A High Court judge has said she will not send any more children to a secure care facility in the west of Ireland until her concerns about psychiatric services there have been allayed.
Ms Justice Bronagh O'Hanlon said she had a "severe doubt and concern" about psychiatric services at the unit after it emerged the consultant psychiatrist who covers the service had himself raised concerns about its adequacy.
The court was told the psychiatrist, who is based in another area 100km away, travels to the unit once a month. A vacancy for a consultant psychiatrist in the local area had not been filled.
As part of a welfare review of the care of two teenagers detained at the facility, the manager of the unit said she believed the service was adequate for the young people, though the location of the psychiatrist could be “more ideal”. The manager said the unit, which takes young people aged 11 to 17, had space and could meet the needs of a third child.
She outlined how when children arrive at the unit they may have absconded from elsewhere. They are usually in a dishevelled state and their basic hygiene, food and nutrition has “gone out the window”.
Staff initially focus on their basic needs before trust is developed and they slowly develop a programme for them.
She agreed with counsel for the Child and Family Agency (CFA) that the facility deals with children at the “extreme end of distress and suffering” for whom drug abuse, “gross exposure to sexual abuse and violence” may be a problem.
Counsel for the court- appointed guardian of one of the children said the detention order to keep a child in a secure unit was very serious and made on the basis of meeting therapeutic needs, including appropriate psychiatric facilities. Concerns had already been raised by the guardian and now “the very person providing psychiatric services” had raised concerns. He asked that the correspondence from the consultant psychiatrist be provided to all parties.
The judge queried whether, if she sent another child to the unit, there would be a full psychiatric assessment within 24 hours of admittance.
Counsel for the CFA said he’d prefer to answer that having spoken to the psychiatric consultant, currently on holiday, in December.
“That’s too long for me,” Judge O’Hanlon responded. “I have a severe doubt and concern and until that is allayed, I am not going to send anyone there . . . I’m far from happy about what I’ve heard.”
She adjourned the case for a week.
Separately, the court was told there was still no place in Ireland for a teenager in a secure psychiatric unit in the UK who has been ready for discharge since last February.
A private service has been identified for the girl, the court heard, but the HSE, which has responsibility for psychiatric services, and the CFA, which has responsibility for children in care, were not in agreement about using it.
Three expert witnesses gave evidence for the HSE that an alternative service, in a rural area, would be more suitable for the girl, though it would not be ready until next March. They argued the private service, suggested since August, would need approval by Hiqa and that would take at least six months.
The court was told the teenager did not want to stay in a rural area and wanted to sit her Leaving Certificate in her local school.
The judge adjourned the case for a week and asked that the three medical experts involved meet again to see if any better plan could be achieved.
