Health Service Executive v M.T.

• Jurisdiction: Ireland
• Court: High Court
• Judge: Mr. Justice Barry O'Donnell
• Judgment Date: 31 July 2025
• Neutral Citation: [2025] IEHC 440
• Docket Number: [2025/22 MCA]

In the Matter of M.T.

And in the Matter of the Inherent Jurisdiction of the High Court

Between:

Health Service Executive

Applicant

and

M.T.

Respondent

[2025] IEHC 440

[2025/22 MCA]

THE HIGH COURT

Care orders – Jurisdiction – Assisted Decision Making (Capacity) Act 2015 – Applicant seeking orders concerning the care and treatment of the respondent – Whether the High Court had jurisdiction to make the orders sought

Facts: The applicant, the Health Service Executive (the HSE), applied to the High Court for orders in relation to the respondent. On the first day of the substantive hearing, counsel for the HSE clarified that the application was for existing orders to be continued, including orders that restricted contact with family members. The application was not predicated or grounded on allegations of sexual abuse and violence but rather in terms of the overall neglect scenario. Those were described as “light touch” type orders. As a result, the orders sought by the HSE were far less restrictive than the orders sought at the outset: an order providing that pending further order the person in charge of the placement (a supported residential unit) or staff in the placement acting under the person in charge’s direction be permitted (i) to regulate any outings by the respondent from the placement, (ii) to regulate and/or prohibit attendance at the placement by any persons other than the guardian ad litem; (iii) to regulate and/or restrict and/or prohibit contact by the respondent with other persons, save for the guardian ad litem, and (iv) to regulate and/or restrict the use by the respondent of telephones and internet connected devices pending further order, save in respect of contact with the guardian ad litem. In addition to those substantive orders, ancillary orders were sought to prevent any person interfering with the care and placement of the respondent, and providing An Garda Síochána with a power to return the respondent to the placement in the event that she absconds or is removed from the placement.

Held by O’Donnell J that the case engaged detailed arguments relating to the operation of the inherent jurisdiction of the High Court to make orders concerning the care and treatment of a vulnerable adult who is asserted to lack capacity to make certain categories of decision; and, in turn, the interaction of that jurisdiction with the operation of the Assisted Decision Making (Capacity) Act 2015. In addition to those legal issues, O’Donnell J noted that the history of the case was somewhat complicated, and the circumstances of the respondent were the subject of extensive evidence, both on affidavit and in oral testimony; a variety of experts were engaged to consider the respondent’s psychiatric and psychological makeup and needs.

O’Donnell J proposed making the orders sought by the HSE. To add clarity to the situation, O’Donnell J held that the orders would include an order that the placement would be the respondent’s place of residence, and that the person in charge of the placement would be permitted to take all necessary steps to promote and ensure the care, protection, safety and welfare of the respondent. The Court would continue the orders relating to family contact and internet access. However, O’Donnell J directed the HSE in consultation with the guardian ad litem and any other relevant professional to give consideration to whether any technical safeguards could be implemented which may have the effect of reducing the need to restrict the respondent’s access to the internet or to use a mobile phone.

Application granted.

JUDGMENT of Mr. Justice Barry O'Donnell delivered on the 31 ^st day of July, 2025

STRUCTURE OF THIS JUDGMENT

I. INTRODUCTION	3
PRELIMINARY MATTERS	3
Anonymity	3
The background	3
The timeline and the orders sought	4
The treatment of the evidence	6
The role played by the guardian ad litem	6
II. THE APPLICATION IN JANUARY 2025	8
THE 2022 PROCEEDINGS	9
THE 2025 ISSUES	13
III. THE PROGRESS OF THE CASE AFTER 17 JANUARY 2025	16
THE TRANSFER TO THE PLACEMENT	20
IV. THE EVIDENCE GIVEN AT TRIAL	24
THE WITNESSES AND THEIR SOURCES OF KNOWLEDGE	25
EVIDENCE REGARDING THE FAMILY HOME	27
The respondent's account to the experts	31
THE RESPONDENT'S PHYSICAL CONDITION	31
The respondent's account	33
THE RESPONDENT'S SOCIAL AND FAMILY LIFE	35
EVIDENCE OF THE PLACEMENT AND THE RESPONDENT'S PROGRESS	39
POTENTIAL DIAGNOSES	40
VIEWS ON CAPACITY	51
THE RESPONDENT'S EVIDENCE	57
V. CONCLUSIONS ON THE EVIDENCE	60
VI. THE LEGAL ISSUES	66
WHAT IS MEANT BY “INHERENT JURISDICTION”	66
SUMMARY OF THE ARGUMENTS	69
THE ARGUMENT THAT THE INHERENT JURISDICTION IS AVAILABLE EVEN IF THE RESPONDENT'S NEEDS CAN BE ADDRESSED THROUGH THE 2015 ACT MECHANISMS	71
TWO GENERAL POINTS	72
THE TREATMENT OF THE INHERENT JURISDICTION PRIOR TO THE 2015 ACT.	73
REPORTED CASES WHERE THE INHERENT JURISDICTION HAS BEEN USED IN RELATION TO VULNERABLE ADULTS	76
POST 2015 ACT CASES	78
WHAT AMOUNTS TO DETENTION OR DEPRIVATION OF LIBERTY	83
VII. RELEVANT PROVISIONS OF THE 2015 ACT	84
VIII. CONCLUSION	87

