The Child and Family Agency v AM (A Minor) and ors

• Jurisdiction: Ireland
• Judge: Ms. Justice Reynolds
• Judgment Date: 13 December 2016
• Neutral Citation: [2016] IEHC 749
• Docket Number: [2016 No. 10312 P.]
• Court: High Court
• Date: 13 December 2016

[2016] IEHC 749

THE HIGH COURT

Reynolds J.

[2016 No. 10312 P.]

IN THE MATTER OF A.M. A MINOR BORN

ON 25TH SEPTEMBER 1999

IN THE MATTER OF ARTICLE 56 OF COUNCIL REGULATION

(EC) NO. 2201/2003 OF 27th NOVEMBER 2003 CONCERNING JURISDICTION AND THE RECOGNITION AND ENFORCEMENT OF THE JUDGEMENTS IN MATRIMONIAL MATTERS AND MATTERS OF PARENTAL RESPONSIBILITY, REPEALING REGULATION

(EC) MEMBER 1347/2000

AND

IN THE MATTER OF AN APPLICATION FOR A.M., A MINOR,

TO TRANSFER TO AND RETURN FROM ST. ANDREWS HEALTHCARE,

BILLING ROAD, NORTHAMPTON NN 15DG, UNITED KINGDOM

AND

IN THE MATTER OF ARTICLE 40.3 AND ARTICLE 41 AND ARTICLE 42 AND ARTICLE 42A OF THE CONSTITUTION

AND IN THE MATTER OF THE GUARDIANSHIP OF INFANTS ACT,

1964 (AS AMENDED)

AND IN THE MATTER OF THE CHILDCARE ACT, 1991 (AS AMENDED)

AND IN THE MATTER OF THE INHERENT JURISDICATION OF THE HIGH COURT

BETWEEN

THE CHILD AND FAMILY AGENCY

PLAINTIFF

AND

A.M. (A MINOR REPRESENTED BY HIS GUARDIAN AD LITEM

(CEILI O'CALLAGHAN)

FIRST DEFENDANT

AND

A.M.

SECOND DEFENDANT

AND

TRACEY SIMPSON

THIRD DEFENDANT

AND

JAMES BERNEY

FOURTH DEFENDANT

AND

ANDREW BERNEY

NOTICE PARTY

AND

HEALTH SERVICE EXEUCUTIVE

NOTICE PARTY

Constitution – Health – Mental illness – Mental Health Act, 2001 – Attenuated psychosis – Transfer of patient from jurisdiction of Ireland to another jurisdiction – Lack of medical facilities – Breach of constitutional rights – Balance of justice

Facts: The plaintiff sought an order for transferring the first named defendant/minor from a medical facility in Ireland to the renowned medical facility in the United Kingdom on the basis that the level of care and therapy required for treatment of the minor was available in that facility only and not in Ireland. The plaintiff had advanced reports of a medical expert in whose opinion since the minor had attempted suicide and suffered from violent and severe suicidal ideations, it was necessary to place him under the care of the chosen medical facility.

Ms. Justice Reynolds granted an order for placement of the minor at the renowned medical facility in the United Kingdom. The Court held that irrespective of the views of the minor and interference of his constitutional rights enshrined under art. 40.2 of the Constitution, the compelling medical evidence and expert opinion favoured that the minor must be transferred to the suitable medical facility. The Court held that the rationale for placing the minor who was about to attain majority under detention should be therapeutic and educational, and not punitive in nature. The Court held that it must exercise its right to vindicate the constitutional rights of a minor only in exceptional circumstances where there was risk to the life of the minor or clear evidence that such minor had become a danger for the life of others, too.

JUDGMENT of Ms. Justice Reynolds delivered on the 13th day of December, 2016

The factual background

1 A.M. was born on the 25th September, 1999 and is now aged seventeen years and almost three months. His early formative years were spent in a difficult and challenging domestic setting and his parents separated while he was still very young. His mother subsequently re-married and his relationship with his stepfather was strained. He has three brothers, four sisters and enjoys a very close relationship with his paternal grandfather.

2 A.M. presented with behavioural difficulties from an early age. Due to the domestic disharmony in his own home, he moved to live with his paternal grandfather by private arrangement. This arrangement broke down in circumstances where A.M.'s behaviour had become more challenging involving school absenteeism, criminal activity and unsociable behaviour.

3 Thereafter, A.M. had a number of failed placements due to his violent and threatening behaviour and indeed spent a period of time in Oberstown Children's Detention Centre.

4 In August, 2015, A.M. was transferred to Mysal Lodge and having completed his period of detention in Oberstown, returned there in December. During his time there, he was involved in drug abuse, criminal behaviour, and high risk behaviour.

