Child and Family Agency -v- Q, [2016] IEHC 335 (2016)

Docket Number:2014 3909P
Party Name:Child and Family Agency, Q

THE HIGH COURT[2014 No. 3909 P.]













JUDGMENT of Ms. Justice Bronagh O’Hanlon delivered on the 16th day of June, 2016

  1. This judgment concerns a review of special care in the case of a minor. Q., the subject matter of these proceedings, is a fifteen year old girl, who has been in special care for most of the last two years since April, 2014. She has had no less than 23 residential care placements. There are only three special care units in this State and her stay in each of the three units has presented significant challenges to her carers and indeed to Q. herself who presents at this stage as a young person in deep distress although there has been some improvement.

  2. This judgment proposes to address a number of issues, which arise by virtue of the evidence heard and submissions made, as follows:-

    • The systemic issues around special care as highlighted by this case and this Court’s response to these issues.

    • The possibility of an agreed protocol between the Health Service Executive and the Child and Family Agency to alleviate the lacunae in care provision which arises through the historical development of the two parallel services.

    • Such directions for the care of the minor during her remaining time in special care as estimated, according to the psychiatric evidence in March, 2016, as needing to be prolonged for a further six months, although by June, 2016 now seen as coming to an end because of her improved presentation.

    • A plan for a step down placement for the minor from secure care to be developed in parallel with the educational and therapeutic interventions now available to her in special care.

    • The law applicable to this case.

  3. A special hearing was held on 2nd, 3rd and 8th February, 2016 and further evidence was heard on 18th March, 2016. This judgment is made on the basis of the evidence heard on those occasions, along with the various reports submitted to the Court when this case was before it for regular review and the legal submissions made by the parties, as well as a wide range of documentation from the Child and Family Agency on policy and procedure and a minimum of two thousand pages of notes taken during the minor’s time in special care, recording her movements and the incidents and interventions.

    Background to the Case

  4. Q.’s father, who is the third named defendant, had sole custody of Q. from when she was approximately 10 months old. Q. and her father resided with his parents until Q. was two and a half years old when they moved to their own home. There has been no period of sustained engagement by her mother, the second named defendant. Q. has attempted to make contact with her mother on a number of occasions and although there has been some response it has not been sustained.

  5. Q. came to the attention of the social work department in March, 2013, due to concerns relating to her “at risk” behaviour including incidents of self harm. Her father sought help from the State to manage her concerning behaviours. She was placed, with the consent of her father, in a number of out of hours foster placements in January and February 2014. It is a matter of fact that all of these placements broke down. She was then placed in a private residential unit with a high level of support and unfortunately she continued to place herself in extremely high risk situations. The level of concern for her became so serious that an application was made for an assessment for special care in March, 2014.

  6. Q. was detained in Coovagh House Special Care Unit by continuous Orders of the High Court from 17th April, 2014 until 13th November, 2014. Her step down placement to a private residential unit broke down and, following a period of five nights in LeFroy House, Q. moved to a placement in Ashfield House. This placement broke down on 5th January, 2015. She was then placed in a short term emergency placement in Mullingar until another application was made for special care and the order was granted by the High Court. Q. was further detained in Coovagh House by continuous orders of the High Court from 23rd January, 2015 to 9th November, 2015.

  7. On 9th November, 2015, by Order of the High Court, Q. was discharged from special care in Coovagh House and detained in Gleann Álainn Special Care Unit. The Child and Family Agency applied for this transfer on the basis of Q.’s best welfare interests and considering that there had been an escalation in her behaviours and she was being held on a “single separation” basis which could not continue for a prolonged period of time. Counsel for the Agency also noted at the time of the application that Q. was being negatively impacted upon by her peers in Coovagh House and that moving away from the Limerick area might assist her to make further disclosures about a significant incident which happened in August 2015. The merits of Gleann Álainn were set out to include the fact that it is a girls only unit and that it has a long track record of dealing with difficult cases. Both the guardian ad litem and the father consented to the transfer from Coovagh House to Gleann Álainn.

