C.R. v. Youthdale Treatment Centres, 2009 CFSRB 7

CHILD AND FAMILY SERVICES REVIEW BOARD

C.R.

v.

Youthdale Treatment Centres

REASONS FOR DECISION ON MERITS

Date: February 10, 2009

Citation: 2009 CFSRB 7

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

1On January 8, 2009, the Child and Family Services Review Board (the “Board”) received the application of C.R., d.o.b. September […], 1994 (the “Child”), for review of his 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”). All of the parties were informed of the Board’s intention to hear this application on January 10, 2009 at the Youthdale Treatment Centre, Toronto.

2The Board must decide, on a balance of probabilities, whether each of the criteria set out in subsections 124(2) of the Act was met at the time of admission. The Respondent’s position was that all five criteria had been met and that the application should therefore be denied. The Child’s position was that none of the criteria had been met and that he should be released.

3Pursuant to section 124 (13) of the Act, upon review,

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).

4The legal test in this case is captured by the criteria as set out in the following legislative provision:

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.

5For the reasons that follow, the Board found that the Child met all of the five criteria for admission and denied the Child’s application. These reasons also address the decisions made in relation to motions for release brought on behalf of the Child.

BACKGROUND

6C.R. is a 14 year old youth who was admitted to Youthdale on January […], 2009. He has been living with his mother, L.A.R., and his 12 year old sister, C., in [ ]. He is currently in Gr. 9 at [School], but has not attended a single full day of school since the start of school in September. He has been suspended for swearing at teachers and allegedly assaulting two girls.

7The Child had a difficult delivery with the umbilical cord wrapped around his neck and he required resuscitation. At eighteen months, he was diagnosed with severe ADHD. He has been a patient at Dr. K.’s clinic since 2002 and has also been diagnosed with Oppositional Defiance Disorder and Conduct Disorder. He has been prescribed concerta and risperidone.

8Recently, he has had anger outbursts, swears and has threatened to kill his mother. He has punched holes in walls, smashed the TV, and destroyed some kitchen chairs. He has been in conflict with his girlfriend who goads him and hits him. She has hit him to the point of chipping his tooth and giving him a concussion. His mother and other family members have had to restrain him during several altercations. He has threatened bodily harm to his sister, mother, girlfriend, and aunt. Police have been called on a number of occasions. These incidents have led to his admission to Youthdale.

REASONS FOR DECISION REGARDING MOTIONS FOR RELEASE

9The lawyer for the Child, Herb Stover, brought a motion for release of the Child on the basis that there were errors in the Form 14 for Emergency Admission to Secure Treatment Program. The admitting psychiatrist had put the name of the Child on the form as applicant, instead of his mother. Specifically, the Form 14 read, “Having read the application of C.R. I believe on reasonable grounds that the criteria for emergency admission under subsection 124 (2) have been met”. There was no application for emergency admission to the secure treatment program made by C.R.

10Herb Stover also raised objection in relation to the signature on the Form 14. He noted that the person who signed the form was Dr. C., but underneath her signature, it said, “person in charge of program”. Herb Stover submitted that he believed that the person in charge of the program was Dr. S., not Dr. C., and that Dr. S. should have signed the Form 14. He argued that the errors on the form invalidate the admission and that the Child should be released.

11The Respondent argued that under the Board’s Rules of Procedure, “no proceeding is invalid by reason only of a defect or other irregularity in form. Substantial compliance with a form, notice or document required under the CFSA, the Education Act, the Regulations and these Rules is sufficient to establish the validity of the form, notice or document”. He argued that the Child’s name on the Form 14 was a mere oversight and should not discredit the validity of the admission. The mother, L.A.R., had clearly applied for the admission. In relation to Dr. C.’s signature on the Form 14, he argued that it was standard policy for the admitting psychiatrist to sign the form.

12The Board heard evidence on the motion for release. The Board was satisfied that the form is in substantial compliance as required under the Board’s Rules of Procedure and denies the motion of the Child. Section 124 (2) of the Act permits the administrator to admit a child to secure treatment “on an application under subsection (1)”. Under subsection (1), a parent may apply to admit a child who is under 16. The Form 14 which inaccurately referenced the applicant as the Child had appended to it a “Statement of Reasonable Grounds Emergency Admission to Secure Treatment” (“Statement”) also signed by the admitting psychiatrist on January […], 2009. The Statement referred to the psychiatrist as “ having reviewed the Form 13 dated today”. The Form 13 dated January […], 2009 was the application of the mother, L.A.R. addressed to the person in charge of the program. The Board was satisfied that this constituted substantial compliance with the Act.

