S.P. v. Youthdale Treatment Centres, 2008 CFSRB 24

CHILD AND FAMILY SERVICES REVIEW BOARD

S.P v. Youthdale Treatment Centres

REASONS FOR DECISION ON MERITS

Date: April 11, 2008

Citation: 2008 CFSRB 24

Indexed as: S.P. v. Youthdale Treatment Centres (CFSA s.124)

1On March 26, 2008, the Child and Family Services Review Board (the “Board”) received the application of S.P., D.O.B. April […], 1993, (the “Child”), for a request to be released from the Youthdale Treatment Centre, Secure Treatment Program, pursuant to section 124(9) of the Child and Family Services Act, R.S.O. 1990, c. C.11 (the “Act”). All of the parties were informed of the Board’s intention to hear this application on March 29, 2008, at the Youthdale Treatment Centre, Toronto (“Youthdale”).

2At the hearing on March 29, 2008, the Child was represented by Herb Stover, Barrister and Solicitor, agent for the Office of the Children’s Lawyer. Youthdale was represented by Maanit Zemel, Barrister and Solicitor with Miller Thompson LLP.

ISSUE

3The Child was admitted to the Secure Treatment Program (the “Program”) at Youthdale on March […], 2008. She was seeking an order releasing her from the Program on the basis that the criterion for emergency admission as set out in subsections 124(2)(a) to (e) of the Act had not been met.

PROCEDURAL MATTERS

4The parties did not have an issue with either the Board’s jurisdiction to hear the application or the composition of the panel.

5The parties declined to give opening statements, however as a preliminary matter, Ms. Zemel did review information regarding the admissibility of evidence by citing passages from section 15(1) of the Statutory Powers and Procedures Act and from the Board’s Rules of Procedure.

6Mr. Stover indicated that the Child was contesting all five (5) of the criteria as set out in subsections 124(2)(a) to (e) of the Act.

7The evidence was a package from Youthdale, exhibit Y-1, and testimony from the following witnesses:

S.P. - the Child

V.P. - the Child’s mother

M.P. - the Child’s father

K.M. - Youthdale, Crisis Support Team Member

FACTS

8S.P. began to exhibit noticeable behavioural changes in August and September, 2007, concurrent with her arrival at M.D.H.S. (“MDHS”) as a grade 9 student. She started experimenting with drugs, namely ketamine, ecstasy, marijuana, and alcohol. Her marks dropped. She was frequently skipping classes. She developed a new group of friends.

9As autumn progressed the Child’s parents became aware of further changes as S.P. appeared quiet, depressed and withdrawn. The school noted that she was detached, showed little interest and had a lack of participation. The school placed her on an attendance contract. This endeavour was somewhat successful; however skipping became a frequent occurrence once the contract expired in December, 2007.

10In late November, 2007, the family doctor, Dr. S., prescribed Prozac for S.P. – 10 mg tablets, once per day for 30 days, as treatment for the depression. S.P. took these pills for two weeks. By late December, 2008 the initial prescription had not shown much benefit, thus Dr. S. renewed the prescription for a further 90 days.

11V.P. noted no improvement by early February, 2008, and arranged for therapy for S.P. with S.R., a therapist at the M.H., who had successfully worked with S.P. 3-4 years earlier. In early March, 2008, Mrs. P.’s worries and concerns had escalated to the point where she searched S.P.’s room where she found and read S.P.’s diary.

12The diary indicated that S.P. had not been taking the Prozac on a daily basis. The tablets were stockpiled and subsequently taken in three large doses: 7 tablets on February, […], 2008, 8 tablets on February […], 2008, and 19 tablets on February […], 2008. As well as the description of these 3 suicide attempts, the diary contained a plan to make a further attempt at suicide in 20 days.

13Between October, 2007 and March, 2008, S.P. would not let her parents or doctors view her arms. She had used razor blades around Christmas to cut her arms. As well, she had used a lighter to burn “happy faces” on her arms.

14On March […], 2008, S.P. was admitted to S.H. on a “Form-1”. Later that same day she was transferred to the Paediatric Psychiatric Unit at the hospital. She was assessed by Dr. B.S. and released on March […], 2008.

15Following the reading of the suicide entries in the diary, Mrs. P. telephoned S.R. for advice. The advice was to contact Youthdale, which Mrs. P. did on March […], 2008. A bed was available on March […], 2008. S.P.’s parents agreed to her admission to Youthdale on March […], 2008.

ANALYSIS

Criterion (a) the child has a mental disorder.

16A mental disorder, pursuant to the Act, is defined as a substantial disorder of emotional processes, thought or cognition, which grossly impairs a person’s capacity to make reasoned judgments.

17The Board received the Youthdale Admission Summary of Dr. G.P. and Dr. N.S. dated March […], 2008. The doctors diagnosed S.P. as having Disruptive Behaviour Disorder, Parent/Child Relational Problem, high Psychosocial stressors, and a history of multiple substance abuses. The doctors opined that in combination, these disorders and stresses have manifested themselves in such a way as to grossly impair S.P.’s capacity to make reasoned judgments.

18The Board heard evidence about five behaviours that demonstrated grossly impaired judgment. S.P. walked to her therapist on a very cold February day; a ½ hour journey without a coat. S.P. and a friend purchased alcohol by standing in front of a liquor store and asking men to buy them vodka or whiskey. She overdosed once on ketamine. S.P. damaged her cell phone while playing with a lighter. And, she also admitted to watching as her friend used a lighter to set fire to her father’s desk, a fire that, according to S.P., only caused a small amount of surface damage.

