B.W. v. Youthdale Treatment Centres, 2009 CFSRB 39

CHILD AND FAMILY SERVICES REVIEW BOARD

B.W.

v.

Youthdale Treatment Centres

REASONS FOR DECISION ON MERITS

Date: August 5, 2009

Citation: 2009 CFSRB 39

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

INTRODUCTION

1This is an application to the Child and Family Services Review Board (the “Board”) by B.W., born November […], 1995 (the “Child”), for a review of her emergency admission to the Secure Treatment Program at the Youthdale Treatment Centre (“Youthdale”), pursuant to section 124(9) of the Child and Family Services Act R.S.O. 1990, c. C.11 (the “Act”).

2The criteria, as set out in section 124(2) of the Act, must be met prior to an administrator admitting a child to an emergency secure treatment program. Section 124(2) of the Act reads as follows:

124 (2) The administrator may admit a child to the secure treatment program on an application under subsection (1) for a period not to exceed thirty days where the administrator believes on reasonable grounds that,

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.

3The Board must determine whether each of the criteria set out in subsection 124 (2) of the Act were met at the time of admission, on the balance of probabilities, having regard to the best interests of the Child. Pursuant to section 124 (13) of the Act, upon review,

124 (13) The Board shall make an order releasing the child from the secure treatment program unless the Board is satisfied that the child meets the criteria for emergency admission set out in clauses 124 (2) (a) to (e).

4Youthdale’s position is that all five criteria were met and that the application should therefore be denied. The Child’s position is that criteria (a), (b) and (e) were not met and that consequently, she should be released.

5For the reasons that follow, the Board finds that the Child did not meet criterion (a) at the time of admission and releases her from the secure treatment program at Youthdale.

BACKGROUND

6The Child is currently thirteen years of age and was admitted to Youthdale on May […], 2009. At the time of admission, she was residing with her mother J.W., sister, uncle and maternal grandparents, in their home in [ ].

7The Child’s parents lived together in [ ] since 2003, until they separated in January 2009 when J.W. left the marital home, after years of reported physical and emotional abuse by her husband, and moved to Toronto. The Child has not had any contact with her father since her move to Toronto.

8The W. family adopted B.W. after she came to live with them at approximately three months of age. Her biological mother, N., is her father’s adopted sister. B.W. had limited contact with her biological mother while growing up. However, she only became aware of her bio-mother’s identity after her parents separated. The W. family consists of six other children, who are all adults.

9In September 2008, B.W. began attending school irregularly, would stay in bed, not shower for extended periods of time, and spend lots of time on the computer. J.W. reports that around this time the conflict in the home was escalating and her husband was not supportive of B.W. and was calling her names. Conflict between B.W. and her mother increased at this time as well. At one point, her mother noticed superficial cuts on her wrists and got a referral to [the Agency] for counseling. After two sessions with a psychologist at [the Agency], B.W. cut her wrists while at school and her mother took her to [Hospital] where she was admitted. She was diagnosed with major depression and was prescribed Seroquil and Prozac. It was during her stay at [Hospital] that J.W. became aware that B.W. was being bullied at her school in [the Agency]. B.W. was released from hospital after two weeks and it was recommended that she continue taking her medication and obtain counseling.

10Shortly after her release from [Hospital], her parents separated and she moved with her mother to Toronto. Around the time of this move, B.W. began having unprotected sexual intercourse with different males, some of whom she had just met. She was not attending school regularly and her mother transferred her to another school in Toronto because of problems that arose at the school she was originally enrolled in.

11In February 2009, B.W. contacted [Centre], for follow-up after her hospitalization in December 2009, and in March 2009, B.W. began seeing Dr. R., a psychiatrist there for individual and family counseling.

12Approximately three weeks before her admission to Youthdale, B.W. called the Catholic Children’s Aid Society of Toronto (CCAST) after arguing with her mother. At that time, B.W. was requesting that she be removed from the home. An Intake Worker, A., recognized that B.W. needed some support and suggested that B.W. enroll in a group for teenagers who may be experiencing conflict in the home.

13On May […], 2009, B.W. had a disagreement with her mother and siblings and left the home to attend her biological mother’s home. She did not return home that evening and J.W. called the police to report her missing after being unable to find her. B.W. returned home the next morning after spending the night at the home of two young men. J.W. contacted CCAST who suggested that she contact Youthdale because B.W. would be safe there.