13The Board was also satisfied that Dr. C., who reported to Dr. S., had the authority as the administrator of the program in the secure unit at the time of admission of the Child.

14Having found substantial compliance, the Board was still concerned about the error and the issue of who may properly admit. The Board cautioned Youthdale to be more careful with their paperwork and to ensure that their forms are legally compliant. This Panel’s decision on this motion is not binding on the decisions of other Board Panel members in terms of substantial compliance.

REASONS FOR DECISION ON THE MERITS

ANALYSIS

Criterion (a) the child has a mental disorder.

15The Board was satisfied that the Child had a mental disorder within the meaning of the Act. A mental disorder is defined 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 had a substantial emotional processes disorder which grossly impaired his capacity to make reasoned judgments.

16Dr. K. has provided outpatient psychiatric care for the Child since January 2002. He has diagnosed the Child with severe ADHD, Oppositional Defiance Disorder and Conduct Disorder. He noted that the Child has been refusing to take his medications which include concerta and risperidone. He wrote a letter dated December […], 2008 supporting the Child’s admission to the ASU secure unit for stabilization so that the Child could be managed in the community.

17Dr. C., the admitting psychiatrist at Youthdale, gave a provisional diagnosis of Conduct Disorder, ADHD, Learning Disability, Possible Cannabis Dependence, and Possible Mood or Anxiety Disorder. In addition, there is possible Borderline Intellectual Functioning and Possible early anoxic insult. There are also significant psychosocial stressors.

18The Child’s mother, L.A.R., provided evidence that since last summer, the Child has stopped taking his medication and is very demanding, irate and aggressive. He resorts to extreme name calling. He verbally abuses her on a daily basis. He has been verbally abusive to his girlfriend, his sister, and his aunt. On two separate occasions, he smashed kitchen chairs. He has punched holes in walls and in doors. He throws anything near him or in his hands, including hot coffee, and whacks pictures off walls. He has cleared off dressers and broken the television. There is evidence that he has been in serious physical conflicts with his girlfriend, his mother and his sister. He has threatened to injure or kill his girlfriend, his mother, his sister, and his aunt. He has used language in his threats such as “smash her” and “beat her to a pulp.” His mother and other family members have had to physically restrain him from hitting others. Police were called on several occasions to contain the situation. The Child had no insight into why he remained in an abusive relationship with his girlfriend who has given him a concussion and chipped his tooth.

19It was the position of Counsel for the Child that the Child’s rages were triggered by specific events, including the hurtful comments made by his aunt. While it is true that certain words and events may have triggered a reaction in anyone, the Child’s reaction was so extreme (including physical actions and threats) that they constitute evidence of a mental disorder.

20The Board was satisfied on the basis of the evidence, including the letter of Dr. K., the Admission Summary of Dr. C. and the testimony of the Child and the mother, that the Child had a mental disorder as defined under the Act.

21The Board was satisfied that criterion (a) was 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 serious bodily harm to himself, herself or another person.

22The Board was satisfied that the Child, as a result of his mental disorder, made a substantial threat to cause serious bodily harm to his mother, his sister, his aunts and his girlfriend.

23In a fight over a cup of Tim Horton coffee with his sister, the Child hit the coffee out of her hand and the coffee went all over the couch. He pushed his sister and threatened to kill her. His mother held him back. He was in hysterics, angry and out of control. He said, “I’m going to kill her.” His sister went running out of the house in her bare feet to a neighbour. His sister had been living in Toronto with an aunt because of problems with neighbourhood children, but due to the Child’s behaviour, she did not come back.

24The Child is in constant conflict with his girlfriend, S., who antagonizes and provokes him. They fight every day. She has hit him on the head numerous times giving him a concussion and chipped his tooth when she threw something at him. During a fight on December […], 2008, the mother got in the middle of the argument and held the Child back as he was trying to punch S.. He punched the mother in the arm, called her a “whore” and he threatened “to punch her f’ing head in”. He has also whipped ice balls at the windshield of the car when the mother was occupying it. Police were called because the mother worried about her own safety and that of others.

