Review of case of teenage girls needing psychiatric care – 2016vol2#17

A case came in for review in the Dublin District Court concerning a psychiatric referral made on an emergency basis six weeks previously that had not been met with an appointment.

The Court heard that it was a very high risk situation involving two teenage girls in foster care. They had been with the same foster family for four years but the placement was under pressure due to challenges in the girls’ behaviour. The GAL informed the Court that the GP who had referred the girls for urgent psychiatric assessment was unaware they had not yet been assessed.

The girls had been linked in four years previously with a psychiatrist from a clinic specialising in young adult mental health services, who was now recommending they start with a separate professional. The judge remarked that if that doctor was not available then the Child and Family Agency should look at other options.

The social worker for the girls told the court that one of the sisters had become withdrawn and labelled the clinic as “the doctors who speak to mad people”, her perception of it was very negative and both girls were adamant they would not engage with it.

“It has taken three and a half months to get to the point that nothing has happened,” said the mother’s solicitor, “surely it is now the time to open the phone book and look for another psychiatrist?”

Although the social worker pointed out that Child A was presenting as very vulnerable and therefore she had not wanted to introduce a new professional, the judge remarked that she could not wait indefinitely.

The two girls were currently in a shared care arrangement which consisted of them staying four nights a week with a friend of their foster mother’s. The court heard that Child A was feeling lost in her foster home because the lifestyle was a mismatch. “The foster parents are middle class,” said the GAL, “they have a magnificent home, the lifestyle is a mismatch, they feel loved but [A] is lost. [Child B] has bought into the environment, the school and friends.”

Worries about Child A had come into the fore in the last three or four months, and Child B also felt low and had suicidal ideation. A safety plan had been put in place for B in that she had been given the number for Childline to ring if she was feeling low.

The judge noted that there had been a totally unsatisfactory response by the service providers when the referral had been made on an emergency basis. “If TUSLA categorise something as urgent I would have hoped the public service would have afforded urgent service. This can’t delay any further, the Agency have a statutory responsibility. If the GP has said it’s urgent, what would a parent in loco parentis do? The evidence is deeply disturbing because of the manifestations,” concluded the judge.

The case was adjourned for a month.