Judge criticises ‘substandard’ options for girl who suffered ‘unspeakable’ abuse

The “completely substandard” options for a very disturbed suicidal girl who suffered “unspeakable” abuse in childhood is “a pen picture” of the “woeful” state of Ireland’s mental health services which unfolds weekly, “if not daily”, before the courts, the president of the High Court has said.

The mother of the 17-year-old girl wept as Mr Justice Peter Kelly outlined the only option for her daughter is to remain in a busy A&E hospital unit until she gets a bed in an adult psychiatric unit. After this it is hoped, within a few days, she will get into an adolescent psychiatric unit.

He noted there is no adolescent in-patient bed free as of now in the entire State, the A&E unit is under huge pressure for reasons including coronavirus concerns. He also noted that the adult psychiatric unit is unsuitable because it is for adults and is of mixed gender when the girl has had major issues about being in the vicinity of males, he noted.

The girl now finds herself effectively alone among strangers and staff untrained to manage her complex condition, he said. He could only imagine “what a frightening prospect that is for someone as vulnerable and disturbed as she is”.

He could also only imagine the mother’s distress at the recent serious setback in her daughter’s condition and the “substandard conditions” for her welfare. “But I cannot conjure up beds that are needed, that are known to be needed but in respect of which little has been done,” he said.

The situation “is a pen picture of the state of mental health services, particularly for adolescents, something I have had to deal with for years and something that does not appear to have been alleviated one whit”.

He expressed additional concern that a specialised unit in the UK, which has treated wards of the Irish court for some time including this girl, may no longer be able to do so and anticipated “a lot of problems” if that happens.

The UK unit had indicated it was not in a position to take the girl back, even if that was appropriate, and may be unable to take other Irish cases in the future, he noted.

He had for a long time expressed the hope the HSE would provide facilities here to deal with our own patients “so they do not have to be exported to depend on the kindness of strangers which is running out”.

The girl has been a ward of court for some years and, after her condition failed to improve here, she was moved to the UK unit until she was discharged recently because she was considered to have made considerable improvements.

A special placement had been designed for her here which involved considerable planning and she appeared to have settled well into it but, after a few days, she became very disturbed, tried to abscond, ran onto roads and made suicide attempts.

A doctor said it was hard to know what triggered this but the girl had said it felt “very scary” being out of the UK hospital unit.

The judge was told the Irish unit reached a position in recent days where staff felt unable to manage the girl effectively and safely, she was admitted to hospital as an emergency and has been in a bed in a hospital A&E unit for some days.

It was agreed the A&E unit is totally inappropriate for reasons including it is very busy and staff lack the skills to manage the girl’s complex condition. Staff from her own unit had been told to leave the A&E department because of pressures of space, leaving the girl without psychiatric support.

On Friday, David Leahy BL, for the HSE, said he was effectively asking the judge to sanction the “least worst” option of moving the girl, hopefully later on Friday, to the adult psychiatric unit in the hope an adolescent psychiatric facility would have a bed sometime next week. That might require discharging patients with less serious conditions, the court heard.