T.T. v. Youthdale Treatment Centres, 2008 CFSRB 73

CHILD AND FAMILY SERVICES REVIEW BOARD

T.T.

v.

Youthdale Treatment Centres

REASONS FOR DECISION ON MERITS

Date: July 28, 2008

Citation: 2008 CFSRB 73

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

1On June 23, 2008, the Child and Family Services Review Board (the “Board”) received the application of T.T., d.o.b. February […], 1993 (the “Child”) for review of emergency admission to the Secure Treatment Program of the Youthdale Treatment Centre, 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 June 26, 2008 at the Youthdale Treatment Centre, Toronto (“Youthdale”).

2At the hearing on June 26, 2008 the Child was represented by Helen Trentos, Counsel from the Office of the Children’s Lawyer. Youthdale was represented by Jennifer Hunter, Barrister and Solicitor with Miller Thompson LLP.

ISSUE

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

PROCEDURAL MATTERS

4The parties declined to give opening statements. Ms. Trentos indicated that the Child was contesting four of the five criteria as set out in subsections 124(2) of the Act. She conceded paragraph (c), that Youthdale would be effective to prevent the Child from causing or attempting to cause serious bodily harm to himself or another person.

5The evidence was a Document Brief from Youthdale with 9 tabs (Exhibit Y-1), and testimony from the following witnesses:

T.T. - the Child

M.S. - the Child’s Mother

L.M. - Counsellor with N.P.Y&F.C.S.

J. - Youthdale Crisis Support Team Member

FACTS

6T.T. is 15 years old and lives with his mother and four younger siblings in [ ], Ontario. T.T. has had no contact with his father since his parents were separated approximately two years ago, except one day in March 2008 when he testified in his father’s trial on charges of assaulting T.T.. At that time, the preliminary hearing was ended when T.T. passed out on the stand.

7M.S., T.T.’s mother, considers that his father was abusive for T.T.’s entire life. As a result, the children and T.T.’s mother banded together as victims, and his mother has only recently attempted to assume the role of an authority figure in the family. T.T. attempts to discipline his younger siblings for actions he sees as wrong, often in a physically abusive manner. He has been particularly abusive toward his 13 year-old sister A. and has acknowledged, in the past, having revenge fantasies against both his father and A..

8T.T. did not attend school until grade 5. He is currently in grade 9 and obtained three credits in the first semester, but virtually ceased to attend school in the second semester. T.T. has been offered counselling at school but considers himself to have “dropped out”.

9Ms. M.S. sought family counselling at [ ] (“N.P.”) in [ ] in February, 2007. T.T. has been attending sessions with L.M., counsellor, approximately once every two weeks since September 2007. He is usually accompanied by his mother. Ms. L.M. commented that she has also advised that some of T.T.’s siblings would also benefit from counselling. During the most recent consultation at N.P. on May […], 2008, Ms. L.M. became concerned about T.T.’s “uncharacteristic anger” and withdrawal from family and school. T.T. most recently has taken to sleeping during the day and being awake all night.

10T.T. was referred to Dr. S.B., consulting psychiatrist with N.P.. Her report of May […], 2008 noted that “T.T. appears to be in the high functioning autism spectrum. He feels overwhelmed by his anger and appears to have withdrawn in order to manage his feelings …. He is at risk of acting out his anger at others such as his sister if sufficiently provoked … what is unclear is whether he is developing a psychotic illness. His grandiosity makes him look as though he may be at risk for a bipolar illness but some of the looseness of this thinking is also suggestive of schizophrenia. It is important that he be assessed in an in-patient setting to clarify his diagnosis and appropriate treatment.” Dr. S.B. recommended anti-psychotic medication, as well as “an in-patient assessment through perhaps Youthdale Crisis Unit or S.H. would be helpful.”

11T.T. has threatened violent “revenge” against his father; he has damaged his home with one of his father’s swords; he has been verbally abusive and threatening with his mother and siblings, and punched his sister A. causing bruising.

ANALYSIS

Criterion (a) the child has a mental disorder.

12A 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.

