A vulnerable 18-year-old Irish woman with a severe personality disorder detained involuntarily in a UK psychiatric facility for the past 19 months has told the High Court the "most important thing is to be returned back to my country".
The woman, said to be a significant suicide risk, told Mr Justice Seamus Noonan by video link from the UK she would not take her own life and has many plans for the future, including to go to university and run a marathon.
She thinks about Ireland "every moment of every day", misses her family and friends and even "silly things" like Supermacs, fields and cows. "I have never gone though pain like this, it makes me feel so bad on the inside."
When she realised the HSE was seeking to have her remain in England despite a High Court order last March she could return home this month, she felt hopeless and believed, if left in the UK, her mental health would "really deteriorate".
While now on a lower level of security at the UK unit, she shares a locked ward with 12 other girls and staff were present constantly. She can now access the gardens but could not when on the highest security, where patients are not permitted wear shoes, must wear just one layer of clothing, cannot watch tv and are under constant one on one observation.
“It’s really undignified, I felt like a prisoner,” she said, referring to having to ask for a locked door to be opened whenever she wished to go to the bathroom.
Asked by Mr Justice Seamus Noonan would she undertake a particular therapy if returned home, she said: “I would be so happy to be home I would do anything you say.”
She did not necessarily agree with the proposed therapy, Dialectic Behavioural Therapy (DBT), because it was about changing behaviour, she said.
She underwent DBT in Ireland previously and her preferred option would be another therapy, about changing thoughts and addressing trauma as she considered her difficulties arose from her past and lack of self-esteem. She believed social intervention, being outside, seeing friends, continuing her education, would be of more benefit.
The woman, who has been in psychiatric facilities in Ireland and England for almost all of the last four years since aged 14, said she considered there were not many benefits to being in England and Ireland was “the only option”.
While services in Ireland are not the same as England, the Irish health services were missing the required therapists and people are not being replaced as they leave, she believed she could manage without the staff supports she has in England.
“I don’t feel I wold be at greater risk, I would talk to family and friends, I would not put them through me ending my life, I would find another way to cope.”
While she had been assessed by about 19 doctors to date and didn’t see the point of more assessments, she would talk to other doctors should the court direct. “I’m willing to cooperate 100 per cent with everything”.
When she said everything she felt was expressed in a poem she had written to the HSE, the judge said that was a “brilliant” poem and he wished her the very best health for the future.
The judge has adjourned to Wednesday the further hearing of the HSE’s application. The court has heard doctors anticipate, if the court orders the woman should remain in England, it will be for at least six months as DBT therapy is intensive.
The case raises important issues about the power of the courts, under the High Court’s inherent jurisdiction, to detain an adult with a personality disorder against their wishes when Irish mental health legislation does not permit detention of adults with personality disorders. Issues concerning the woman’s rights under the Constitution and European Convention on Human Rights have been raised.
A core issue concerns the woman’s capacity to make decisions about her treatment.
Earlier, a UK specialist in personality disorders involved in the woman’s care, said she has emotionally unstable personality disorder borderline type which is difficult to treat.
He believed she was at risk of suicide whether she remain in England or was returned to Ireland but it would be easier to manage that risk in England as he was told there were no suitable facilities for her here.
He believed she had not fully engaged with DBT therapy, the “gold standard” for treating personality disorders, and agreed the UK unit is managing risk rather than administering therapy because she is not engaging with it.
The nature of her disorder involved periods of stability and relapse and there was no evidence she could manage safely when distressed, he said. As of today, he considered she had capacity to make decisions about her treatment but capacity issues were addressed weekly.
