‘Very vulnerable’ woman to remain detained in psychiatric unit

A "very vulnerable" young woman who is not mentally ill but has complex disorders and chaotic behaviour must remain detained in an acute psychiatric unit for the time being, the president of the High Court has ordered.

Mr Justice Peter Kelly said the HSE may need to explore the option of addressing the woman's needs in a specialist UK unit as different placements here over years have not worked and she is now effectively being "contained".

“We are running out of options,” he said.

In the interim, the evidence is that the woman, a ward of court for some seven years who has a mild intellectual disability and is emotionally unstable with complex disorders, requires detention in a safe and secure environment where she will at least get food and medical attention, he said.

When previously released into the community, she ended up with homeless services and lived in squalid conditions with a family member in a tent for a time.

Other concerns are her lack of insight, occasional substance misuse and history of fire-setting which, the judge said, made unsupervised residential accommodation for her “virtually impossible”.

Involuntary detention

The woman does not meet the criteria for involuntary detention under the Mental Health Act but equally he could not have a vulnerable ward of court exhibiting such distress that leaves her so vulnerable, he said.

He had “no choice” but to order her continued detention for the time being in the psychiatric unit.

She was detained there by court order some weeks ago after a homeless service expressed concern about her “very erratic” behaviour

The judge suspected this was “another stopgap” solution and said the HSE will have to consider whether any facility here can address her needs or whether a UK facility may be more appropriate.

It seemed virtually every option here has been tried, including inpatient and outpatient facilities and supervised residential care but “nothing seems to have worked”.

Earlier, the judge was told two psychiatric reports concerning the woman’s current placement noted her behaviour towards staff and other patients means she sometimes requires sedation to be managed safely in the unit.

Paul Brady SC, for the HSE, said the reports state she disregards the rules of the unit, is eating minimally, has minimal understanding of her difficulties and wants to return to another unit where a placement had previously broken down.

Psychosis

The psychiatrists took the view, while there was no evidence of psychosis or a specific mental illness, she needs to be safely managed and that should be done via a mental health service with which she is already familiar.

The reports were to the effect her presentation is complex and she probably has a personality disorder and is likely to need ongoing support in a placement. The doctors considered, if she was not restricted in some way, there was a high risk of her absconding, counsel added.

The HSE wants the woman to remain detained where she is while it explores whether to return her to the other psychiatric unit, he said.

David Leahy BL, for the general solicitor for wards of court, did not object to the HSE's application for a two week adjournment to explore returning her to the other unit but urged that option should be advanced speedily.