13The Board received the Youthdale Admission Summary of Dr. B.W., staff psychiatrist, dated June […], 2008. The doctor found T.T. to be suffering from a mental disorder, but refrained from giving a provisional diagnosis. Rather, Dr. B.W. found a “possible mood disorder”, wanted to “rule out psychotic illness such as Schizophrenia,” noted “Psychosocial stressors have been severe over the last couple of years with parental separation and T.T. having to testify in court”, and noted “Current level of adaptive functioning is very poor.” In the doctor’s opinion, these disorders grossly impair the Child’s capacity to make reasoned judgments. Dr. B.W. intended that the Acute Support unit would provide “stabilization and assessment” for T.T..

14Dr. S.B.’s letter to Youthdale of June […], 2008 notes “there were times when I was concerned about a thought disorder but he would shut down and it was difficult to assess. I could not adequately assess his level of risk but I am concerned about his acting out some of his fantasies because of his sense of entitlement.” She concluded that her tentative diagnosis is “high functioning autism possibly with the early stages of a psychotic process.”

15Ms. L.M., who has conducted bi-weekly counselling sessions for T.T. and his family since September 2007, also noted that T.T. is difficult to assess and in her opinion appears in better shape than he really is. She testified that she became severely concerned with T.T.’s mental state following a consultation in May, 2008 when he appeared much more angry than she had ever seen him, and unable to mask or control his outbursts. At that point, she bumped another family in order to have T.T. meet with N.P.’s psychiatrist.

16The Board heard and received evidence about the Child’s behaviours that demonstrated grossly impaired judgement.

17M.S., T.T.’s mother, testified that T.T. has damaged the basement walls and a door with a sword he took from his father’s collection. She testified he told her that he “needs” to use the swords. He has also carved up a desk and chair with knives from his father’s collection. She is concerned both about his use of the weapons in the house, and the possibility he may take them out of the house and end up in a confrontation with the police. T.T. shows complete disregard for his mother, and tries to take over when she is attempting to discipline the other children. T.T. takes it upon himself to try to force his siblings to behave.

18He has taken to sleeping all day and being awake all night. She testified that T.T. has very little interaction with the family. He has claimed the basement as his territory, and is resentful and threatening if anyone else wants or needs to go there. The other children are afraid to go to the basement. T.T.’s 8 year-old brother G. recently came to his mother, upset that T.T. said he would kill him and G. believed it.

19She testified that T.T. speaks in an odd manner, using unusual words and often not using them properly. She believes this to be an effort to sound intelligent. She described panic attacks and incidents of paranoia in T.T.’s past.

20Ms. M.S. testified that she worries for the safety of her other children and herself. She described T.T.’s intense anger, as well as the fact that he plays with knives and has started fires in his room in the recent past. He is angry most of the time. Ms. M.S. testified that T.T. blames his sister A. for most things, and targets her. She also noted T.T. has a “target list” in his notebook, including his father’s name, A., some students from school, as well as G.B. and the State of Alaska. Ms. M.S. testified that, although he is hitting less, T.T.’s behaviour has worsened in the last two months. While he used to do occasional chores, he now refuses to do anything, including attend school. He has threatened suicide in a joking manner in the past, although Ms. M.S. is uncertain how seriously to take the threat.

21She also testified that T.T. has a fear of the police and of small spaces. For these reasons she wanted to avoid having to use a Form 2 (Court order with police enforcement, possible transport in an ambulance) to have T.T. admitted to Youthdale, and thus declined to tell him he would be staying at Youthdale until his arrival.

22J., a Youthdale Crisis Support Team Member, testified that he was involved with the Child as a member of the crisis team and did the admission on June […], 2008 when the Child was admitted to Youthdale. He described the admission process and the services available at Youthdale.

23T.T. testified on his own behalf. With respect to damaging the walls of the home, he testified that he was acting out his pent-up frustration and that he barely noticed he was doing it. He testified that he refused to take medication because he wants his mind to be clear, since his IQ is more important to him “than his life”. T.T. testified that he was no longer attending school because the system is poor and needs to be completely overhauled. He acknowledged that he gains comfort from gazing into a controlled fire. Although he stated that he has “no intention of lighting indoor fires again”, he immediately agreed he would light candles. T.T. testified that when he feels he is losing control, he is “in a haze” and, although he knows he should stop, he “barely cares”. T.T. also agreed that his mother could “use some pointers” with regard to disciplining his siblings.

