Wardship reviewed for young man in secure hospital outside jurisdiction – 2022vol2#62

The case of a young man [A] under wardship came into the High Court for review. He had been admitted into wardship in early 2020 and been transferred to a high secure hospital unit outside of the jurisdiction for therapeutic treatment in late 2020. There was a detailed psychiatric report provided in the most recent affidavit from the unit.

The continuation of the wardship orders were being sought by the HSE. A had reached his majority, he had been a child in care and had spent time in special care in Ireland.

The court had been advised that A had assaulted a peer seven months previously and was subsequently moved from a medium secure unit and placed in the extra care unit in the hospital where there was separation from peers. There had also been an incident in the previous month which had required the police to attend the unit. However he had been “doing quite well” recently and was awaiting a transfer to a medium secure unit bed in the hospital.

The psychiatric report advised that “with treatment, A could lead a relatively independent life, the risk to others of physical harm is moderate to high, and there is a moderate to high risk of A discontinuing his medication”. There was a moderate to high risk of accidental harm to others and that risk was life-changing or threatening, therefore a medium secure setting was recommended. The report supported the continuation of the existing order.

The barrister for the GAL sought a review in three to four months rather than the standard six-month review as A was waiting on the move to the medium secure unit. His views were expressed through the sworn affidavit of the GAL, and the court heard that A felt frustrated waiting to move to the other unit and felt that it was delaying his eventual discharge. He was seeking more psychology sessions and accepted that the incident that occurred with him earlier in the year was very serious. Ultimately A sought to be discharged back to Ireland. More community leave might be available if he could make some progress.

The barrister for A’s mother advised the Court that the issue of the medium secure hospital placement was foremost in the mother’s mind but the key priority was his welfare. Her barrister explained that she had not seen her son in two months because he was being kept in seculsion but that he had come out of seclusion in the last few days. Under normal circumstances she went to visit him every six weeks. The barrister sought for the review to come back again in three months time as A had already been waiting six months to transfer to a medium secure unit from seclusion.

As A was attending the proceedings via videolink, the judge spoke with the young man and asked him how he was coping. A told him that he had a “few coping strategies, listening to music, going out to the courtyard.”

“You’re managing but it’s frustrating?” asked the judge. A confirmed that it was frustrating because he wanted to get to the medium secure unit and “then look towards getting released after that.”

After talking with the young man, the judge ruled: “While A was generally getting on very well, there was a very serious incident this year, so he moved to an extra care facility rather than medium secure.

“It is very clear from the evidence that he has many complex needs, his case is a complex one, he has an intellectual disability, a personality disorder, bi-polar disorder and autism, his treatment is complex, and his placement is absolutely essential. The balance of the opinion is that he should be moved to a medium secure unit in [the hospital].

“The problem has been there is no availability in the medium secure unit. He has very fairly said he has developed various coping mechanisms to deal with the frustration. The evidence is that he should be moved when the bed becomes available, the evidence in that respect is clearly set out in [the psychiatric consultant’s report] that with treatment he could lead a relatively independent life. At present if discharged he would present to services in a short space of time, and poses a severity of risk to himself and others which is life threatening and life-changing.

“A medium secure placement is what’s recommended. [The psychiatrist’s] view is supported by various others who gave evidence today, not least his mother, who is of the view he should move to a medium secure placement and is very concerned that this has not happened to date.”

The judge noted that the young man’s views regarding the medium secure unit were set out in the GAL’s affidavit. He was happy to live in supported accommodation if moved back to Ireland. He also noted that the general solicitor for the Committee supported the continuation of the placement and that a move to be made to a medium secure placement when available.

The judge set down a short review date “in order to keep the pressure on” with liberty to apply should a medium secure unit bed become available in the hospital.