Detention of girl suffering from anorexia nervosa, father not consenting

The District Court made an order under section 25 of the Mental Health Act 2001 for the involuntary admittance to hospital of a teenage girl suffering from anorexia nervosa. The court was told the girl’s father, who had not previously been involved in her life, had recently indicated he wanted to discharge her from inpatient care.

The child had been admitted to hospital with anorexia. The child had stopped eating and was reducing her intake of fluid and so there was concern that her blood pressure might drop dangerously. The girl was also self-harming. The hospital was regularly monitoring her vitals and was concerned that she might require tube feeding and admittance of fluids.

The child was initially admitted to the hospital voluntarily, but it was understood that her parents indicated they were going to take her home so an order for involuntary admittance to hospital under section 25 of the Mental Health Act 2001 was sought by the HSE.

The child’s doctor told the court that the child’s parents were separated, and that the father had had limited contact with the child, though his contact with her was increasing due to the current situation

At this hearing the parents were not present in court. The father was in hospital and the solicitor for the HSE gave evidence in relation to emails between her and the mother.

The doctor said that the girl’s father accused her of taking liberties by keeping the child in hospital. She said that she explained why it was necessary to keep her in hospital, but the father became very angry and she had to end the call. The doctor said that the girl’s mother wanted what was best for her daughter. The judge made an order for involuntary admittance to hospital and appointed a guardian ad litem (GAL).

At a further hearing the solicitor for the HSE said the matter had been before the court the previous week, but as the mother was not present in court at the time, the judge felt she should be given an opportunity to attend, so a very short order had been made at the time and the matter was adjourned. The solicitor said the mother had since been contacted and had advised that she was not in the jurisdiction and would not be back for six weeks.

The solicitor for the guardian ad litem (GAL) said that a GAL had been appointed on the last date, but had not had the opportunity to review the file or meet the teenager as she was on annual leave, so she could not make any submissions.

The teenager’s consultant psychiatrist was called to give evidence and provided the court with an update. She said the girl was suffering from “significant anorexia,” and was also self-harming. She said the girl’s father had recently stated that he wanted to take his daughter out of inpatient care. She said the father had not been involved “at all” in the girl’s life to date, but from speaking with him and from speaking with the mother, it appeared he had taken the view that his daughter was “not unwell.”

When asked whether the girl was well enough to be discharged from inpatient care with the Child and Adolescent Mental Health Service (CAMHS), the expert said that her self-harm had increased. She described the teenager as a young person whose weight was “significantly low and continued to be low,” despite some slight weight gain since her admission to the inpatient centre in question.

The expert said that prior to coming to court on the last date, she had spoken with the teenager’s mother, who was in agreement that the girl was unwell and needed treatment, but that a more recent conversation suggested the mother did not think her daughter was quite so unwell. The expert felt this was to do with the father’s recent views.

The expert reiterated her own view that the teenager was “very unwell” and that her vitals remained low. She said the girl had “a bit of a way to go,” but that she had started to show signs of some improvement. She said she had started eating over the weekend and was slowly working with the team. She noted there was a plan in place with the community team and the intention was to “work with mum to get her daughter home.”

When asked about a recent telephone conversation with the father, the expert said he had been “abusive” to her. She said the father had not been involved in the teenager’s regular care before. The expert further confirmed that she had spoken with the mother since the last date and that she had indicated she was not in the country, and that she did not know she was supposed to come to court when she was in “full agreement” with the application.

The expert confirmed she was seeking a six-week order for the teenager.

Having heard the evidence the judge said it appeared to him that the proofs had been established to grant the order and noted the mother was consenting to it, in spite of some confusion as to her views. The judge said it was clear the teenager was suffering from a mental illness and the 21-day order was required in those circumstances.

At a subsequent hearing, the matter came back before the court for an order extending involuntary admittance to hospital. The child’s parents were both in attendance. The court heard from the child’s psychiatrist who reported that the child was struggling, not only with food, but with engagement with the dietician and other services.

During one of the mother’s visits a window was left open and the child absconded from the hospital.

The GAL told the court that she had met with the child on two occasions and that she was very polite and had told the GAL that she wanted to go home. She said that the child understood that she had to engage and get better before she could go home. The court again extended the order for involuntary admittance to hospital.