A High Court judge has ordered that an extremely disturbed young woman who is not mentally ill but is considered a "very serious" risk to herself and others, be sent to the Central Mental Hospital.
Mr Justice Kelly yesterday condemned the "legislative inaction" which had forced him to send the 17-year-old there, and criticised the continuing failure to enact the Children's Bill into law.
A consultant psychiatrist at the CMH, Dr Helen O'Neill, said she was not aware of the hospital ever having received into its care a young woman in such circumstances. She said the CMH would receive the teenager for assessment and report back to the court.
The court was told the 17-year-old had been held in recent days in the acute psychiatric unit of a general hospital. A consultant psychiatrist at that unit said her continuing detention there was totally inappropriate and possibly illegal.
The teenager suffered from a borderline and anti-social personality disorder which was pervasive and of long standing, and posed a serious risk to her own safety and that of others. She had demonstrated very aggressive and violent behaviour, had cut herself with razors, threatened to kill people, and had had to be sedated for her own safety and that of staff in the unit. The young woman's father had died recently and she fantasised that he would come and rescue her.
The psychiatrist said the teenager had received medication and was restrained against her will while at the unit, and two nurses had to be assigned to her at all times. "I have to say I have reservations about the legality of this," she said.
The psychiatric services had been put into the position of detaining the young woman because other services had not met her needs and no other services were in place. "I want to say that," she said.
Mr Justice Kelly remarked that he had been attempting to highlight that very situation for the past four years.
The Eastern Regional Health Authority (formerly the Eastern Health Board) had brought the case to inform the court of the teenager's present situation.
However Mr Felix McEnroy SC, for the authority, said it was not formally applying for her to be sent to the CMH, and said there was no precedent for such an order. It was very unsatisfactory that the authority had to keep coming back to the court, but there was a Bill pending which would give the authority powers in such matters.
Mr Justice Kelly said Bills "have been pending for years" but the situation was that the authority, after giving distressing evidence, would not make the application but left it to the court.
Ms Mary Ellen Ring, counsel for the teenager, said she could not support her client being sent to a hospital for the criminally insane. She had been in care since she was 13, and had been diagnosed with a personality or conduct disorder, but there was no psychiatric intervention at that time.
What the teenager required was a place in a secure unit with appropriate childcare staff and therapy to meet her needs. That was not being offered now. The State was proffering no alternative.
Mr John O'Donnell, for the State, said sending the young woman to the CMH was the only order which could be made. This should not be seen as a precedent, he said. The case was unique and the most distressing he had yet seen.
Ruling on the matter, Mr Justice Kelly said that yet again, the court was "the refuge of last resort" where neither the legislature nor executive had provided appropriate legislation or facilities to deal with children with such problems.
The teenager was not suffering from a psychiatric illness but there was no doubt she was suffering from a personality disorder of major proportions.
The acute psychiatric unit of a general hospital was not an appropriate place for her. Her detention was of dubious legality, given that she had no mental disorder.
He was grateful to the CMH for agreeing to receive the teenager and he would send her there with reluctance and a heavy heart because it was not an appropriate place for a child who was not mentally ill.
"Where else can I send her?" he asked. There was no legislative framework to deal with such a situation. He was told the Children's Bill was in the planning stage "where it has been a long time". It had been left to him to do the best he could in circumstances where the legislature and executive "have signally failed".
The case was adjourned until April 7th.
