The High Court has criticised failures in the care of a 15-year-old girl identified as Q., finding that restrictions imposed on her at Gleann Álainn Special Care Unit in January 2016 went beyond the court’s orders and were not properly reported to the court or her guardian ad litem.
In a judgment delivered on 16 June 2016, Ms Justice Bronagh O’Hanlon reviewed Q.’s special care and broader systemic problems in psychiatric provision. Q. had spent much of the previous two years in secure care and had experienced at least 23 residential placements. By June, the court said, her presentation had improved and those involved considered her time in special care was coming to an end.
The court heard that, for much of January, Q. was kept in a bare section of Gleann Álainn under a “single occupancy” arrangement, with little furniture or stimulation. The unit’s manager accepted that the guardian ad litem should have been consulted and the High Court informed. The judge found that the level of deprivation exceeded what the court’s orders contemplated, and that required safeguards and procedures had not been followed.
The judgment also identified delays in therapeutic support after Q. disclosed alleged sexual assaults following an episode when she absconded in August 2015. The court said specific psychotherapy did not begin until November. It found that an earlier onward placement breakdown contributed to Q. remaining in special care when she was ready to move on, worsening her frustration and behaviour. The allegations of sexual assault were not findings that assaults had occurred; the judgment notes that not all accounts of the events were tested in evidence.
Psychiatrists gave differing assessments of the length of secure care needed in March. Dr Ekata Uduehi and Dr Brendan Doody supported a further period of at least several months, while Dr Keith Holmes agreed that Q. remained at serious risk. By June, the court said, Dr Uduehi considered Q. capable of stepping down after her Junior Certificate examinations.
The court accepted an interim protocol developed by the Child and Family Agency and the Health Service Executive to address gaps in psychiatric care across special care units. It set out a “Programme of Special Care” with care, placement, education, therapeutic and, where needed, psychiatric plans. The judge recommended that the model be used in future special care applications and expected regular updates during welfare reviews. The court said it could not direct how public resources were allocated, but that detention could not be justified if necessary therapeutic resources were absent.
The judgment did not itself order Q.’s immediate release or specify a final onward placement. It said a placement tailored to her needs should be developed and that the court would continue to review the transition. It also advised mediation over a dispute concerning family access, while noting that it had not suspended Q.’s access to her father.