Teenager detained under Mental Health Act following serious psychotic episode – 2022vol1#27

The District Court extended an order under section 25 of the Mental Health Act 2001 for a young person suffering from serious psychosis. The treating psychiatrist said the teenager had suffered one of the worst psychotic episodes she had ever seen while he was receiving inpatient treatment with the Child and Adolescent Mental Health Service (CAMHS).

The solicitor for the HSE said the application was to extend a section 25 order in respect of a teenage boy. He said the teen’s parents were both present in court and were legally represented. They were consenting to the extension, but wished to address the court in relation to their son’s ongoing treatment. The court was told the boy was currently in a CAMHS approved centre and that his consultant psychiatrist was present to give evidence.

The solicitor for the parents said his clients were consenting to the order on a without prejudice basis for a period of six weeks. He said both parents were “eager to engage” with their son’s treating doctors and hoped the order might be discharged early. He said it had been a “very difficult” time for them given how unwell their son had been. He went on to say they had been “very worried, and anxious to be kept updated consistently and frequently.”

The solicitor noted that there had been a positive development earlier in the day, as access had taken place and it had gone “really well.” The boy appeared happy that they were there. He said the parents wanted to give brief evidence only.

The solicitor for the guardian ad litem (GAL) said the GAL had not been able to visit the teenager to date, as he had been “too unwell,” but that it was “great to hear” the parents had been able to see him. He said the GAL was supporting the application, but could not give evidence in the absence of having met the boy. He said a visit was to take place as soon as possible.

Consultant psychiatrist evidence

The psychiatrist described the teenager as a “lovely young boy” who had come into the care of the inpatient service following a referral from a Dublin-based hospital. She said she screened the teenager on arrival and felt he had psychosis. She told the court that he had a background of enzyme deficiency, which was associated with a number of mental health conditions, to include narcolepsy and anxiety. She said he had a very complex background.

“When he first came to me he was pleasantly psychotic. He was able to talk to me and engage with me. We kept him on the medications he was already on and these assisted for a time, but unfortunately he got Covid and had to be kept isolated,” she said.

The expert described how the teen had been a “very pleasant boy,” but that his isolation period had led to a “huge dis-improvement” in his behaviour. She said he had caused a significant amount of property damage to the unit. She said he had “smashed his head repeatedly” against a glass frame, injuring himself. She noted that at the time he had been “so distressed”, it had been a “really awful deterioration.”

The expert explained that the teen was suffering from delusions and thought people were “after him.” She said he had to be put into seclusion for nearly seven days and also had to be restrained twice a day so that the team could check his vitals and give him his medications. She said that unfortunately she had to significantly increase his anti-psychotic medication at that time.

The expert went on to say that she had linked in with colleagues to discuss the boy’s behaviour, and it was agreed that it was one of the worst psychotic episodes they had ever seen. She that the teen had since “thankfully turned a corner,” things were getting better and he had started eating again. She said the parents had visited him earlier that day and had been able to talk to him.

It was the expert’s opinion that the teenager required further time in inpatient care, as he had “only just turned the corner.” She said she was aware the parents were “not on board” with the increase in the teen’s anti-psychotic medications, but that it had been necessary and she stood over her decision “100 percent.” She said the dosage was currently being tapered off and his medications reduced. The hope was that the parents would be able to increase their visits with the teen “slowly,” but it was her firm view the extension was necessary and proportionate. She asked that the court grant a further order allowing the use of restraints if necessary.

In cross-examination, the solicitor for the parents asked what was envisaged in terms of meeting with the parents and keeping them updated. The expert said she wanted to “sit down with them” to discuss the teen’s treatment, and intended to have a meeting alongside the clinical nurse. She added that she also regularly emailed the father so as to keep him updated, and she would continue to do so.

Solicitor for the parents: “If [the teen] makes sufficient improvements within the next six weeks would you be inclined to withdraw the order?”

Expert: “Absolutely.”

The solicitor said the parents had “huge concerns” over the high dosage of anti-psychotic drugs being administered to the boy, and asked the expert to confirm that he was no longer on these. The expert said she had “taken a lot of it away.” Asked whether she had any difficulty with a third opinion being obtained from a consultant psychiatrist, she said: “No, that would be very helpful.”

Father’s evidence  

The boy’s father said he only wished to address the court briefly. He said access had taken place that day and he thought his son “kind of recognised us.” He said the teen responded well to himself and his wife and let them “bathe him and give him food and water.” He said he hugged his son and told him to be patient and not to be rude to the staff.

He said he had “begged” the staff to allow him see his son for the last three weeks, but they would not allow any visits as he was so sick. He said he was “really angry” because he “just wanted to see him.” He said that he hoped the visits would continue now that they had recommenced.

The teen’s father went on to describe his son as “such a good boy,” the “best in the family.” He said that before he was admitted to the inpatient centre in question, he had “some issues,” but was generally okay. He said his son could do everything by himself and was able to eat fine, but that when he was admitted to the inpatient centre, “everything changed” and he could no longer do any of these things. He described how “stressful and worrying” this had been for the family.

He said: “I was worried about his medication and I wanted to talk to his doctors about this… I said the medication was just too much. When he is given these medications he can’t function properly. Right now, when we saw him today at least he could speak to us, but he was still shaky and I think that was because of the medication, so I am hoping that [the teen’s consultant psychiatrist] will talk to us before he is given his medication.”

Mother’s evidence 

The mother said that she wanted to include some additional comments. She said she knew her son had needs. She described how he had been admitted to hospital “a few times” in the past, because he had been confused, stressed and “hearing voices.” She said the doctors in that particular hospital had informed her that he was suffering from psychosis.

She described her worry when the doctors informed her that her son needed to go to the inpatient centre for treatment. She said: “I read reviews of [the centre] on the internet and people were saying bad things about it. I was not happy, so I spoke to the doctors about it, but I was assured it was the best place for him.”

She said that following her son’s admission to the inpatient centre, she could see that “everything changed in him.” She said he was unable to bathe himself, he stopped being able to do anything for himself. She said she wanted her son home, as he needed “his family’s love.” She went on to describe how he was not getting any exercise at the moment and was “sleeping all of the time.”

The teen’s mother said she knew her son had a “long way to go,” but hoped he might be released early. She reiterated the request to be kept informed about the boy’s treatment and progress.

Having heard the evidence, the judge noted there was consent to the extension of the current order for a period of six weeks, so he said he would grant the extension, as well as the ancillary orders for the use of restraints where absolutely necessary. He said: “These are always very sad cases, but it’s good to see the parents are engaging and that they want the best for their son.” The judge further commented that the inpatient centre in question had an excellent reputation.