The High Court heard that a young Irish man, who is a ward of court, had been on a deaf ward in a specialist psychiatric unit in the UK since he was a teenager, where most of the patients were much older than he was. The HSE was seeking the renewal of orders keeping him in the unit.
The court heard that he and most of the patients on the ward, all with mental health issues, were deaf. At the time of the hearing he was also secluded following incidents of racial abuse and assaults and threats against staff.
The court heard the ward he was in was not an acute ward, but was a blended unit with medium and low levels of security. Because of the specialist nature of the ward there might be patients on it that are acutely unwell and also those undergoing long term rehabilitation. Some patients had been on the ward for a very long time.
Some of the patients represented a long-term risk to people, but it was acknowledged that the young Irish man did not. Because of their hearing disability, access to psychology for the patients was limited, and they had difficulty understanding the concepts required in psychology. The lack of interpreters contributed to this.
The unit psychiatrist said that this was the longest period in seclusion she had seen for any patient. In reply to a question from the judge, she said there had been no comparable incidents of seclusion in the last four years. The young man had been going into the community escorted by two members of staff until recently.
Referring to his deafness, she said that he could lip-read and had some reading and writing. He had also learned sign language. She said it was difficult to obtain a thorough understanding of what he was saying, she would understand about 60 per cent. While he did not initially want an interpreter, she felt she needed one and when the interpreter was engaged he interacted with the doctor through the interpreter, and they had a really helpful conversation, she was able to assess his mental state in a helpful way.
She gave evidence concerning the medication he was on, which included a drug administered by injection, it could be administered under restraint. This caused him pain and she did want to go down that road. He was now on different medication. He had developed some understanding that he needed the medication and had asked for more. It was given every two weeks, and could be given every 10 days if a higher dose was needed.
“I’m hoping that I won’t be talking about seclusion for [the young man] early next week if we continue the way we are going,” she said. However, he had had an important issue in the ward with other patients.
She said she was recommending he have access to open spaces, quiet, green spaces and fresh air. Replying to the judge she said: “He’s going to the courtyard today for two brief periods and spending time out of the seclusion room, and I’d like perhaps to see him on the ward with other patients around, to see how he gets on and to give them time to get used to him on the ward.”
She said the young person had a strong Irish identity, but there were no other Irish people there. The judge said that his mother spoke to him about twice a week, which was a lot, she had seen other wards of court who had no contact at all with their family.
The psychiatrist was concerned about the young man’s lack of exposure to his own culture. “He has no access to that anywhere, he doesn’t see himself as a young person, he is a bit stuck in the young identity of being a bad boy, he is lacking an identity at the moment, if there was a service like us in Ireland I would strongly recommend he return, but seeing the trouble he has been in, it would be naïve for us to think he could be cared for anywhere else,” she said.
Asked what was her view of the overall cost benefit analysis of him staying in the UK unit, she said that given his anti-social views he would get into trouble with the police. “I don’t think it’s just [a question of] offering mental health treatment, he became this patient because of the long-term exposure to a chaotic environment and it’s going to take him an equally long period of time to relearn a new way of caregiving, a new language.”
The judge said unlearning those behaviours seemed to be very difficult and she presumed in Ireland he would need to be in a detention centre. “Would he be better off in Ireland being detained in Ireland near his family, he seems rudderless, I understand all the caveats in relation to his mental health?” The doctor said that previously when he was in contact with his family, and when he needed consistent input by services, that had not been facilitated by his family. If the exact same services could not be provided, she would say no.
Counsel for the HSE said that a centre in Ireland had indicated an openness and willingness in this case. He had had a placement with them for two years, but it didn’t work out. They had been to the UK unit to assess him and it was deemed he was not ready. The HSE would get an updated view on possible placements.
The judge said she had seen the case for a number of years, it had been said there would have to be a step-down placement first, a community house, a deaf house. However, if he did not progress he was destined to remain where he was. The lawyer said that Ireland could be better in terms of cultural connections but the communication opportunity was not there. The doctor said that with deaf services and family contacts he could progress.
The judge extended the orders, including those relating to the seclusion protocol and the medication, but said she would like the HSE to come back in relation to possible alternatives.
