “anorexic thinking is very strong”.

The judge asked whether the parents agreed with the report and whether they had any queries. The parents said that they had no concerns but the HSE solicitor said that the parents had expressed a concern prior to court in respect of access with their child at the inpatient unit. The issue in respect of access was that no face-to-face contact was permitted in the inpatient unit during the Covid-19 pandemic and the parents had only had Skype access for the month since the child was admitted. The HSE said that it was “particularly difficult as people there are exceptionally frail and immune-compromised”

The solicitor for the HSE asked the court to list the matter for mid-June 2020 and by that stage “hopefully restrictions will be relaxed”. The solicitor said that if it was still an issue at that stage the HSE would bring a witness from the inpatient unit to provide the court with the rational as to why face-to-face contact cannot happen.

Judge: “It is not satisfactory for the parents but they are standards affecting everyone.”

The solicitor for the GAL told the court that the primary issue the GAL was anxious about was the issue of access but that she appreciated the vulnerability of the patients in the unit.

GAL solicitor: “The GAL would be anxious if any steps going forward can be taken to facilitate access but she is supporting the order at this time.”

The judge said that he noted the parents had no issue with the report and did not wish to cross examine in respect of the report. The judge accepted that the HSE’s proofs were in order to obtain the extensions order sought. The judge said that he was satisfied that the child was suffering from a mental disorder anorexia nervosa within the meaning of the Act and that she was refusing food and fluids.

The judge said that the reason he was making the order was that failing to admit her would lead to a rapid deterioration of her condition. The judge ordered that the child be admitted and retained at the approved centre inpatient unit up to late July 2020 and that the directions previously made were to continue. The judge listed the matter for mid-June 2020 for review and to hear evidence if necessary for access and he noted that the GAL was concerned about access but accepting that it was all that could be done.

The parents were asked if they would like to say anything to the court. The father said that they knew she was “in the right place and she needs to be there”. The father emphasised that due to her age they were stressed that there was no access and she had been there three weeks.

Father: “She was admitted once lockdown was in place so we are not familiar with the unit at all. We haven’t met the people there. It is not just the impact on us but it might exacerbate everything for her. We don’t know how to get around it but it is a major concern.”

Judge: “I appreciate that it is a major concern. The court is operating on this premise because of Covid-19 and it is an appropriate centre with its own rules and a lot of people there are immune-compromised. It is the least worst option for her and the best thing that can be done at the moment. We all hope that progress with Covid-19 will allow access to happen as soon as possible without any false hope.”

The HSE solicitor said that the unit was working on protocols to resume face-to-face contact and the hospital was not totally ignoring the stress on family but that any plan must be for the whole unit. The HSE solicitor said that she would keep the parents up to date with access protocols.