A High Court judge today has to decide whether to return a traumatised teenage girl to a locked, adult psychiatric unit or to send her to the Central Mental Hospital (CMH) for the criminally insane.
The 16-year-old girl was sexually abused as a child and has a drug and alcohol problem and a mental age of 14. Neither the CMH nor the psychiatric hospital wishes to have her in its units.
They have argued such placement is totally inappropriate. All the medical experts also agree she cannot be released because she is a serious risk to herself and others.
The State yesterday had no alternative option to put before Mr Justice Kelly. Mr Paul O'Higgins SC, for the State authorities, said he accepted there was no facility to meet the needs of the girl and recognised the judge faced an appalling dilemma.
Asked by the judge why the girl had not received treatment in line with recommendations made by psychiatrists who assessed her four years ago, counsel said he had only heard of this situation in court yesterday.
Mr Justice Kelly said efforts were made only when the courts got involved. He said the Department of Health appeared to have turned a deaf ear to the doctors who sought treatment for the girl.
During a review of the girl's plight, Mr Justice Kelly has heard in camera evidence from consultant psychiatrists at the CMH who have said that, following an assessment of the girl, they regard her placement in the CMH as unsuitable.
In any event, the judge heard, the hospital was full, with nine psychiatrically ill men and women awaiting places.
If the girl was placed, she would be in the hospital's seven-bed female unit and would be alongside people with serious psychiatric illnesses. The unit also includes another teenage girl sent there recently by the High Court.
Mr Felix McEnroy SC, for Dr Charles Smith, clinical director of the CMH, and for the East Coast Area Health Board (ECAHB), in whose area the hospital is located, yesterday strongly resisted applications to send her there. The applications were made on behalf of the girl, the State and the health board (not the ECAHB) which is now charged with her responsibility.
Ms Mary O'Toole SC, for the latter health board, said its services were under-resourced. Its child and adolescent service only operated from 9 a.m. to 5 p.m.
Although the board had statutory responsibility for this child, it had nothing to offer her that would make any material difference to her present condition.
Counsel said the board was examining a number of options, including a placement in England, and the possible development of a unit in its own area with some form of security and therapy. But it could be several months before an alternative was available.
At this moment, the girl was in a locked ward where she could not be contained without medicating her, and she might have to be injected at some stage, counsel said.
This was a very unsavoury prospect. The girl had not been outside the ward since May 10th and would not be let out for fear she would escape. She was very angry and frustrated. The option of the CMH, where the girl might be able to have her own room, was better.
Mr McEnroy said the applicant health board had statutory responsibility for the girl. The ECAHB had no responsibility for this case, yet is was being asked to assume responsibility.
He believed the applicant board had put insufficient information before the court about the girl and what had been done for her.
His clients' medical evidence was that the CMH was totally unsuitable and the court had to have regard to the needs of the other patients and potential patients of the CMH. The court should not ask doctors to go against their professional judgment.
Counsel said the court was being put into an impossible corner and he asked the judge to make no order relevant to his clients in the case.
Mr Justice Kelly said this was a child neglected by every agency of the State so far. If no order was made, the applicant health board had no power to detain the girl and all the experts agreed she should not be put on the streets.
The hearing continues today.