I. INTRODUCTION

1 . This judgment concerns an application for orders under the inherent constitutional jurisdiction of the High Court in relation to the respondent. It also provides an account of and explanation for orders that were made from January 2025 in the proceedings and which put in place regimes of care for the respondent pending the outcome of the substantial application.

2 . The case engaged detailed arguments relating to the operation of the inherent jurisdiction of the High Court to make orders concerning the care and treatment of a vulnerable adult who is asserted to lack capacity to make certain categories of decision; and, in turn, the interaction of that jurisdiction with the operation of the Assisted Decision Making (Capacity) Act 2015 ( the 2015 Act). In addition to those legal issues, the history of the case is somewhat complicated, and the circumstances of the respondent were the subject of extensive evidence, both on affidavit and in oral testimony. A variety of experts were engaged to consider the respondent's psychiatric and psychological makeup and needs.

PRELIMINARY MATTERS

Anonymity

3 . The matters considered in the judgment relate to the psychological, medical and welfare circumstances of a person who, on any analysis, is a very vulnerable person. As explained below, the court is satisfied that identifying the respondent or her whereabouts will give rise to unacceptable risks to the respondent's health and wellbeing. It has been necessary to set out some details of the respondent's family circumstances, some elements of matters that are under current criminal investigation, the results of assessments that have been conducted, and her current situation and placement, all of which are sensitive and confidential. For those reasons, the court has made orders that nothing can be published or broadcast that could directly or indirectly identify the respondent or her whereabouts, whether by attempting to connect this case to other events or persons or otherwise.

4 . To assist in preserving the anonymity of the respondent, the court has used initials to identify her and will not identify the location of her family home, a hospital in which she was treated, or her current residential placement. The respondent will be identified as “ M.T.”; the place from which she was removed is described as “ the Family Home”; the hospital where she was treated will be referred to as “ the Identified Hospital”; and the placement referred to as “ the Placement”.

The background

5 . The applicant is the Health Service Executive (“ the HSE”). The respondent was represented by a court appointed guardian ad litem, who from an early stage had instructed senior and junior counsel, and who also engaged various experts to assist in the case. The court is grateful for the professionalism and care taken by both parties, their legal representatives and the experts retained, all of whom have been extremely helpful over the course of this difficult case.

6 . The respondent, M.T., was 29 years old when the proceedings commenced, and she is now 30 years old. Prior to the commencement of the proceedings, she resided with her family at the Family Home in a town in the east of the country. Her family consisted of her mother, father, and two older brothers. Until they were removed into care by the Child and Family Agency (“ the CFA”) the respondent's niece and nephew resided with the family. They were the children of one of M.T.'s brothers, and their mother had disappeared some years previously. Unfortunately, the respondent's own mother died from illness at an earlier stage in the proceedings.

7 . The case is not straightforward on a number of levels. The case was made that the respondent was a person who lacked capacity to make decisions regarding her residence, care, and personal safety and welfare. It became clear shortly after the commencement of the proceedings that the respondent did not suffer from an intellectual disability or any identified major psychiatric disorder. Instead, her lack of capacity was attributed to her abnormal and dysfunctional upbringing and family circumstances and a serious lack of insight into or understanding of those matters. The argument was that these factors meant that the respondent had no real experience of living outside of her close family environment or making her own decisions, she had learned simply to agree with the views of others – particularly her family, and her ability to make decisions regarding her own situation was seriously compromised. It was identified by one of the clinical experts that, although cognitively the respondent was...