Teenager detained under provisions of Mental Health Act; GAL criticises lack of assessment – 2023vol2#44

A judge in a rural town granted an extension of an order made under section 25 of the Mental Health Act 2001 for a teenage boy. The parents were supportive of the application. Evidence was heard from the consultant psychiatrist and the guardian ad litem.

(Section 25 of the Mental Health Act permits a child to be detained and treated for mental health illnesses.  It says:

“Where it appears to the Health Service Executive that—

(a) a child is suffering from a mental disorder, and

(b) the child requires treatment which he or she is unlikely to receive unless an order is made under this section,

then, the Health Service Executive may make an application to the District Court (“the court”) in the district court district where the child concerned resides or is found for an order authorising the detention of the child in an approved centre.]”

Section 25(9) also permits an extension of this order.)

The court heard that the teenager had been suffering from mental health problems for some time. An initial application under section 25 had been made by the Health Service Executive (HSE) and granted, along with associated directions. The teenager had initially been admitted to a psychiatric unit and his initial treatment had gone very well. He had been discharged with medication and regular follow up with the mental health team.

However, he had stopped taking his medication and this had caused a bad relapse. He had become significantly agitated, lost motivation and had low mood. He had significant depressive symptoms and ongoing developmental difficulties. He acted impulsively and unintentionally. The consultant psychiatrist said that he was exceptionally vulnerable. He was at risk of harm by actual or unintentional acts.

The consultant psychiatrist said she was concerned about why he had relapsed. She had changed his medication, and more time was needed to establish the correct medication dose. The teenager also needed a period of stability and recovery. There also needed to be an assessment of what supports would be needed by the teenager to comply with his medication regime when he was discharged.

There needed to be a planned alternative for his education as the teenager had been badly bullied at school. A return to his previous school would not be in his best interests. She said that in her opinion she thought it likely the teenager would fall within the autistic spectrum and had requested the disability network to do an assessment, this assessment was still outstanding.

The teenager had severe expressive language difficulties. He did not have the capacity or judgment to keep himself safe. He was not able to identify his needs or how they could be met. The consultant psychiatrist said that he would not be able to cope in the community at present and she had no confidence that he would be safe.

She said the teenager’s parents had visited him regularly. She had had frequent meetings with them to update them on his progress. There had been regular meetings between the mental health team social workers and the social workers from the Child and Family Agency (CFA).

The guardian ad litem (GAL) told the court that she had concerns for the safety and well-being of the teenager. She said that a referral to the disability team had been made many months ago during his last admission, but it had not been completed. She said once a referral had been made the assessment should have been completed within three months, but the assessment had not even started, and this was outside the time permitted by the Disability Act 2005.

Section 9(5) of that Act states:

“Where an application under subsection (1) or a request under subsection (4) is made, the Executive shall cause an assessment of the applicant to be commenced within 3 months of the date of the receipt of the application or request and to be completed without undue delay.”


She said it was mandatory for the Health Service Executive to complete this assessment and it was of particular concern to her that a teenager was being detained under the Mental Health Act 2001 and that this assessment had not been completed. She had written to the HSE asking it to forward this assessment.

She said the original order and the associated directions made in the order were still required. The teenager had required physical restraint at times. She said part of the direction was that the teenager would be secluded. This was a last resort but was necessary if it was needed by the teenager for his safety and wellbeing. She said currently it was not necessary and the teenager had been well enough to be visited. He had expressed a hopelessness and was withdrawn.

The GAL shared the concerns of the consultant psychiatrist that the teenager would fall within the autistic spectrum. She said she was also concerned about the teenager’s education and wanted the Child and Family Agency to undertake an educational assessment.

The judge extended the section 25 order for six weeks. The court also by its own motion directed the CFA to initiate and completed an educational assessment and directed the CFA to construct an education plan. The court directed the HSE to initiate the disability assessment.

When the case came before the court again the judge expressed her deepest concerns for the welfare of the vulnerable teenager. The teenager was due to be discharged from the detention order, but the judge said she had serious concerns about his home life and the circumstances to which he would be returning. She said she had read the report of the community consultant psychiatrist that had highlighted grave and serious concerns about the teenager’s home life.

The solicitor for the Child and Family Agency (CFA) said that the teenager was not the subject of any child care orders and the detention order was an order from the Health Service Executive (HSE). He said that he had been informed there was to be a discharge planning meeting and the CFA were to complete an assessment of the teenager’s needs. The judge said: “I am being asked to send a child back to the same circumstances that necessitated a section 25 order, the CFA may need to initiate child care proceedings.”

The judge noted that the section 25 order was not due to expire for another week and asked the solicitor for the CFA to mention this case to her in the following week with the outcome of the CFA assessment and the discharge plan from the psychiatric unit.