  8. Q. was detained in Gleann Álainn by continuous Orders of the High Court until 29th January, 2016. On that date, she was moved by Order of the High Court to Ballydowd Special Care Unit. The Child and Family Agency applied for the transfer to Ballydowd on the basis of Q.’s best and immediate welfare interests. Counsel for the Agency emphasised that Ballydowd is the most advanced of the special care units in the State and that there is a specific psychiatric service attached to the Ballydowd Unit. Counsel for the guardian ad litem stated that they were consenting on the basis that they believed Q. was not safe in Gleann Álainn and that anywhere would be better than where she was. Counsel for the father stated to the Court that he was neither consenting nor objecting to the move as he was appalled at Q.’s treatment in Gleann Álainn but he was worried about what may occur in Ballydowd. Q. remains in detention in Ballydowd at this time.

    Summary of the Expert Evidence on the Systemic Issue Concerning Psychiatric Services in Special Care

  9. The issue of the provision of psychiatric treatment to minors in special care facilities was first highlighted because of an email regarding this case sent by Dr. Eamon Raji, Consultant Child and Adolescent Psychiatrist with the CAMHS (Child and Adolescent Mental Health Service) Inpatient Unit in Merlin Park, Galway on 15th October, 2015. In this email, Dr. Raji highlighted the difficulties he faced in providing consultative support to Coovagh House in Limerick. He stated that he believed that Coovagh House (referred to below as CH) residents required:-

    “1) A full multidisciplinary CAMHS service, like every other young person is entitled to. I fall short in this regard due to my role being consultative and the absence of CAMHS MDT back up. I personally find this dissatisfying in that the young people with the most complex difficulties receive less than treatment as standard.

    2) A local CAMHS team, that would be more responsive to the young people’s needs in CH. Due to my commitments and distances involved, I find a simple review of a young person may take an entire days work with the travel involved.

    3) A clear and equitable referral pathway for young people in CH. As far as I am aware the only avenue to the local CAHMS for a one off review is through the A/E dept, I do not think that standard GP referrals are accepted.”

    This Court also heard evidence from Dr. Raji on 10th December, 2015. He told the Court that it would be vastly preferable if he or another suitably qualified consultant psychiatrist were based in Limerick in order to better attend at Coovagh House, especially to oversee the administration of medication. He did, however, tell the Court that some workable solutions have been proposed for the time being including that Dr. Raji would be made aware of new arrivals in Coovagh House and be able to review their files in advance of any emergency occurring.

  10. Ms. Laura Tynon, Acting Manager of Coovagh House Special Care Unit, gave evidence on 12th November, 2015 on the issue of the provision of psychiatric services to minors in special care in Coovagh House. She indicated that there was a current vacancy for a consultant child and adolescent psychiatrist in the Limerick area which has caused the arrangement by which Dr. Raji travels from Galway to Coovagh House once a month. Ms. Tynon stated that she was satisfied with the adequacy of the psychiatric services that were being provided by the HSE to Coovagh House residents. This Court does not accept her evidence in this regard. Ms. Tynon explained that when Dr. Raji was unavailable and psychiatric support is required, Coovagh House can telephone the local on call GP service and then go to the A & E Department to access a psychiatric nurse who can refer the young person to the local CAMHS team a day or so later. Ms. Tynon emphasised that none of the minors in special care have a mental illness as defined in the Mental Health Act 2001. In terms of a psychiatric assessment, Ms. Tynon identified that the GP does an assessment of the young person within 24 hours of their arrival in Coovagh House and also that the young person’s file would be sent to Dr. Raji for review.

  11. Ms. Tynon accepted that young people should not be in Coovagh House unless there is a therapeutic benefit to them. She identified the benefits of being in Coovagh...

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