The Supreme Court has said it is not in a position at this stage to hear an appeal to determine the legality or otherwise of the unprecedented detention in the Central Mental Hospital of a teenage girl, who is extremely disturbed but not psychiatrically ill.
The appeal has implications for other cases of troubled children. This week, the State applied to have another profoundly disturbed, but not mentally ill, teenage girl (who is currently in a locked adult psychiatric unit with seriously mentally ill adults) sent to the Central Mental Hospital but was told there was no place there. The matter was adjourned to tomorrow to see if a place could be made available.
In the present case, the 17-year-old girl took legal proceedings in summer 1997 seeking orders compelling the relevant health board and State to provide her with appropriate care and accommodation. Reports have stated that she requires placement in a secure unit operated by childcare professionals with appropriate therapeutic facilities.
However, 2 1/2 years after the proceedings were instituted and despite the need for a secure adolescent psychiatric facility being highlighted in many other cases over the years, there is still no such unit in the State.
The girl, who was sexually abused as a child by an adult male and later by a brother, has a history of heroin abuse and prostitution and suffers from behavioural and personality disorders. She is described as a serious danger to herself and others. She has had 34 placements, all of which have broken down. Last March, following violent and aggressive behaviour by her while in a high-support unit, she was moved to the adult psychiatric unit of a general hospital. While there, she cut her arms and neck with razors and threatened staff.
The situation prompted an application to the High Court by the health board. The board told Mr Justice Kelly on that occasion it felt obliged to draw the situation to the court's attention but advanced no proposal on where she could be accommodated.
In the absence of any alternative, Mr Justice Kelly suggested the Central Mental Hospital as a possible option. The State applied to have her sent there and an order was made. The situation was reviewed on March 29th and the girl was again returned there.
Following a further review on May 9th, during which Mr Justice Kelly heard evidence from a consultant psychiatrist with the Central Mental Hospital, social workers and also heard from the girl herself, he again returned her to the hospital and listed the matter for review in two months. He said it was significant that all the evidence was that it would be detrimental to the girl's welfare, health, safety and even life if released. She had said she had settled down at the mental hospital, believed it had helped her and was opposed to going elsewhere. The judge noted there was no other place in the State where she could be sent.
An appeal had been lodged with the Supreme Court against the March 29th order returning the girl to the Central Mental Hospital. The appeal was taken by the girl's guardian ad litem on behalf of the girl. However, the girl had indicated in a letter to the High Court judge, and in court on May 9th, that she wished to remain there.
The appeal was listed for hearing yesterday. Mr Gerry Durcan SC, for the guardian, contended the girl's detention was illegal and said he wanted the health board and State to be ordered to provide an appropriate facility. The Chief Justice, Mr Justice Keane, presiding over the five-judge court, said they were told the girl wanted to remain at the Central Mental Hospital. He also noted the unanimous view of all concerned seemed to be that there was no unit suitable to deal with her. The alternative was to send her on to the streets and all were opposed to that.
Mr Durcan said the fact there may be no other appropriate facility could not render lawful what was unlawful. It was not lawful to house a child - and the girl was legally a child - in the Central Mental Hospital.
Mr Felix McEnroy SC, for the health board, said if the appeal was to be against the May 9th order, he was anxious the Supreme Court should have before it all the material put before Mr Justice Kelly. He said the court should also have regard to the views of the girl herself. A British manual dealing with guardians ad litem stated that where there was a conflict between the views of guardian and child, the court should, taking into account age and other considerations, follow the instructions of the child.
Mr Patrick Keane SC, for the State, supported the health board's submissions.
After considering the matter, the Chief Justice said the appeal could not be heard at this stage. The March 29th order was spent and to hear an appeal against that would be a moot, however important the issues.
He said Mr Justice Kelly's latest order, of May 9th, was based on evidence put before the judge by experts and on the girl's statement, which were not before the March 29th hearing. The Supreme Court did not have these materials and also had no approved transcript of the hearing.
If the court had an appropriately constituted appeal before it, there would be an issue for it to resolve but it could not be done now. He adjourned to May 26th to allow time to consider whether to proceed with the appeal.
