Aftercare review for child with fragile mental health– 2015vol2#12

An aftercare review was held in the District Court for a teenager who would reach the age of majority later in the year. The teenager [A] was living with a foster family and had become the subject of a Full Care Order three months previously. The court heard that he had disengaged from a unit specialising in services for child sexual abuse and was refusing to return. His quality of life was quite poor, he was not in education and rarely left the foster home.

The social worker told the court that A’s mental health was fragile at the time of the Care Order, he now had low motivation, was irritable and very dependent on his foster carer which was a concern. “His self-esteem is quite low,” said the social worker, “it takes a lot of effort for him to complete basic tasks such as showering and brushing his teeth.” His foster carer had been offered one-to-one support.

A’s ability to engage with the aftercare planning process was a concern, said the social worker. His independent living skills needed to be developed, however his foster family were extremely dedicated to him and he would continue to live there. His name would also be added to the local authority housing list.

A was on a new “early warning system between Tusla and the HSE”, said the social worker, his name had come on the list because he would be reaching adulthood and would need to progress to adult services [from Child and Adolescent Mental Health Services (CAMHS)].

The judge asked the social worker about the fostering allowance once A had turned 18.
“He will get benefits but an automatic entitlement is not there for funding as he is not in education, an argument could be made that special circumstances are there,” replied the social worker. His psychologist had said it would be years before he could engage in full time education.

“When will it be made, anything that involves an exception will take time. Who will make it, when will it be done?” asked the judge.

The social worker told the court that the usual aftercare fostering allowance was €188 a week.

“There is an aspiration he can stay on [at the foster home], the usual would be that the fostering allowance would continue if he was in full time education, now is the time to bite the bullet,” said the judge. The social worker would have to put in an immediate application for the aftercare fostering allowance.

“The early warning system in the context of mental health services – I’m very pleased to hear there is such a system, it’s the first time I’ve ever heard of it,” said the judge. He wanted to know when A would transfer to the adult mental health services. The social worker told the court that his doctor had said the transfer would have to be at A’s pace, he often held onto his patients if the need was there.

Judge: “In my experience of these things the transfer from child and adolescent mental health services to adult services appears on the ground to go quite well, but it is very difficult to nail anything down. Is there a commitment to support from the adult services?” He asked everyone to refer to the guidelines for adult mental health.

The guardian ad litem (GAL) told the court that A could not go outside the door. There were threats associated with self-harm and his foster mother needed a lot of on-going support. There were behavioural aspects to A’s needs which crossed over with mental health.

“He can’t go outside the door, any conversation around leaving care is too much for him. He can’t go beyond the next hour in the day. His world is his animals. [His treating psychologist] should have transferred [A] a long time ago, but is giving him support, the massive support he needs. He has a hard path ahead but the family are completely committed to him. His animals live in his bedroom, that’s his world, it’s quite stark.

“Pushing him to change could push him to break down. It is day by day for him, his mood and behaviours escalate and de-escalate regularly. [The CAMHS clinic] are offering a high level of support now, but he will need to transition, that will be a difficult time for him,” said the GAL.

The GAL said that on-going funding for the foster family would have to be addressed. At the moment the teenager was overwhelmed at what he was trying to process but his psychologist was monitoring and managing the bi-polar aspect of it. The reality of his life was not great.

The judge said he noted there was to be a meeting headed up by [the CAMHS clinic] regarding A’s ability to engage in the aftercare process, he said that this would appear to be a complex and difficult situation. He said the usual rules about the aftercare fostering allowance should be looked at because A was unable to engage in education and the provision of aftercare was dependent upon it.

The case would come back in again for after care review before A reached the age of majority.