Court orders girl be held in adult psychiatric unit until place found

A troubled teenage girl who is not mentally ill but whose behaviour is considered a serious risk to herself and others must remain in an adult psychiatric unit because an appropriate place has yet to be identified for her, the president of the High Court has ordered.

The girl, in care since she was a young child, has a history of self-harm and her court-appointed guardian said she believed she is at risk of death or injury if not securely detained.

Mr Justice Peter Kelly said all involved in the girl's care accept the psychiatric unit placement is inappropriate but, as of now, it was the least inappropriate option. A better solution must be found quickly, he urged.

In the interim, the judge directed the girl’s continued detention for administration of such treatment as considered necessary in her best interests. That includes permitting doctors to sedate her if necessary, including with anti-psychotic medication, to control her behaviour.

A consultant involved in the girl’s care had said she had ethical difficulties in administering such medication but considered it necessary, the judge noted.

He added the girl’s own views had, through her guardian and a letter from the girl, been made known to him and he had taken those into account and wanted to assure her the measures being taken were considered in her best interests.

An application concerning whether the girl should be made a ward of court will be considered next week, he directed.

All the professionals involved in the girl's care agree she requires secure care in an appropriate setting but no place had been identified so far, either here or in England.

In those circumstances, the girl’s guardian told the judge on Friday, while the psychiatric unit is “totally inappropriate”, she considered the girl should be detained there for another week as keeping her secure was essential.

During that time, there must be "huge efforts" by the Child and Family Agency to identify or design an appropriate secure placement and a place in the UK should be a "last option".

While the HSE has plans to close a particular secure unit, that remains open at present and that option might be explored, the girl’s guardian suggested.

As of now, the girl is number five on a list of children waiting for secure care beds, she said.

Unlocked unit

Another option was to ultimately return the girl to a therapeutic but unlocked unit where she had done well for a number of years but any such return would have to be on the basis of appropriate supports being provided to ensure her security, the court heard.

The girl liked that unit and considered it her “home” and had been “delighted”, when the guardian saw her this week, to be asked what her own wishes were for her care, she said. The girl had demonstrated insight and said she would use the counselling and other services available to her.

The girl had done well in the open unit for a number of years but, after a serious deterioration in her behaviour and self-harming incidents, she was moved to a paediatric unit last month.

Due to her behaviour in that unit, an emergency application was made to the High Court last week for her to be moved from it due to serious concerns that her behaviour presented a risk to infants, staff and herself.

Based on that and other evidence, the judge moved her to the adult psychiatric unit where, he was told on Friday, her behaviour appears to have stabilised for now. The unit is considered very inappropriate but it at least keeps her safe, he was told.