B.G. v. Youthdale Treatment Centres, 2008 CFSRB 63

CHILD AND FAMILY SERVICES REVIEW BOARD

B.G. v. Youthdale Treatment Centres

REASONS FOR DECISION ON MERITS

Date: June 25, 2008

Citation: 2008 CFSRB 63

Indexed as: B.G. v. Youthdale Treatment Centres (CFSA s.124)

1On May 16, 2008, the Child and Family Services Review Board (the "Board") received the application of B.G. (the "Applicant"), d.o.b. August [...], 1992, for a request to be released from the Youthdale Treatment Centre, Secure Treatment Program (the "Secure Treatment Program"), pursuant to section 124 of the Child and Family Services Act, R.S.O. 1990, c. C.11 (the "Act"). The parties were advised that the application would be heard by the Board on May 20, 2008 at the Youthdale Treatment Centre ("Youthdale") Toronto.

2At the hearing on May 20, 2008, the Applicant was represented by Herb Stover, Barrister and Solicitor. Youthdale was represented by Laura Cassiani, Barrister and Solicitor with Miller Thomson, LLP.

ISSUE

3The Applicant sought an Order releasing him from the Secure Treatment Program on the basis that the criteria for Emergency Admission in subsections 124(a), (b), (c), (d) and (e) of the Act had not been met at the time of admission.

EVIDENCE

4The following evidence was relied upon by the Board:

• "Document Brief" prepared by the Respondent containing the Form 15; Notice of Hearing; Youthdale intake and assessment forms; Form 13; Form 14; Statement of Reasonable Grounds for Emergency Admission to Secure Treatment by the admitting physician, Admission Summary; Consent Forms; and a Crisis Assessment Form;
• Testimony of M.G., the Applicant's father;
• Testimony of L.B. (Program Manager) and A.T. (Case Manager) at the residential facility;
• Testimony of J.M. (Child Youth Worker) at Youthdale; and
• Testimony of the Applicant, B.G.

REASONS

5The Applicant was admitted on an emergency basis to the Secure Treatment Program at Youthdale on May [...], 2008. On May [...], 2008, he applied under the Act to be released from Youthdale on the grounds that he did not fit the legal criteria (at subsection 124(2) of the Act) for admission to the program. The Board rendered its decision verbally at the end of the hearing, with these reasons to follow.

6The Board is satisfied that the Applicant met the following legal criteria at the time of his admission:

(a) the child has a mental disorder; (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 serious bodily harm to himself, herself or another person; (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; (d) treatment appropriate for the child's mental disorder is available at the place of secure treatment to which the application relates; and (e) no less restrictive method of providing treatment appropriate for the child's mental disorder is appropriate in the circumstances.

Criterion (a) the Applicant has a mental disorder.

7The Board gave considerable weight to the Admission Summary provided by Drs. W and C-B, both psychiatrists at Youthdale. The Summary recited the history of the Applicant's presenting problems and the results of a mental status examination. The description of the Applicant's situation and recent events was consistent with the oral testimony that the Board heard from the Respondent's witnesses about the Applicant's behaviour.

8The Admission Summary also showed the following provisional diagnoses:

• Adjustment Disorder, Acute with Mixed Disturbance of Emotions and Conduct
• Oppositional Defiant Disorder
• Attention Deficit Hyperactivity Disorder (by history)
• Learning Disorder in Math and Reading Comprehension

9On the "Axis V," the Applicant was described as "Function in the past several months has been poor." The Board gave considerable weight to the evidence in the psychiatric Admission Summary as well as all the other evidence about his pre-admission behaviour and situation.

10The Board was urged by the Applicant's lawyer to reject a finding of mental disorder because a psychiatric diagnosis is not tantamount to a legal finding of "mental disorder" as defined under the Act. In particular, counsel submitted that the Applicant's disorder was not "substantial," and that his capacity to make reasoned judgments was not "grossly" impaired as required under the Act. Counsel submitted that poor judgments can still be reasoned judgments and therefore not indicative of a mental disorder. Counsel argued that the Admission Summary states only that judgment was "poor" but not "grossly impaired" as required by the Act.

11The Board gave serious thought to these cogent arguments when making its decision as to whether the Applicant had a mental disorder. The definition of mental disorder under section 112 of the Act is set out below:

"mental disorder" means a substantial disorder of emotional processes, thought or cognition which grossly impairs a person's capacity to make reasoned judgments.

