Chronically suicidal teenager must stay in inappropriate unit because no secure care place available, judge orders

A High Court judge has said the vindication of the right to life of a chronically suicidal teenage girl means he has “no option” but to order her continued detention in an inappropriate unit until a secure care place is available.

Due to staff recruitment problems, just 14 of 26 secure care beds are currently occupied, Mr Justice Conor Dignam was told on Tuesday.

He was dealing with the case of a 16-year-old girl who has spent some 2½ years in a psychiatric unit which, it is agreed, cannot meet her complex needs.

She regularly self-harms and has made multiple suicide attempts.

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Barrister Mary Phelan, for the Child and Family Agency, said it is hoped three secure places will become available later this month but the girl has to be ranked alongside eight other children also approved for secure care in terms of priority.

Intended wardship proceedings concerning the girl, initiated by her court-appointed guardian, were before the judge due to the urgency of her situation.

Separate judicial review proceedings have been brought by the girl over the secure care referrals and prioritisation system which, it is claimed, does not fulfil the CFA’s statutory duties.

The girl sometimes availed of outpatient facilities provided by Child Adolescent Mental Health Services (Camhs) before becoming an in-patient, under the Mental Health Acts, at the psychiatric unit 2½ years ago.

Her treatment team say her current risks are not in the context of a treatable mental illness as defined under the Acts and her continuing detention there is not appropriate.

The girl’s mother, whose concern about her daughter led her to place her in voluntary care last October, was again in court on Tuesday.

Ms Phelan asked the judge to continue the girl’s current detention and adjourn the matter to August 24th when it will be known whether a secure place is available.

Her treating professionals consider that her return home, or discharge into the community, would place her at serious risk, counsel outlined.

Ms Phelan said the girl has indicated a strong suicidal ideation, including when taken out on mobilities from the unit. Every effort is being made to place her in secure care, she said.

Donal Ó Muircheartaigh, instructed by solicitor Seona Ní Mhurchu, for the guardian, said the girl is “at the highest level of suicide risk” and should have been approved for a secure care place months ago. The secure care referrals committee was the only entity that disagreed about that until it recently approved her for secure care, he said.

The concern is that secure care beds might have come free in past weeks but, because the girl is technically safe in her current placement, she did not get one, counsel said. The CFA “is in default of its statutory obligations”.

Solicitor Katherine Kelleher, for the HSE, said the girl does not have a mental disorder and that is why her ongoing detention in the psychiatric unit is so inappropriate.

The court is in “an impossible position” because the girl is inappropriately placed but would be at risk if discharged home or into the community, she said.

Ciaran Craven SC, for the mother, said the girl’s current placement is “not only inappropriate” but is “dangerous” and causing her harm.

While the CFA had indicated she is “safe” in the placement, that word “must be “viewed with circumspection”, he said. “She is safe insofar that staff are preventing her killing herself”.

The CFA has delegated its functions to a non-statutory special care referrals committee which approved the girl for special care “but then everything stopped”, he said.

The court was being asked to continue her “safe/unsafe” detention, which is causing her harm, but the alternative was “unspeakable”. There is no statutory basis for the ranking of children for secure care beds, and the court should grant the shortest possible adjournment, he urged.

[ The Irish Times view on the report on Camhs: a service creaking at the seams ]

Describing the situation as “very difficult”, Mr Justice Dignam said the girl is at “very grave” risk of self-harm, including a “very serious” threat to her own life, and there was no dispute her current placement is not appropriate. Her emotional distress has caused self-harming behaviour that has required staff to intervene and on occasions place her in seclusion.

Noting no secure care place is available, he had “no option” but to continue her current placement. The court is obliged to vindicate her rights, including her right to life, and continuing the placement is the only way of doing that, he said.

Stressing this had to be a temporary arrangement, he adjourned the matter to August 24th.

If you are affected by any issue in this article, please contact Pieta House on 1800-247247 or Samaritans can be contacted 24/7 on freephone 116 123 and email at jo@samaritans.ie