Child with addiction and cognitive issues returns to special care

A new special care application was made in the High Court in the summer of 2019 for a teenager (A) who had previously been in special care detention since September 2016 (with a break of a few weeks between detention orders) until the spring of 2019. She was also under a full care order.

Prior to the application in the High Court the guardian ad litem (GAL) had been advocating special care for the child due to the difficulties she was facing in her high support step down unit where she had transitioned from special care in spring 2019. These difficulties included substance abuse, impulsivity and addictive patterns of behaviour. Her high support unit was only one of two such units in the country and represented the highest level of support the Child and Family Agency (CFA or Tusla) could provide in the community.

A difference of opinion had arisen between the GAL and the CFA for over a month. The GAL had advocated special care for the teenager, however the CFA felt she needed a placement in a residential substance abuse programme. The CFA had to establish whether the residential centre had experience in treating persons with speech and language difficulties and cognitive issues such as this child had, as established by an ACTS psychologist through a previous assessment.

The GAL had a concern about A’s capacity to engage in talk therapies in such a residential centre as the teenager needed a slower pace than others in groups. The teenager had told the GAL she was taking cocaine and cannabis and going to Europe with a man, so something had to change, in the GAL’s opinion.

The judge noted a “litany of difficulties and drug use in the reports in recent times” and the GAL’s reservations (shared by other professionals) about the proposed residential substance abuse programme. The CFA wanted to pursue that route and had written to the residential centre to see what safeguards and assistance could be given to a person like A, who had cognitive difficulties.

“We’ll be more informed by whatever response comes back, something absolutely has to be done,” said the judge. “It is concerning given her history there is talk of going to [a European country] with some unknown individual. That has to be managed and everything that should be done to keep her safe has to be done, given her particular vulnerability, which is more than well known to this court at this stage.” The case was listed to return the following week.

When the case returned the following week the GAL’s view remained clear that special care was indicated while the view of the CFA still differed. The substance abuse residential programme had been unable to inform them if they could accept someone with a cognitive issue as the manager was on leave.

Counsel for the GAL told the court that the teenager’s behaviour had been concerning in the last week, issues had arisen included property damage, alcohol intoxication and bringing a male in his 20s back to her unit. The child was oscillating between agreeing to go to the residential substance abuse programme and not going. It was the view of the professionals she would require to be supported by people from her current high support unit if she did go.

When the case returned to the Minors’ Review List two weeks later, counsel for the CFA told the court that although the manager of the residential substance abuse programme had returned from leave and there had been a number of attempts to make contact, it had not been successful. A’s pattern of behaviour had not changed and there had also been property damage and an assault on a member of care staff in the last two weeks. Due to a disclosure of suicidal ideation the teenager had been brought to hospital where she had been assessed by a psychiatrist before being discharged. She had not been found to require treatment from mental health services.

Counsel for the CFA said that the child’s needs were being met in her high support unit, only one of two such units in the country, and the threshold for special care was not met, the criteria for which would continue to be monitored. He said that the GAL was recommending a bridging application for special care be made, it would take four to six weeks for a placement to be ready for A in the residential substance abuse programme and during that time the GAL was advocating the teenager stay in special care.

The barrister for the GAL told the court that A’s sister had contacted the high support unit and informed them that she had taken heroin. The unit had reported incidents where A had been intoxicated with alcohol and that she had taken sleeping pills and an anti-psychotic which she had not been prescribed, she had also taken ecstasy. She had been found in the unit with a bag containing a white substance and had told the care staff she had been dealing drugs, however the bag contained a sugar substance, and she had now put herself at risk of repercussions.

She had tried to set a piece of her clothing on fire when she was with the Gardai and was reported to have scratches on her face. Her GAL reported her asking, “a lot of people say I’m going to die, what do you think?” Furthermore, her high support unit had reported multiple absconsions for extended periods of time during which she was out of contact with her placement.

A was refusing to accept input from ACTS and had been arrested by the Gardai due to her heightened behaviour and property damage in the unit as well as an assault on care staff. There were significant risks to her safety, life, health, development and welfare.

The barrister asked that the matter go back for a week, to the day before the end of the law term in light of the new information to decide whether special care was appropriate. “Were she in any private placement it would have broken down, she is in a CFA placement, they are no more able to keep her safe, every second day or every day she is absconding and taking drugs. Even if my friends [the CFA] are not able to provide special care, they could at least be clear to the court that a referral has gone in and is being expedited,” said the barrister.

