The president of the High Court has ordered “with a heavy heart” that a chronically suicidal teenage girl now attempting to take her own life on a near daily basis must remain inappropriately placed in a psychiatric unit because a special care place has not so far been allocated to her.
Staff interventions, the court heard, are keeping the 16-year-old girl alive but the situation sometimes requires up to six staff to restrain her suicide attempts and she is kept in seclusion in special clothing on occasions.
Mr Justice David Barniville said this was one of the “most distressing and upsetting” cases to have come before him.
It is “extraordinary” the placement matter has not been resolved and it is only due to “amazing” interventions by staff the girl has not succeeded in taking her own life, he said.
There may, he noted, be an inquiry in other proceedings on behalf of the girl about why Ireland is a country with not enough places for these children “while awash with money in other areas”.
The lack of places could have been foreseen and planned for as it was “not something that happened overnight but rather developed over years”.
The girl was among 10 children considered for three special care places that became available last month but were allocated to three other children deemed to be at higher risk.
The court previously heard, due to staff recruitment problems, not all 26 special care places here are occupied.
On Monday, Mr Justice Barniville concluded he must continue the girl’s detention in the unit, despite evidence from her treating psychiatrist it is causing her harm and her situation has deteriorated to a point where she is now attempting to take her own life almost daily.
The only alternative was to discharge her into the community with “unimaginable consequences”, he said.
He continued the placement to September 13th after being told by Sara Phelan SC, for the Child and Family Agency, there is cautious optimism “but no guarantee” the girl may be allocated a special care place at a special care referrals committee meeting on September 12th.
If she does not get a special care place next week, the judge warned he may refuse to continue her current placement and an alternative will have to be found.
He said he would be very concerned if the three other children were ranked ahead of the girl for special care because she has a place, albeit an inappropriate one.
The girl availed of outpatient facilities from Camhs before becoming an in-patient, under the Mental Health Acts, at the psychiatric unit two and a half years ago.
Her treatment team say she has an attachment disorder, her current risks are not in the context of a treatable mental illness as defined under the Acts and her continuing detention in the unit is not appropriate.
Her guardian in District Court proceedings, due to concerns about her suicidal ideation, asked the High Court in early July to continue her detention in the unit under its wardship jurisdiction pending a special care place being allocated as a matter of urgency.
Having heard evidence the girl could not go home, despite her wish to do so, and discharge into the community posed serious risks in the context of her attempts to take her own life, Mr Justice Barniville made that order. Two other judges continued it last month but shared Mr Justice Barniville’s concerns about delay in allocating a special care place.
Separate judicial review proceedings have been brought by the guardian, represented by David Leahy SC, over the secure care referrals and prioritisation system which, it is claimed, does not fulfil the CFA’s statutory duties.
In evidence on Monday, the girl’s psychiatrist told the judge her current placement is causing her harm and is affecting her development and trust in those caring for her.
She is feeling a “never ending degree of uncertainty” because she knows this placement should be at an end and she wants to be discharged. The failure to move her brings up her feelings of rejection and abandonment, of not having a future she can look forward to, and is almost retraumatising her, he said. This has resulted in more self-injurious behaviour, including ligaturing and head-banging.
Her detention keeps her safe but “at a continuing price to her” and has delayed the admission of two other children with severe mental health disorders who urgently require its services, he outlined.
Counsel for the girl’s mother, who placed her in voluntary care last October, said her client is very frustrated a special care place has still not been allocated but did not oppose her daughter’s continued detention because the alternative was “unthinkable”.
The judge said he had “huge sympathy” for the mother who must be “at the end of her tether”.
