The High Court granted an application for a secure care order for a teenage boy who had demonstrated serious behavioural problems, had been diagnosed with ADHD and Asperger’s Syndrome and had a history of alcohol and drug abuse.
He was initially taken into a secure care unit on an ex-parte secure care order basis, followed six days’ later by an interim secure care order and finally with a secure care order granted two weeks’ after the ex-parte order.
The young person had had a diagnosis in 2014 of attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) which had become magnified in the last few years by patterns of poly-substance drug abuse and alcohol abuse. This had led to anxiety, suicidal thoughts and extreme aggression, his behaviour was described as “out of control”.
On the day the secure care order was granted for three months, the court heard that the teenager’s parents were very supportive and fully committed to their son and were consenting to the secure care order. Their son had never been the subject of a care order previously and there were no other orders under the 1991 Act other than the secure care order. However, he had been hospitalised a number of times and had been in a residential unit on a voluntary basis. He was now in secure care and his parents had signed him in on a voluntary basis.
Background
He had first been referred to the child and adolescent mental health clinic (CAMHS) in 2014 where the professionals had diagnosed him with ADHD, ODD and Asperger’s Syndrome and prescribed Ritalin. He was then referred to day hospital in the Lucena Clinic (a clinic for young people experiencing complex difficulties). His family paid for a private assessment at the time and he was again diagnosed with ADHD and Asperger’s Syndrome.
In 2017 he was admitted to hospital several times, for acute alcohol intoxication on one occasion and a poly-substance overdose on another, during which time he had assaulted a member of the hospital staff. In 2018 the teenager was referred to the Aisling Programme for substance abuse but he was not willing to take part in the programme and unable to meet the requirement of contacting the service twice a week.
In early 2019 he had been discharged from his residential unit due to 19 significant event notifications. These included property damage, substance misuse while in the unit, increasingly dangerous behaviour, aggression and attempted arson. He was admitted to another residential service but discharged two and a half months’ later due to his refusal to engage in all of the services. He was subsequently deemed unsuitable for 14 private placements and returned home.
He accrued criminal charges in early 2019 and was deemed suitable for the JLO programme and a number of cautions were anticipated.
He was admitted to hospital in March 2019 and April 2019 due to escalating behavioural difficulties. In April he was admitted because of extreme aggression and was given two doses of sedative via an injection that did not have any effect, subsequently he was given an intra muscular dose of sedative that did take effect.
The court heard that the teenager was admitted to hospital four times in 2018 and three times in 2019. His treating psychologist, who had known him for two years and also diagnosed ADHD, wrote in his report that the young person now had a “clear cut conduct disorder”. His denial of any use of drugs was compromising him, he had added.
His parents had been unable to administer his ADHD medication in the community and his anxiety was currently very marked. The child also had a very poor sleep pattern and had been prescribed medication for depression and anxiety. His ADHD was being magnified by his drug use and he needed to find a way of restoring regularity and structure to his life.
During the last admission to hospital the teenager’s stomach was pumped due to alcohol and drug intake. He had become unresponsive and that had led to his admission to hospital by ambulance.
Over the last couple of years, the teenager had been in residential placements due to his behavioural difficulties and substance misuse. He returned to his family home in March 2019 when he was discharged from his last residential placement and no other placement could be found for him. However, the situation at home was found to be untenable, he was putting himself and his own family at risk, crisis management had been put in place prior to the secure care order but it was not sufficient.
His parents had to lock themselves into their bedroom at night, lock other rooms and all the doors and lock away the knives due to his level of aggression. On assessment his consultant found there to be no evidence of psychosis, his problem was behavioural and it was magnified by patterns of drug abuse. He was not deemed suitable for treatment under the Mental Health Act.
His parents were currently attending a therapy service with YoDA, a HSE youth drug and alcohol service, that provides support and guidance to families trying to help a young person address their drug or alcohol problem.
The barrister for the CFA told the court that the teenager was at a serious risk of harm and secure care was the only option that could be offered to keep him safe. However there had been some positive changes since his admission into secure care two weeks’ previously which included his attendance at school and the gym.
Prior to secure care the young person had not attended school and been deemed unsuitable for educational programmes due to his escalating aggressive behaviour. He had not engaged in support services in the community but liked the staff in his secure care unit and had had a consultation with his psychologist and met with his father.
The barrister for the guardian ad litem (GAL) told the court that the GAL had explored his views and wishes as well as his educational options. There were no serious issues since his arrival in secure care.
The GAL’s report stated that a robust therapy plan would now need to be put in place and that ACTS (assessment consultation and therapy service) would need to assist the teenager to give him insight into his drug dependence as it was a significant aspect of his current presentation. ACTS is a small national specialised clinical service that provides multidisciplinary consultation, assessment and focused interventions to young people who have high-risk behaviours associated with complex clinical needs (ref: tusla.ie).
Furthermore, added the barrister for the GAL, it was never too early to plan ahead and now was the time to think of down the line and the next placement post secure care. The teenager already had a very difficult placement history. An educational plan would also have to be put in place.
The judge granted the secure care order. She said that she was satisfied that the young person’s behaviour posed a real and substantial risk to his life, health, development and welfare at that time, the test and proofs had been met in the case and in his history.
The judge said she was satisfied that another placement other than secure care was not adequate for the teenager, he had a history of different placements going back over a number of years. He had been discharged from his last two placements due to his behaviours.
She noted that the young person had engaged in education in secure care which was something that had not happened for quite some time. This factor showed how it was in his best interests to remain in secure care.
The judge’s directions included that his therapeutic needs be assessed and addressed to include an individual therapeutic plan. If therapeutic intervention got off the ground quickly, said the judge, then perhaps some idea of a step-down placement would become apparent.
It was also very important that he had started to engage in education, therefore the Agency had to turn its mind to see what type of educational programme would be suitable for him, post secure care.
She also requested that the Agency write to the parents regarding the order made by the court and inform them of the three review dates and to emphasise the fact that they were entitled to be there and entitled to legal aid for that purpose [if they met the criteria for legal aid].
The secure care order was granted for three months.