5 On the 3rd February, 2016, A.M. was admitted to Connolly Hospital after attempting suicide. While waiting for a bed, he absconded. He was subsequently retrieved and admitted to the High Dependency Unit in Connolly Hospital.

6 He subsequently returned to Mysal Lodge and continued to present with violent and threatening behaviour. He threatened staff lives and was found in possession of weapons on a number of occasions. He was discharged on 20th June 2016 due to his on-going threatening behaviour.

7 On foot of an order of this Court dated the 5th July, 2016, A.M. was transferred to Ballydowd Special Care Unit. Again his placement was not without difficulty and he repeatedly expressed suicidal ideations. His violent behaviour caused considerable difficulty for the staff as follows:

(a) he injured 34 staff, causing fractured ribs for one and head butting others in the face;

(b) he engaged in property damage;

(c) he regularly absconded and returned to Ballydowd having engaged in use of illicit substances and was difficult to control.

8 On the 27th September, A.M. was admitted to an adult psychiatric unit at Connolly Hospital as there was nowhere else that could manage his presenting behaviour.

9 During the early stages of his detention there, he was assessed by Prof. Harry Kennedy, Clinical Director of the Central Mental Hospital and Consultant Forensic Psychiatrist. He formed the view that A.M. met the criteria for Attenuated Psychosis, a mental disorder as defined in the Mental Health Act, 2001.

10 A.M. is a minor who is being detained in an adult psychiatric unit where there are no therapeutic supports available to him. The placement is unsuitable for his needs and in circumstances where it is contended that no appropriate secure placement is available within this jurisdiction, the Child and Family Agency are seeking an order to place A.M. in St. Andrew's for the purpose of obtaining appropriate medical and clinical treatment.

Summary of the evidence

11 Professor Kennedy gave evidence and referred to his first report dated 5th October, 2016. He had been asked to advise on the therapeutic management of risk in relation to A.M. with particular reference to the most appropriate placement in which his need for psychiatric treatment could be met, given that he had already exceeded the capacity of Linn Dara Approved Centre for adolescents and of Ballydowd Special Care Unit to safely contain him for treatment. In preparing his assessment, he interviewed A.M. on a number of occasions and was provided with previous assessment reports. He provided a diagnosis of Attenuated Psychosis and noted that there had been some beneficial response to anti-psychotic medication since his admission to James Connolly Hospital. He opined that A.M. is at a very high risk of unnatural death over the next six to twelve months, due to a number of factors:-

(a) risk of death due to accidental overdose;

(b) death due to injury caused by impulsive and reckless behaviour;

(c) death due to suicidal acts; and

(d) death due to unintended consequences of deliberate self-harm.

He noted that A.M. had demonstrably exceeded the capacity of a well-staffed and well-designed modern but open in-patient child and adolescent psychiatric unit and indeed had exceeded the capacity of a secure special care unit. He advised that A.M. now requires sustained treatment under conditions of enforced abstinence while detained under the Mental Health Act or its equivalent in a therapeutically safe and secure in-patient CAMHS hospital setting for a period of six to twelve months. As there is no such setting in Ireland at present, in his opinion it is necessary that a place should be sought at St. Andrew's, Northampton or its equivalent.

12 In his further report dated 18th November, 2016, Professor Kennedy expressed reservations about a placement for A.M. in St. Andrew's as A.M. had indicated he would not cooperate with such placement. It was his view that an overseas placement without consent or cooperation was in itself inherently anti-therapeutic. In the circumstances, he formed the view that all possibilities for safe placement in Ireland ought to be explored. In his evidence before the Court, he was satisfied that all such enquiries had been exhausted and that in his professional view, St. Andrew's was the only appropriate therapeutic placement where it is possible to meet A.M's needs. When questioned about the therapeutic value of a placement in the absence of consent from A.M., Professor Kennedy reiterated his view that St. Andrew's is the only facility where A.M. would be in a safe therapeutic environment, without risk of absconsion and even in those limited circumstances, the placement abroad would still be preferable than any treatment regime that can achieved here in Ireland. In addition, because A.M. would be in the company of other young adolescents attending there for treatment, he was much more likely to engage with the services available there.

13 Evidence was also heard from Dr. Peter Dineen, Consultant Child and Adolescent Psychiatrist who has been treating A.M. at James Connolly Hospital. His findings can be summarised as follows:-

• ‘In my opinion because of the symptoms of mental illness there is a serious likelihood of A.M. causing immediate harm to himself and others’.

• ‘The pattern since admission is that A.M. appears to experience a period of up to seven – ten days with reasonable behaviour and interaction; these periods are bookended by episodes of deterioration which are marked by an escalation in agitation, restlessness, increased hostility and aggression these episodes have lasted from 30 minutes to approximately twelve hours based on the history’.

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