The judge remarked that it was “a difficult, disturbing and complex case, [A] had been in special care for a long period and the litany of interaction with negative peer groups and drug dealing had come back with relentless predictability. It was very sad and very concerning given her presentations.” The matter was put back in for the following week.

“I am very concerned she said she had [illicit drugs] but it was only sugar, if she’s out on the streets pedalling this to third parties that presents a very concerning situation, we all know what can happen to people in those circumstances,” said the judge. “She is an extremely vulnerable young woman and the CFA will have to look at this through a different lens and at the very least give this court some comfort, the referral should also be expedited to the [residential substance abuse programme]. There comes a point where either they are willing to take her or not.

“The Agency will have to move whatever mountain is necessary in this case to protect this young woman, there is no dispute about the level of absconsions and engagement with substances. I have to have some indication from the Agency that her best interests are being looked after. It’s at the level of risk under the Act, it’s a matter for the Agency,” concluded the judge.

The case returned four days later and was then listed the next day for a special care order application as her needs exceeded her current high support unit placement. The CFA found that provision of care other than a special care would not adequately address her behaviour, risk of harm and care requirements. This was also due to her high level of absconsions within her risk profile and her detention was required in order to address her therapeutic needs as no CAMHS was capable of offering such a facility. The special care order was granted for three months.

Four months later, the teenager was still in special care and due to her disturbed behaviour all mobilities had been suspended for eight weeks. The court heard that aftercare planning for the teenager had already begun and there had been an agreement by the professionals involved to engage a psychiatrist to assess her capacity. This could lead to a wardship jurisdiction being exercised by the High Court once A had reached her majority. The funding had been granted for the capacity assessment to be carried out by an eminent psychiatrist. The important thing, the court heard, was to have this done before she turned 18.

That morning she was appearing in the Children’s Court for possession of illicit drugs and had pleaded guilty to two incidents of assaults in a much earlier step-down placement, furthermore she had recently bitten a member of An Garda Siochana and drawn blood. The importance of A remaining on her best behaviour could not be under-estimated.

The judge told the parties that she wanted the capacity assessment ready for the next review date in four weeks’ time and she lifted the in camera rule in order for information to be provided to any potential step down placement.

The barrister for the GAL pointed out to the court that A had first been admitted to special care just over two years ago and with an interval of only a few months she had been there “to this day”. Twice this year she had she attempted to rob a staff car and drive it. Her level of risk-taking in her high security step-down placement outside of special care, her substance abuse, and her frequent absconscions had all led to her being readmitted.

Although a residential substance abuse therapy centre had been previously sought for A, at this point her GAL was quite sceptical as to whether the teenager would be able to manage it at all. She was now unable to provide clean urines. Her mobilities had been linked to extreme risk-taking and drug use and the GAL agreed that the only way of denying her drugs was to deny mobilities. In the meantime, ACTS would continue to work with her on an independent programme in her special care unit to reduce her craving for drugs.

A Garda sergeant told the court that the teenager had assaulted a member of An Garda Siochana, the incident had occurred when A was found with drugs in her possession during an absconsion and she had bitten the female guard who had tried to take them off her. The station she worked with had been dealing with A for a year now, A had been in the Garda station 65 times this year due to absconding on mobilities. “When she goes on mobilities we expect her to abscond, sometimes she returns herself and sometimes we find her and return her, but it means you have to be watching out for her… it’s a drain on our resources and it’s an on-going issue,” said the sergeant.

The barrister for the CFA asked the court to leave the special care order in place, and said that the psychiatric report would address the question of whether the teenager could engage in situ in the proposed independent programme of drug addiction work under the aegis of ACTS, on the next review date in a month’s time.

When the case returned before the end of this legal term, the court heard that a lot of preparation work had been done in advance of the psychiatrist meeting with the young person in the next four days in order to assess her capacity.

The judge noted from the court reports regarding A, that the period of special care did not appear to have achieved much if anything, however the explanation for that might be found in the report concerning the capacity assessment.

“Save for of course potentially keeping her alive,” remarked the barrister for the CFA.

“The indicators are that this matter will be moving from this list into another list, I will leave it in for review,” said the judge. It was due back in for a statutory review the following month when the capacity assessment report was also due.