19The Board finds that incidents reveal that S.P. has a grossly impaired capacity to make reasoned judgments.

20This finding, in combination with S.P.’s recent history of self harm behaviour with razor blades, lighters, prescription medicines and “street” drugs, enable the Board to accept the opinion of Dr. G.P. and Dr. N.S. and find that S.P. has a mental disorder.

21The Board is satisfied that criterion (a) has been met.

Criterion (b) the child has, as a result of the mental disorder, caused, attempted to cause or by words or conduct, made a substantial threat to cause bodily harm to himself, herself or another person.

22Dr. N.S. and Dr. G.P. were of the opinion that as a result of her mental disorder S.P. caused, attempted to cause and by conduct made a substantial threat to cause serious bodily harm to herself. These numerous self-harm incidents and threats are summarized below. The doctors also noted that S.P. did not think anything needed to be changed in her life as she was happy and that she did not understand why she needed to be at Youthdale.

23S.P. made three suicide attempts on successive nights using more pills each time. She wrote in her diary that she was planning a fourth attempt. Mrs. P. found the stash of pills that would substantiate this threatened suicide. While S.P. was stockpiling pills she had asked her mother for a doubling of her dosage; a request that was denied.

24During testimony the Child admitted to experimenting with drugs, to overdosing once on ketamine and to being a semi-regular user of marijuana and alcohol and to stealing money from her brother to pay for some of the drugs. She also admitted for the first time to having used razor blades to cut her arms. She also admitted to using a lighter to burn happy faces on her arms.

25S.P. tried to validate the written descriptions of her suicide attempts and plans as creative embellishments and release mechanisms. She explained many of the other activities as non-important or accidental. During testimony, she stated that she would not really want to commit suicide as that would be stupid. She wanted her mother to believe that there were no threats to either her (V.P.’s) safety or the home. The Board does not accept these arguments. The Board finds that S.P., as a result of her mental disorder, caused and threatened to cause serious bodily harm to herself.

26The Board is satisfied that criterion (b) has been met.

Criterion (c) the secure treatment program would be effective to prevent the child from causing or attempting to cause serious bodily harm to himself, herself or another person.

27Youthdale offers a secure program that is effective in preventing the Child from causing or attempting to cause serious bodily harm to herself or others. K.M., in her testimony, spoke of the structure provided by Youthdale in its program and daily routine. She said that this structure reduced the risk of patients engaging in self harm or harm to others. She spoke of the high degree of supervision and the lack of access to potentially harmful objects such as forks and knives. The Board accepts the fact that the secure setting at Youthdale eliminates the risk of harmful threats.

28The Board finds that criterion (c) has been met.

Criterion (d) treatment appropriate for the child’s mental disorder is available at the place of secure treatment to which the application relates.

29Youthdale can provide appropriate treatment for children with mental disorders and has the qualified staff to meet any needs that arise. The Board accepts the fact that psychiatric counselling and treatment is available in the secure environment at Youthdale and that this would be of benefit to S.P.. At Youthdale, S.P. would have access to counsellors, a psychologist, a psychiatrist and other mental health staff who would be able to address her mental health needs. K.M. gave testimony to the security that is available at Youthdale. She stated that if S.P. were to remain at Youthdale, her peer group would not be influencing her decisions, she would have no access to drugs or alcohol and that she would be under continuous supervision.

30The Board finds that criterion (d) has been met and that Youthdale can provide the appropriate treatment for S.P.’s mental disorder.

Criterion (e) no less restrictive method of providing treatment appropriate for the child’s mental disorder is appropriate in the circumstances.

31Testimony from the Child’s parents indicated that the risky behaviours were escalating, especially in the degree of risk. Skipping school and appearing depressed and withdrawn in the fall had changed to cutting her arms with a razor, burning herself with a lighter, overdosing on ketamine, exposing herself to frost bite for ½ hour, three suicide attempts and a plan for a further suicide attempt.

32All previous attempts to resolve S.P.’s problems had failed. The school offered an attendance contract that was partially successful, but only while in force. The school also suggested that S.P. leave MDHS and enrol in a special S.T.E.P. program. S.P. declined this offer. The efforts of the Vice-principal, guidance counsellor, attendance counsellor and social worker at MDHS had little or no positive outcomes for S.P.. Skipping, lack of participation, drug and alcohol use and declining grades continued.

33Treatment from the family doctor also failed. Self-administered Prozac did not work for her depression as S.P. only tried the medicine therapy for two weeks before she began to stockpile the tablets.

34Therapy sessions with S.R. initiated in February, 2008 were unlikely to produce positive results as S.P. admitted during testimony that she was attending the sessions merely to satisfy her mother’s wishes.

35A personal behaviour contract agreed to on March […], 2008, by S.P. and her mother, seems to have had partial success. However, Mrs. P. had to take time off work to be home with S.P. during the March break to supervise implementation of the contract.

36The Board believes that the parents and other professionals made numerous attempts to resolve S.P.’s behaviours and that none were successful. Furthermore, the Board agrees with Dr. G.P. and Dr. N.S. that S.P.’s safety is at risk and that immediate stabilization and assessment, leading to the initiation of a treatment program, in a secure setting is recommended.

37The Board finds that criterion (e) was satisfied.

DECISION

38On the basis of the evidence presented and in keeping with the principles contained in section 1 of the Act, the Board is satisfied that the relevant criteria were met at the time the Child was admitted to the Program and for that reason unanimously order that S.P.’s application for release from the secure treatment setting be denied.

Lorna King Presiding Member

Celia Denov Panel Member

John Gates Panel Member