The District Court was asked to make an order detaining a child in a psychiatric unit under Section 25 of the Mental Health Act. She had been admitted to a Child and Adolescent Mental Health Inpatient Unit the previous weekend on the basis of parental consent. The child, of primary school age, had been in voluntary care, but the placement had broken down and she had been admitted to the Inpatient Unit. The father had signed the admission forms on the previous Friday evening. The court was asked to make an order under Section 25 of the Mental Health Act.
The court asked what view the parents had in respect of the order.
CFA solicitor: “Their view is that she is a terrible trouble maker. She has been huge trouble in [the Inpatient Unit]. She needs to be in hospital.”
The solicitor provided affidavits to the court and asked the court to consider making an order for 11 days. The court asked why the order was sought for such a short period of time and the solicitor responded it was because the application was made ex parte.
The court was told that the child had been in voluntary care due to a family conflict. The child had been in a children’s hospital since March as a place of safety as the foster placement had broken down. The child arrived at the hospital accompanied by Gardaí in March following an argument with the father and it had been reported that the child had tried to self-strangulate and she was in “huge distress”. The court was told that the child had had numerous attempts of self-harm and nine admissions to an emergency department and had low mood.
The solicitor referred the court to a paragraph of the doctor’s report stating his opinion was that the child suffered from emotional dysregulation and an adjustment order. The doctor expressed the opinion in the report that the child was at an acute risk to her physical and mental health and that she required inpatient treatment in an approved centre or the child would be likely to deteriorate.
The report confirmed that the psychiatrist was not related to the child and that the child was suffering from a mental disorder falling within the Act. The solicitor said that the application was brought ex parte in circumstances where the parents were notified of the application and had not indicated that they were not consenting to the application as they “accepted the reality of the situation” and the father had signed the child in to the Inpatient Unit on the previous Friday evening.
The court was satisfied to make the order sought for a period of 11 days and made a number of directions including that the child could be transferred to the children’s hospital for acute treatment if it was required and if medically advised. The court directed for the order to be served on the parents immediately and that they had liberty to have the matter re-entered in court with 48 hours’ notice. The court also made an order appointing a guardian ad litem to the child.
When the case came up again some weeks later the District Court was informed that the order previously made was due to expire at the end of the week and the HSE solicitor had not received instructions confirming whether an application to extend the section 25 order would be sought. The solicitor for the guardian ad litem(GAL) and the solicitor for the father indicated that they were consenting to the short adjournment.
The court was informed that the child’s time in her residential placement was coming to an end, she was in need of a placement and that a safe discharge to an appropriate placement was part of the treatment plan. The court was told that there was concern that the child would be detained in a psychiatric setting for longer than was required and the CFA had identified an onward residential placement for the child.
The solicitor for the GAL informed the court that the GAL had visited the proposed facility last Thursday and that it “appears to be a placement that may well meet the needs of the young girl” and in principle there was agreement to her moving to the proposed placement. The solicitor for the HSE indicated that there was a meeting scheduled to discuss the timeline for that move to happen and she hoped to have more detail later in the week. The solicitor said that the HSE was concerned that “she would be in a hospital setting for longer than required”.
The court was told that it would be an unusual situation at the end of the week if the HSE did not seek to extend the section 25 order as if it was not extended the GAL would be discharged in respect of the section 25 order but the section 47 application would remain before the court. This would cause a “potential huge difficulty if not extended as she will have to leave [the residential unit] and she may not have a placement” to go to.
The judge stated that he was aware of other cases previously where an order was made “extending the order for a short period as part of the discharge plan”.
The court was told that it was usually the position that a child was not discharged until a placement is identified and the CFA were concerned to ensure a placement and hopefully they could confirm that the placement was ready for her to transition to in a safe and appropriate manner with introductory visits.
The solicitor for the HSE said that it was “a challenge” as the child cannot be held under a section 25 order unless she meets criteria [for detention due to mental illness] and the situation was that whilst she met the threshold previously it was not clear that she still met the threshold. The parties hoped to have clarification later in the week as the HSE “want to get children out of psychiatric placement if they don’t need to be there” and the risk of COVID- 19 was also a reason [for her to be moved] provided the child did not require to be in the unit.
The solicitor for the father told the court that the father was concerned with the child’s welfare and that a placement was required and had agreed to an adjournment to Friday. The judge asked whether the mother was represented and he was told that both parents were on notice of the application but only the father had applied for legal aid. The HSE solicitor said that when the matter was first before the court she had spoken to both parents and the wife’s English was excellent but she had told the HSE solicitor that it was for “her husband to deal with all these matters” and it was described as a “very traditional relationship”.
The judge raised a query that as the mother and father had withdrawn contact and care from the child, “that being the case I wonder what input they can have into what her care might be? They are responsible for her care and have withdrawn from it. [I am] trying to tease it out.”
The solicitor for the father said that the father had “great affection for his daughter and was very concerned”. The court was told that the father had cared for her for six months prior to the voluntary care order but needed support at the moment. The judge said that that was “some engagement, which is a good thing”.
The judge adjourned the matter to end of the week. The HSE solicitor flagged that, subject to her instructions, she potentially could be issuing a further section 25 application on that date.