Bespoke residential placement directed for a child with serious mental health issues

See also: https://www.childlawproject.ie/publications/judge-extends-order-for-child-detained-in-a-specialist-mental-health-centre-for-her-own-safety/

A judge in a rural town decided that residential care was the best option for a child of primary school age, who had recently been released from the psychiatric unit of a provincial hospital. The child had undergone treatment for anorexia nervosa and had spent a number of months at the hospital under a Section 25 involuntary detention order. The child had been due to live with her mother following her release from the hospital but she had returned to her father.

The mother’s lawyer said that the child was now hostile towards her mother but the father’s lawyer said he was not opposing access and would give evidence of his encouragement of access. The judge directed that a bespoke residential placement be found for the child and directed an update to be given after one month.

Both the parents were represented in court and there was also a lawyer to represent the guardian ad litem(GAL). The mother’s lawyer told the court that she was making a Section 37 application for increased access because the access between the child and her mother had been diluted and was continuously worsening. The lawyer for the Child and Family Agency (CFA) reported that the child was due to live with her mother once she was released from hospital but that she had only stayed with her mother for two nights before leaving and going to live with her father. She said that the child was “very rigid in all her thinking”.

The social worker said she wanted to progress the access with the mother. Since going to live with her father, the child had become very hostile in her attitude towards her mother and even started fighting with her mother on car journeys. The judge said that he had sympathy for both parents. The social worker said she had done some activity-based access sessions between the mother and the child but that the child remained very hostile towards her mother.

The judge said that it appeared that some progress had been made regarding the child’s anorexia nervosa but that it still seemed to be very much present. The lawyer for the CFA said that parental conflict was the underlying issue and that the child very much wanted her parents to get on with each other.

Judge: “It’s clearly not likely.”

The social worker informed the court that when the child was discharged there was great concern about her parents. She said that the Assessment Consultation Therapy Service (ACTS) had psychologists on their team who intended working with the child regarding her attachment relationships. It was very important that the child was not alienated from her mother.

The judge asked about the financial situation of the family and if the parents were working. The father’s lawyer told the judge that the father was not working at the present time. The father informed the judge that he had gone back to work as a consultant and had made adequate money for the time ahead.

Judge: “Are we at a point where we need a residential setting? Her judgment is impaired by her illness. Is she better off in a residential setting?”

The judge added that he believed it must be very difficult for the parents at night if the child was continuing to vomit and over-exercise.

Judge: “Why not residential care… Tusla is the parent now. I want to preserve what is left of the relationship with the parents.”

The social worker informed the judge that there was no residential placement available and that the child’s father had been keeping her safe and well.

Judge: “They’re doing their best, but for how long?”

The mother’s lawyer said that access to the mother was not being promoted by the child’s father, although she had promoted access to the father and their relationship. The judge asked the lawyer for the CFA if he could make an order for residential care and the lawyer replied that she did not support it at that time.

Judge: “I want a bespoke placement. If she was there, Mam would get more access.”

The mother’s lawyer pointed out to the court that the mother thought an independent placement would be the best option for the child as it would be a place where both parents could get access independently.

The lawyer for the GAL reported that the GAL wanted the care order to remain in place as the child’s blood tests had indicated that “things could deteriorate very quickly and easily”. The judge outlined his concerns for the parents in this situation and the potential for them to even get some respite. He again said that a residential placement was the only future for this child. Otherwise, the judge said that the child would end up in hospital on feeding tubes, being force-fed, which was a very traumatising experience. The lawyer for the GAL added that there was also a risk of the child developing osteoporosis in the future.

The judge said he wanted the child’s mother to get improved access. The lawyer for the father informed the judge that he was not opposing access. She told the judge that the father would go into those details in evidence. The judge replied that he did not think there was any need for this because the child could “play the parents like a piano”. The father’s lawyer said that he would go into evidence to show that he was encouraging access with the mother.

The mother’s lawyer said that the mother had been totally excluded from the child’s recent Confirmation Day. The child had been “whisked away” to the father’s family and a hair appointment made for her by her mother had been cancelled.

The judge said that he was dealing with the case for the previous six months and seemed to be making very little progress. He said he was still of the view that residential care was needed. He said he would list the matter again after one week. However, the lawyer for the CFA said that a week was too soon and that the matter would take a number of weeks. The social work team leader, who was also in court, said that it was unlikely there would be any resolution or answer on this for at least a month.

The judge said that the daily cost of keeping the child in a psychiatric bed in hospital outweighed the cost of a place in a residential setting. He stated that he was adjourning the matter reluctantly to a date one month later. He directed that the child’s mother was to get increased access. He also made a direction that he wanted to be given an update on a residential placement when the matter came back before him after one month.

The father’s lawyer pointed out to the judge that she had not had any opportunity of cross-examining either the mother’s lawyer or the social worker in this matter. She said that she was reserving the right to undertake a cross examination when the matter came back before the court after one month.

The case was listed for a date one month later.