A judge has granted a vulnerable young Irish woman's plea for her return to Ireland after being detained more than 20 months in a specialised psychiatric unit in England against her wishes.
The woman, on consent of the HSE and lawyers for herself, her parents and court appointed guardian, is to return this week.
The 18-year-old woman, who has a borderline personality disorder making her prone to unpredictable episodes of self-harm including trying to take her own life, has spent almost all of the last four years in psychiatric units in Ireland and England.
Legal proceedings concerning her care and treatment have involved costs estimated at more than €1m while the annual costs of her care in St Andrews' hospital in Northampton were €400,000. Such costs would have afforded a purpose-built unit for her here, Mr Justice Seamus Noonan observed.
After the High Court last March directed an arrangement should be put in place for her return to Ireland by June 12th last, the HSE later brought further proceedings arguing her circumstances had changed since that March order of Ms Justice Bronagh O'Hanlon.
Those circumstances included a view of some doctors she could not be kept safe in the Irish services and should remain in the UK unit where high levels of security could be put in place.
The further proceedings, involving six senior counsel, at least three juniors and six solicitors, came before Mr Justice Noonan on some 23 occasions, ultimately leading to the HSE accepting the woman has capacity now to make decisions about her treatment and no longer seeking to have her detained further in England.
The case raised complex legal issues related to the Irish High Court’s jurisdiction to order the involuntary detention in a psychiatric unit in England of an Irish adult with a personality disorder when Irish mental health legislation specifically prohibits the involuntary detention of adults with personality disorders.
The Oireachtas' view that personality disorder should not be subject to involuntary detention is shared by other jurisdictions, including Scotland and Wales, Mr Justice Noonan noted.
On Tuesday, he was told lawyers for the HSE, the woman, her parents and her court-appointed guardian all agree she has the necessary legal capacity to make decisions regarding her treatment and should be returned to Ireland.
While all sides agreed a provisional arrangement put in place by the HSE for her to be treated on a voluntary basis in a psychiatric ward of a general hospital is not the most appropriate for her, it was hoped that would be very short term and she will move soon to an adult psychiatric hospital and, later, within months, onto a private facility which can afford her appropriate treatment.
Once the woman arrives in Ireland, she can choose whether or not she engages with the services put in place for her. She previously said she would do so.
Mr Justice Noonan said she had impressed him as a “very bright and articulate” young woman, full of hopes and dreams, “of whom any parent would be proud”. She has her whole life ahead of her and every reason to live it, he said.
There were still significant risks, that part of her condition cannot be avoided but the medical evidence was there are also risks from long term detention and disempowerment, he observed.
In his ruling, the judge said he was satisfied “significant” new evidence was put before him which was not before the High Court last March and that entitled him to consider the issues afresh.
That evidence included all the doctors involved now essentially agreed the woman has capacity to make decisions about her treatment.