24The Board finds that a clear diagnosis does not have to be made at the intake stage, in order to conclude the Child has a substantial disorder of emotional processes. In this case, three mental health professionals were of the view that T.T. had a mental health issue which urgently required diagnosis and treatment. T.T.’s intense anger and increasing withdrawal from society, his “need” for revenge, his refusal to attend school and grandiose ideas are indicators of this substantial disorder. The panel finds T.T.’s evidence that he carved the walls with the sword without noticing what he was doing, and the fact that he “barely cares” when losing control of his anger, indicate his capacity to make reasoned judgments are grossly impaired.

25The panel finds that the Child has a substantial disorder of emotional processes which grossly impairs his capacity to make reasoned judgments.

26The 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.

27Ms. M.S. testified that the [ ] Children’s Aid Society has been involved with this family, and have instructed her not to leave T.T. alone with his siblings or by himself.

28Ms. M.S. testified that T.T. assaulted his sister causing a large bruise on her arm, approximately 2-3 weeks ago. He also chased her through the house with a sword, causing her to lock herself in the bathroom, the only room in the house with a lock. T.T. has said on numerous occasions that they should “get rid of” A.. Ms. M.S. testified that she has never called the police, and the school never called home regarding incidents of aggression. While T.T. has never hit his mother, she testified he attempts to “tower over” her and looks menacingly.

29When questioned about the “target list”, T.T. testified that it is mostly a joke. He went on to discuss, although it did not address the question asked, how friends overpowered him and read it aloud, to which he replied with snappy comments in a mocking voice. Similarly, he testified that his comment that he should “just kill himself” was “laden with sarcasm” and he had no intent to carry it out. With respect to A., T.T. testified that with his dad gone, he “needed” someone close by to target. He acknowledged that, although she was the most annoying one around, it did not excuse aggression against her. T.T. believes he can manage his own anger, and that he has been doing so through meditation.

30The Board finds that any attempts made by T.T. to manage his anger prior to his admission to Youthdale were not successful. We find that he caused bodily harm to his sister A., and threatened to cause bodily harm to various other family members including his mother, father and brother G. The 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.

31Counsel for the Child conceded this point, and the Board accepts the fact that the secure setting at Youthdale minimizes the risk of harm to the Child and others. We find 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.

32T.T.’s mental disorder still required diagnosis at the time of admission to Youthdale. Dr. S.B. recommended Youthdale in order to “stabilize and assess” T.T.’s mental health. Ms. L.M. testified that she saw T.T. over 12-15 sessions, yet still did not have a clear picture of his problems.

33J. testified that Youthdale presents a low-stimulus environment in which children have access to counsellors. A psychologist, a psychiatrist and other mental health professionals are also available for the Child to address his mental health requirements, as is an education assistant, who will assist the Child to possibly make up school credits.

34Youthdale provides an appropriate setting for finding a diagnosis for this child, and for the appropriate treatment. The Board accepts the fact that psychiatric counselling and treatment is available in a secure environment at Youthdale and that this would be beneficial for the Child.

35The Board finds that criterion (d) has been met and that Youthdale can provide the appropriate treatment for the Child’s mental disorder.

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

36The Children’s Aid Society was concerned about the safety of the other children in the home. J. testified that foster homes are next to impossible to secure where there is an issue of fire-starting, as with T.T.. The evidence before the Board is that S.H. would not accept T.T., due to his aggressive behaviours. T.T. has refused to take medication. He has been attending counselling sessions since September 2007 and appeared to be making some progress, but then had a precipitous drop in mental health. None of the psychiatrists that had seen T.T. prior to admission to Youthdale, have been able to make a firm diagnosis.

37Counsel for the Child submitted that, notwithstanding the waiting lists, treatment is available in the form of consultations with Dr. S.B. in Barrie. She argues that it is inappropriate to place a child in a secure treatment facility for the purposes of assessment.

38The Board finds, however, that there is imminent risk of harm to T.T.’s siblings. We are also of the view that previous counselling at N.P. has not been successful, either from an assessment or treatment perspective. Given the Child’s risky behaviours, the Board accepts that a secure treatment facility is necessary for this child.

39We find that criterion (e) has been met.

DECISION

40On 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 the Child’s application for release from the secure treatment setting be denied.

Mary Wong

Presiding Member

Heather Gibbs

Panel Member

Fizul Sima

Panel Member