25On January […], 2009, during a heated argument between the Child and S., the mother jumped in the way to stop him from hitting S.. The mother ended up with a split lip. While the mother was holding him, he kicked her causing bruising. The mother went to emergency, but the doctor did not use stitches on her lip.

26At a family gathering on Christmas day, the Child was vulgar and rude to the mother. His aunt got angry with him and told him that he was going to be a loser just like his dad. The Child became enraged and said that he would kill her. His mother’s niece, daughter, younger sister and her father were all holding him back. He called the aunt a slut and said that he will kill her. Police were called. While the other aunt was driving the mother and the Child, he told the aunt that if she said one word, he would smash her.

27Based on this evidence, the Board was satisfied that criterion (b) had been met in terms of threats of substantial bodily harm to another person.

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.

28The Board was satisfied that the secure treatment program would be effective to prevent the Child from causing or attempting to cause serious bodily harm to another person.

29The Crisis Worker testified that Youthdale has a secure and very strict locked unit with staff highly trained in behaviour management. There is a high level of supervision of interactions between peers and parents. Nurses, doctors and staff are available to monitor moods and behaviour. The high level of security and supervision ensure the safety of the Child and prevent harm to other persons. Youthdale is a means of physically separating the Child from his girlfriend whom he would seek out if in the community, exposing her and himself to harm.

30The Board was satisfied that criterion (c) was met.

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

31The Board was satisfied that treatment appropriate for the Child’s mental disorder was available at Youthdale.

32The Crisis Worker testified that the primary purpose is to stabilize the Child through behaviour management and medication. Youthdale can provide many services to treat the Child such as regular sessions with his psychiatrist, peer therapy, individual programming, and one on one assistance from front line staff. In-depth psychiatric assessment, psycho-educational testing, neuro-psychiatric testing and medical testing are all diagnostic tools which can be used with this Child and which form part of his treatment. Psycho-education assessments are not necessarily available and depend on resources and timing of past assessments. To determine the proper medication, observations by staff and psychiatrists and input from the Child are used. This Child’s mood, behaviour, feelings and problem-solving would be monitored and rated. Since Youthdale is a secure, locked facility, there is no interference from street drugs when determining the appropriate medication and dosage.

33The Board was satisfied that criterion (d) was satisfied.

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

34The Board was satisfied that no less restrictive method of providing treatment appropriate for the child’s mental disorder was appropriate in the circumstances.

35The Child has had access to treatment in the community. He has had psychiatric treatment from Dr. K. as an outpatient since 2002. He saw Dr. K. in April 2008. He has had family therapy from [ ]. [An Agency] provided a specialized day school program for him in Grade 8, as well as individual and family therapy. Around September or October of 2008, the Child’s counsellor recommended [X], a residential treatment centre, which was four hours away. However, his mother did not want him to go so far away. At the time, his mother did not feel that his mental condition warranted a stay at [X]. The Child testified that he did not want to be so far away from his mother. In November of 2008, his counsellor recommended [ ], a group home in [ ]. His mother visited the house and did not find it suitable as it did not offer appropriate mental health interventions.

36At the time of admission on January […], 2009, the Child’s mental health had de-compensated to such an extent that the residential facilities which had been considered were not secure enough to meet the Child’s needs. The Child needed a period of stabilization in a secure, locked facility in order to determine an appropriate treatment plan and a regimen for medication. He could not be treated in a less secure environment because his behaviour was so aggressive and he was so volatile. In addition, he would need to cooperate. His history of medication refusal is evidence that he would not cooperate with voluntary admissions. In addition to these reasons, a residential placement far from his mother would not be appropriate because of the evidence of his strong attachment to his mother and his potential feelings of rejection which could trigger his behaviours.

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

CONCLUSION

38Pursuant to section 124 (13) of the Act, the Board, having satisfied itself that the criteria in subsections 124 (2) (a) through (e) had been met, dismissed the application of the Child, C.R., under section 124(9) of the Act on January 10, 2009.

Sheena Scott

Presiding Member

Mary Wong

Panel Member

Alina Lazor

Panel Member