14B.W. and her mother argued, when she was told that she was going to Youthdale, because B.W. did not want to be placed there. Her mother called Anita, from CCAST, who came to their home and after some discussion B.W. went with A. to Youthdale.

15Upon her arrival at Youthdale, Dr. D.B., Clinical Fellow in Psychiatry at Youthdale, admitted her to the Acute Support Unit, which is the emergency secure treatment program at Youthdale.

EVIDENCE

16The child’s mother, J.W., gave evidence that although B.W. was prescribed medication to deal with her depression and sleeplessness, Prozac and Seroquil, she consistently took her Seroquil, but did not often take the Prozac. B.W. testified that she took the Seroquil because it helped her to sleep, but only took the Prozac when she was not feeling well.

17Ms. J.W.’ evidence is that she and B.W. argued frequently about her wanting to spend time with her birth mother, who she met only two months ago. It appears that B.W. fantasized about reuniting with her biological mother. Another of Ms. J.W.’ concerns was that B.W. who had frequently threatened to run away, would run away, not return home, place herself in an unsafe situation and be actually harmed. The psychiatrist from [Centre] had also told Ms. J.W. that it would take some time before she saw a change in B.W. and that her behavior may actually escalate before it got better.

18When Ms. J.W. told B.W. about being admitted to Youthdale, B.W. was angry at her and wanted to know why she was not told the day before. It was Ms. J.W.’ evidence that she believed that when A. of CCAST came to the home, B.W. went voluntarily and no one had to push her.

19Ms. J.W. was very concerned that B.W. was having unprotected sex, that is, no birth control or condom use. B.W. attested that her mother did not discuss the use of birth control with her. On a visit to her family physician, B.W. disclosed that she was having sex and was prescribed and received samples of birth control pills. Ms. J.W., after learning of this, took the samples away from her and never filled the prescription. Ms. J.W. had on two occasions, after B.W. reported having unprotected sex, obtained the morning after pill, Plan B, which B.W. refused to take.

20Ms. J.W. reported that B.W. told her sister that she did not want to engage in sexual activity and Ms. J.W. found that B.W. was remorseful and would be in tears as a result of her actions. B.W. gave evidence that she felt that she was no longer the centre of attention since her parents’ marriage started to quickly unravel. Prior to this, she was the centre of attention, from her parents and older siblings. B.W. felt that if she acted in ways which upset her mother that she would get some attention.

21Ms. J.W. was also concerned that B.W. was not attending school regularly and not completing her homework. B.W.’s evidence is that she liked going to school, but was finding that she was not able to do the work. As a result, she did not go to school because she did not want to look stupid.

22B., Crisis Support Team Worker at Youthdale, advised that her role is to take calls at Intake, assess the children, speak with collaterals and make plans for the child up to admission. In this instance, she spoke to Ms. J.W. when she called Youthdale seeking an emergency assessment. Another member of the Team spoke with B.W.’s treating psychiatrist at [Centre] who stated that B.W. needed inpatient treatment because out patient therapy was not effective at this time.

23Her evidence is that after consultation with Dr. S., a psychiatrist at Youthdale, he recommended that B.W. would meet the criteria for admission to the secure treatment program. Her testimony is that the team concluded that B.W., who had been through many recent changes, with a diagnosis of depression, was acting out inappropriately, AWOLing for some time and exposing herself to risks, was an appropriate candidate for admission to the Emergency secure treatment program at Youthdale. No one from the team spoke to B.W. or conducted an assessment on B.W., prior to making this determination.

24Dr. D.B., a Clinical Fellow at Youthdale, was the first person at Youthdale to speak with B.W.. He admitted her to Youthdale on a Form 14 (Exhibit Y-3). Although B. gave evidence about Dr. B.’s involvement with B.W., the Board found that this evidence lacked the specificity which the Board requires to make its determination. As such, the best evidence, which in this case would come from Dr. B., was obtained.

