An extremely disturbed 14-year-old girl, who almost died after a drugs overdose and who was allegedly raped while in the care of a residential home, is to be detained in an acute psychiatric unit, despite the fact that she is not psychiatrically ill.
Mr Justice Kelly complained in the High Court yesterday that he was being put in an "appalling dilemma" in such cases, the second to come before him in a week. He blamed the failure of the State to provide appropriate facilities and to introduce legislation to give health boards additional powers regarding such children.
The judge said the State's failure "manifests itself week in, week out and will continue until the Department of Health and Children comes to terms with providing for such children those entitlements declared by the courts in 1995, and which, in the year 2000, are not yet provided for".
He said if this State would not provide for such children, he would order that the girl be treated in an appropriate facility outside the jurisdiction.
The judge recalled that last week he had been compelled to order the detention of another young girl in the Central Mental Hospital, although she was not psychiatrically ill, because the facility she required was not available here.
That child, who until then was held in an acute psychiatric unit of a general hospital, required a place in a unit which was secure but had appropriate therapeutic facilities and trained staff.
In the latest case, Ms Teresa Blake, for the health board, had applied to the judge for an order directing that the 14-year-old girl be detained in the acute psychiatric wing of a general hospital for four weeks while the board looked for a more suitable placement, perhaps outside the jurisdiction.
The girl would have a childcare worker on a 24-hour basis and be under the care of a consultant psychiatrist who deals with adults.
The court heard the girl was very disturbed and out of control. She was taken into voluntary care by the board two years ago because of a difficult family home life. She had been placed in open residential homes but her behaviour had seriously deteriorated in recent months.
Earlier this month, the girl was found collapsed and rushed to hospital. She had taken ecstasy tablets and alcohol and had suffered cardiac arrest. She had to be ventilated and almost died.
She had also been hospitalised following an incident in January when she took ecstasy tablets.
Earlier reports outlined the nature of the child's risk-taking behaviour while staying in an open residential unit run by the health board. On one occasion she had stayed out late, taken drugs and alcohol and a man was found in her bed. There were allegations of at least two assaults, including rape, and the child had been treated at the Sexual Assault Unit in Dublin's Rotunda Hospital. She had been diagnosed with a sexually transmitted disease.
The girl was said to be very disruptive and had assaulted and been verbally abusive to care staff. The manager of the residential unit said it was not secure and could not meet her needs.
A consultant child psychiatrist said the girl suffered from epilepsy and had no insight into how dangerous it would be for her to continue taking drink and drugs.
She was also vulnerable to sexual exploitation and abuse. She had said she wanted to leave the psychiatric unit where she at present was and take more drugs and alcohol. She believed there was nothing wrong with her.
If the girl took more ecstasy, she could be severely brain-damaged or die, given her epileptic condition.
The psychiatrist said the girl had ingrained maladaptive patterns of behaviour and was a great risk to herself and perhaps to others. She needed a secure residential environment where she could receive appropriate therapy and treatment from suitably qualified staff. There was no such unit available.
Mr Justice Kelly said the girl's life was in imminent danger but the health board had no facility appropriate to her needs and had no legal entitlement to provide what was required.
The State had failed to provide the appropriate facilities or legislative framework to deal with such cases and this had resulted in such children coming to the court as a last recourse.
What the health board was proposing was unsatisfactory and the board had admitted that. The girl would be in an insecure environment, the acute psychiatric unit of a general hospital. This was not fair to the girl, other patients or the public visiting the hospital. It had also put great strain on the psychiatric facilities as the girl required 24-hour supervision.
Considering the alternatives open to him, the judge said he could send her to the locked wing of an adult psychiatric hospital, which the psychiatrist had said would do more harm than good. The psychiatrist had also said the Central Mental Hospital was inappropriate.
He could make no order, which would free the girl to continue the self-destructive behaviour that had brought her to within an inch of her life. The judge said he had no option but to make the order sought by the board and give it the power to take all necessary steps to promote the girl's welfare.
At least, the girl would be in a hospital setting and an environment as secure as the staff could make it. He listed the matter for April 6th next and directed reports be prepared on the girl in the interim.
