A High Court judge has said the costs of legal proceedings by the HSE aimed at keeping an 18-year-old woman with a severe personality disorder in a specialised unit in England against her wishes would fund a "purpose-built" unit for her in Ireland.
The costs to date of various proceedings in Ireland and England concerning the woman are estimated to exceed well over €1 million.
It also costs £400,000 (€560,000) a year to keep her in St Andrew’s unit in Northampton, where other Irish children and adults are regularly detained .
The woman has been detained for 19 months in St Andrew’s. Before that, from age 14, she was treated in various units in Ireland for some two years.
When Mr Justice Seamus Noonan observed the costs of the case would fund a purpose-built unit for the woman here, Gerry Durcan SC, for the woman, said the legal costs of similar cases involving vulnerable young people over the last 20 years would pay for an entire "purpose-built system".
Eleven barristers, including six senior and five junior counsel, and at least five solicitors are involved in the latest case, brought by the HSE, before Mr Justice Noonan.
It raises important issues, including whether the involuntary detention in St Andrew’s, when the Irish Mental Health Acts prohibit detention of adults with personality disorders, breaches the woman’s rights under the Constitution and European Convention on Human Rights.
Most of the doctors agree that, as of now, she has capacity to make decisions about her treatment.
The HSE wants the woman to stay in St Andrew’s and she wants to return to Ireland, as provided for by the High Court in an order last March.
Voluntarily co-operate
It directed a care plan and other arrangements be put in place in time for the woman to return earlier this month. She has told the judge via videolink from Northampton she will voluntarily co-operate with treatment here.
The HSE claims circumstances have changed since the March order and has appealed that order to the Court of Appeal.
Pending that appeal, it has asked Mr Justice Noonan to vary the March order to keep the woman in St Andrew’s in the hope she will co-operate with a form of therapy considered the “gold standard” for her condition.
Doctors involved with her treatment have said they consider her a high suicide risk.
Lawyers for the woman, her estranged parents and her court-appointed guardian, all of whom are separately represented, accept she is a suicide risk but disagree her circumstances have changed materially since last March.
It has also been argued the HSE took no effective steps to put measures in place allowing for her treatment here.
The HSE argues she cannot be effectively treated here and her condition is best managed in St Andrew’s.
In evidence to the court, a psychiatrist who dealt with the woman in Ireland said there is a tension between her liberty, her right to live in the land of her birth and her need for treatment.
He considered it was in her best interests to have her condition managed in St Andrew’s.
That facility was best placed to provide her with treatment and while she had declined it, it could be offered again.
If she continued to refuse it, she should, after a specific time, be permitted to return, he believed.
Kept alive
He agreed she had been detained in hospitals here and England effectively for the past four years, with little improvement in her condition. However, she has been kept alive, he said.
If permitted to return home, the woman should not be subject to imposition of in-patient admission, he said. Should she opt for treatment in Ireland, the services here would be offered to her, he said.
His concern is about staffing, he said. Ireland does not have the resources available to large countries, and does not have the most appropriate facility to treat people with this form of personality disorder.
When Mr Durcan said Ireland does not detain people with personality disorders, the doctor said other jurisdictions do.
The Irish psychiatric services can manage most people apart from a “tiny minority” being treated in England, he added.
Mr Durcan said a medical report of August 2014 set out a view on what was necessary to be put in place for when the woman turned 18 this year, but it seemed there was no contact between the Irish adult mental health services and St Andrew’s concerning the woman’s possible treatment in Ireland for some six months after that report was produced.
The psychiatrist said he disagreed the analytic therapy recommended in that report was appropriate for the woman.
The necessary specialist service is just not available here - he could not “conjure up” such a service and nor did he think such was a good idea.
In her evidence via videolink to the court last week, the woman said the “most important thing” for her was “to be returned back to my country”.
She said she would not take her own life and has many plans for the future.
