‘Profoundly disturbing’: Woman with intellectual disability deprived of liberty for long period of time

The president of the High Court has described as “profoundly disturbing” the case of a woman (30s) with various intellectual conditions who has been deprived of her liberty and medicated without judicial scrutiny for a considerable period of time.

The woman, who has autism, a mild intellectual disability and a generalised anxiety disorder, lives at a single-occupancy residential placement that was commissioned by the Health Service Executive (HSE).

She has a history of causing significant property damage, injuries to herself and has not taken a shower in more than a year, the court was told.

Mr Justice David Barniville said he will require “very extensive reporting” from the HSE about how the situation went unregularised for so long.

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On Friday he granted orders, urgently sought by the HSE, to regularise the legal basis for the woman to continue to be prescribed antipsychotic and other medications and to remain at her placement with restrictive practices in place.

The situation required the judge to “act immediately”, he said, adding that the medical evidence presented to him was “very clear” she lacks mental capacity. The HSE’s application is the first in a series of necessary steps to be taken to protect the woman’s interests and to understand how this situation occurred, he said.

The HSE’s senior counsel, Barry O’Donnell, said his client “fully recognises” the need for further explanation in this case.

Mr O’Donnell, appearing with barrister Aoife Mulligan, said the HSE has known about the woman’s placement for “quite some time”, as it commissioned the service provider some 20 years ago, but it does not understand how matters came to be unregularised for what appears to be “quite a proportion of that”.

The situation is “very unusual and unsatisfactory”, he added.

In a sworn statement to the court, a disability service manager said many of the issues crystallised in recent weeks and urgent efforts were made to gather information and carry out assessments of the woman’s care needs.

The HSE is continuing to examine the use of restrictive practices that have deprived the woman of her liberty for a “very significant time”, she added.

The woman entered the voluntary care of the HSE some two decades ago when her behaviour became unmanageable at home, the manager said, adding that her family is involved in her care.

She lives by herself in a “very sparse” house due to causing significant property damage, including dismantling appliances, removing doors from their hinges and blocking the toilet, said the manager. Due to the woman’s very limited ability to cope with the presence of others in the home, staff largely operate from a separate building and she generally communicates with them through an intercom.

The windows and doors of her house are locked, and staff must use a keypad on the patio door to enable the woman to leave the house. She absconded a number of times from her placement.

In 2016 the woman began to refuse to leave her home and she began to refuse to shower the following year, the manager said.

The woman’s presentation deteriorated in mid-2021 after builders carried out significant works on the house on foot of an inspection by the Health Information and Quality Authority (Hiqa).

She caused further property damage, began to pull out her hair and had to be hospitalised due to injuring herself. An external contractor raised concerns about the habitability of her house due to repeated flooding and said he observed the woman walking barefoot in water containing sewage.

This week the service provider told the HSE it will be terminating the placement, the manager said.

A consultant psychiatrist specialising in intellectual disabilities met the woman and said she does not understand that the door to her house is locked and she cannot leave. She is not able to consider the benefits to her safety of having a locked door or appreciate the detrimental impact on her wellbeing of spending lengthy periods isolated, the doctor said.

The psychiatrist believes restrictive orders are necessary to protect the woman.

The High Court’s orders permit the woman’s continued detention and medication. Reasonable force and restraint can be used by staff where necessary to ensure the woman’s safety and welfare.

The woman’s case will return to court next week.