Ward of court twice in UK for specialised treatment not available in Ireland; judge expressed wish to see similar service in Ireland – 2023vol2#48

The High Court extended orders for a young woman who had been admitted to wardship as a minor in 2017 and was sent to the UK for two periods for specialised treatment in 2017 and 2020, as the treatment was not available in Ireland. She had experienced sexual abuse at the hands of a close family member and others and her diagnosis was of an emerging personality disorder, depression and complex needs.

Her case came up for review in the High Court in 2023, when she was 20, and the court heard she lacked the capacity to consent to or refuse treatment, and it was in her best interests to remain in the UK unit.

The solicitor for the HSE exhibited a detailed report from the consultant psychiatrist in the UK unit outlining the therapies available, the girl’s engagement, her physical health, risk issues, medication and the appropriate medical treatment. The report said her mood and mental state had continued to fluctuate. In the early stages of her admission she had been reluctant to attend to her personal hygiene or engage in activities, but her self-care had improved markedly, she was cooperative and engaging in a wide range of activities, she tolerating lengthy individual sessions with a psychologist and engaged in therapy. She had committed herself to long term therapy and had had a number of visits from her guardian ad litem (GAL).

A summary of the current risks said the girl had a complex presentation with features of several mental disorders. Her mental state had improved with medical treatment, but she needed long term therapy before her return to Ireland. The consultant was entirely satisfied that she suffered from a disorder of the mind, meaning she was of unsound mind for the purposes of the matter before the Irish High Court. Her detention was appropriate and necessary, her disorder had begun in childhood, it was severe, she continued to require intensive and specialist treatment in a medical service.


The consultant outlined the conditions necessary for her successful rehabilitation in order to return to step-down services in Ireland; these were: a) to tolerate the presence of male staff in her vicinity; b) three months without an incident of self-harm or serious violence; c) to be able to leave the grounds; d) to have no recourse to self-harm due to therapy; and e) to commit to continued therapy.

A report from a HSE social worker, the acting principal mental health social worker, said his primary role was to provide support to the respondent’s mother in particular. He provided general emotional support and details of visits. She reported difficulties with the pace of progress but understood that it could take time. The young woman had had a visit home last year and had made retrospective abuse disclosures. Tusla had been informed.

An updated report had been prepared by her GAL. She said the young woman was “a sweet and gentle soul who frequently pines for home, she clings to this dream of being in Ireland, she knows this can only happen when she is ready with her treatment.” The young woman also wrote a letter to the court.

The judge said he had very carefully considered its contents, and thanked the young woman sincerely for taking the time and effort to set out her views. She had said she missed her family, friends, Ireland, the atmosphere and craic, sports, camogie and GAA. She wanted to celebrate her 21st and grandmother’s birthday at home, she would love a placement like [the UK unit] in Dublin. The judge commented: “While making clear that this court had no role in how public funds are spent, it couldn’t be other than this court’s wish it was so. I too would love that a placement like [the UK unit] was in Dublin, I certainly agree with [the young woman].”

The judge understood her frustration that she had had transfer twice to UK to receive care not available here. She said she was willing to do this, emphasising her need to feel comfortable in her placement, she struggled with change. She had praised her current placement. “They have my best interests at heart, even when I’m being difficult, they ALWAYS try their best,” she had said.

The judge said it was a testament to her care that she had made a video in order to show how far she had come, titled “My Two-year Journey”. He said it was a privilege to watch, there were lots of smiles, more than a few thumbs up gestures, it showed someone enjoying life. “As someone who struggles with technology, it is a professional video, it had music to accompany images, very positive images.

“I have taken very full account of her views, and it seems to me that although she would far prefer to be here and it is frustrating there is none like [the unit] here, there is more progress to be made in her current placement in the context of her ongoing work. [The GAL] supports her current placement, progress is being made, her therapists are extremely proud of her for the hard work she is putting in, they feel she is where she needs to be for progress.”

The mother’s lawyer accepted the need for the continuation of the current orders.

The judge said he felt it was very important to explain the reasons for the decision of the court, that it remained appropriate and in her best interests that she remain in the UK unit. The evidence outlining the need for this was given for the 2020 order, and there was now concrete evidence of the progress that such specialist treatment had allowed her to make, as a result of the hard work she and the team supporting her had done. The ultimate goal remained absolutely to return home, and home leave should be facilitated.