25Dr. B.’s Provisional Diagnosis on Axis I of the DSMIV on the day of admission, was Depression with Impaired Social Judgment, Oppositional Defiant Disorder, Suspected Learning Disability and Insomnia. He opined that on the date of admission, the Child’s depression with impaired social judgment was being exhibited by her inappropriate sexual activity with strangers and not using any protection. Dr. B.’s evidence was that the Child was neither psychotic nor suicidal at the time. He was of the opinion that having unprotected sex, which could lead to AIDS, reflected suicidal behaviors, although the risk was not immediate. He felt that her behavior – multiple sexual partners, unwillingness to use birth control or take steps to prevent the transmission of sexual diseases and refusal to take tests for sexually transmitted infections (STIs) - reflects a gross impairment to make reasoned decisions. He therefore concluded that the Child had a mental disorder as defined in the Act and met criterion (a).

ANALYSIS

Criterion (a) the child has a mental disorder.

26The Board was not satisfied that at the time of admission the Child had a mental disorder within the meaning of the Act. A mental disorder is defined in the Act as a substantial disorder of emotional processes, thought or cognition which grossly impairs a person’s capacity to make reasoned judgments. The evidence demonstrated that, at the time of admission, the Child did not have a substantial emotional processes disorder which grossly impaired her capacity to make reasoned judgments.

27Section 124 is under Part VI, Extraordinary Measures, of the Act. There must be extraordinary circumstances before a child is placed, on an emergency basis, in a secure treatment unit. As such, the right to review the placement before the Board is a significant safeguard, which was put in place to protect the Child’s liberty rights. There is a duty on the admitting program, Youthdale, to present strong and compelling evidence to support its position that a child met the criteria as set out in section124(2) of the Act at the time of admission.

28Although Dr. B. gave a provisional clinical diagnosis of Depression with Impaired Social Judgment for B.W., a mental disorder under the Act need not reflect a clinical diagnosis. The Board accepts his diagnosis, however, there was no evidence that B.W. had a substantial disorder of emotional processes. She was depressed, but was not suicidal or psychotic and there was no evidence to support a finding that at the time of admission and the weeks leading up to it that she had the substantial disorder which is required for admission. There must be more than a clinical diagnosis of depression to support such finding.

29B.W. may have been making some poor decisions and was placing herself in risky situations, but that does not warrant an admission to an emergency secure treatment program. B.W.’s behavior is clearly a reaction to her parents’ marriage dissolution which has left her feeling abandoned. To cope with this abandonment, her attention-seeking behaviors increased: she had unprotected sex with strangers and did not conceal this activity. Instead, she told her family members in order to get their attention which she felt she no longer received.

30Dr. B. gave evidence that B.W.’s refusal to take birth control pills or any other form of protection indicated a gross impairment to make reasoned decisions. The evidence does not support a finding that B.W. was unwilling to take birth control pills. Ms. J.W. did not discuss birth control or other forms of protection with B.W.. When B.W. took steps to ensure that she was protected, by speaking to her doctor who gave her and prescribed birth control pills, her mother took them away from her and did not fill her prescription. Ms. J.W. did not believe that it was right for B.W. to take contraception and that it would encourage her in more promiscuous behavior. It would be unfair to hold B.W. accountable for a decision which was taken out of her hands.

31Dr. B. also suggested that B.W. was non-compliant with her medications to treat her depression, which supported his claim that her ability to make reasoned judgments was impaired. The Board finds that in this regard B.W. was actually making reasoned decisions. She had a history of sleep difficulties and therefore consistently took the Seroquel to get a good night’s rest. However, she understood that the Prozac was needed to make her feel better, so when she felt better, she did not take it. This is typical of even adult patients taking medication. Therefore to suggest that a child should be admitted to a treatment centre because of this is unrealistic.

32B.W. also does not attend school frequently. From the evidence it is very clear that B.W. is having difficulty coping with the academic program and needs some assistance. This is an area in her life where she is unsuccessful. This feeling is not unreasonable and is supported by Dr. B.’s provisional diagnosis of Axis I Suspected Learning Disability.

33The Board finds that the Child’s behaviour, as identified and assessed by the admitting doctor and as outlined above, although not appropriate and involves some risk, does not support a finding that the Applicant has a mental disorder as defined by the Act.

34The Board was satisfied that criterion (a) has not been met. Pursuant to section 124 (13) of the CFSA, the Board, having satisfied itself that the criterion has not been met, released the Child, B.W., from the Emergency Secure Treatment Program at Youthdale on May 23, 2009.

Denyse Diaz

Presiding Member

Alina Lazor

Panel Member

Donald Butler

Panel Member