12Although the Board found that all the criteria at subsection 124(2) were met, the criterion with the least supporting evidence was the one pertaining to whether the Applicant has a mental disorder. The Board was persuaded to find a mental disorder based on the following evidence.

13The cumulative nature of the Applicant's poor judgment was escalating. Recently, the Applicant was showing a propensity to inflict cuts on his forearms. In closing argument, counsel for the Applicant submitted that these cuts do cause bleeding, and sometimes a person can "bleed out" from what might be characterized as "superficial" or skin wounds. It goes without saying, however, that blood veins are very close to the surface on the forearm, and therefore there is little margin for error. A fraction of a millimetre can be all the difference between a fatal action and a superficial cutting.

14Another example of the escalating nature of the Applicant's impaired judgment was his trafficking in narcotics on school property. The Applicant testified that he was buying and selling marijuana and had recently stolen Oxycontin pills from his father's medicine cabinet. Oxycontin is widely known to have street-value as an illegal drug. Oxycontin, an opiate, can be dangerously addictive when abused and not taken for pain. When questioned as to why he stole the pills from his father's cabinet, the Applicant stated that he was curious as to what they were and that he intended to take them to his local pharmacist for identification.

15The Applicant's explanation as to why he stole the narcotic pills defied credulity. When seen in the context of his daily tobacco smoking, and his escalating marijuana smoking and dealing (several times per week at school), the theft of the Oxycontin shows itself as the next step in an escalating drug problem brought on by, and illustrative of, his impaired capacity to make reasoned judgments.

16The weekend prior to his admission to Youthdale, the Applicant was taken both to the emergency ward of his local hospital and then to the police station after light bulbs and a bookcase were broken at a group home where he was staying. There was conflicting testimony as to exactly what happened and why. It was clear to the Board that the Applicant's emotional state was in crisis, and that he displayed a great deal of angry and impulsive behaviour. This evidence persuaded the Board that the Applicant was, prior to admission, suffering from a substantial disorder of his emotional processes that grossly impaired his capacity to make reasoned judgments. The Board finds that criterion (a) has been satisfied.

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

17As discussed above, the Applicant had been recently cutting his forearm as a "coping strategy." For the reasons discussed above, the Board considered the Applicant's very recent self-mutilation as the beginning of serious self-destructive behaviour that constitutes a substantial threat to cause bodily harm to himself. The Board finds that criterion (b) has been satisfied.

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

18The Board heard evidence describing the Secure Treatment Program, the various levels of observation and intervention tailored to the needs and circumstances of each resident, the high ratio of staff to residents, and various other measures that can be used to prevent the Applicant from causing serious harm to himself. On this basis, the Board accepts that the Secure Treatment Program would be effective to prevent the Applicant from causing serious bodily harm to himself.

19Counsel for the Applicant argued that Youthdale cannot prevent all "attempts" to cause harm, and thus the criterion was not satisfied. However, the Board finds that the criterion was satisfied because the proposed Secure Treatment Program would be a reasonably effective way of reducing the likelihood of attempts by the Applicant to cause serious harm that could translate into actual harm. The Board finds that criterion (c) has been satisfied.

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

20Appropriate mental health treatment is available at Youthdale. The facility has full-time staff psychiatrists and mental health professionals from various disciplines. One of the concerns that the Applicant's own community psychiatrist expressed was that the Applicant "needs to be stabilized and his medications need to be reviewed." The in-patient facilities at Youthdale will allow that stabilization and medication review to occur. The Board finds that criterion (d) has been satisfied.

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

21Based on the preponderance of evidence, there was no less restrictive method of providing treatment for the Applicant. Counsel for the Applicant suggested that the Applicant's community psychiatrist could have increased her level of treatment; however, the evidence of the residential facility witnesses was that the psychiatrist was available to the residents only on her scheduled visits, once or twice per month. As mentioned, the evidence was that the psychiatrist herself suggested that the Applicant could benefit from stabilization and a review of medication at an in-patient facility like Youthdale. The Board finds that criterion (e) has been satisfied.

22On the basis of the evidence presented and in keeping with the principles in s.1 of the Act, the Board is satisfied that the relevant criteria were met at the time the Applicant was admitted to the Secure Treatment Program and for that reason, unanimously ordered that the Applicant not be released from the secure treatment setting.

Brian Cohen Presiding Member

Ruth Ann Schedlich Panel Member