Q.B. v. Youthdale Treatment Centres, 2012 CFSRB 23

CHILD AND FAMILY SERVICES REVIEW BOARD

Q.B.

v.

Youthdale Treatment Centres

REASONS FOR DECISION

Date: July 5, 2012

Citation: 2012 CFSRB 23

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

INTRODUCTION

1This is an application by Q.B. (the “Child”) born August [ ], 1999 for a review of his Secure Treatment Program at the Youthdale Treatment Centre (“Youthdale”), pursuant to section 124(9) of the Child and Family Services Act (the “Act”). The application is dated June 14, 2012 and relates to the Child’s admission to Youthdale on June [ ], 2012. The hearing was held on June 16, 2012.

2The Board must decide, on a balance of probabilities, whether each of the criteria set out in subsection 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 all five criteria had not 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).

4For the reasons that follow the Board finds that the Child met all the criteria as set out in clauses 124(2) (a) to (e).

BACKGROUND

5The Child is 12 years old and lives with his mother and younger half sister. He has an older half sister who is living with the grandparents. The Child has never had contact with his father. The Child has refused to attend school for the past 3 years and is currently studying on his own in a home school program. Over the last 4 years, the Child has had severe mood swings ranging from violent episodes to periods of crying and depression. During his violent episodes, he would hit his mother and destroy property. His behaviour has escalated recently and he was admitted to Youthdale on June [ ], 2012.

ANALYSIS

6The criteria that the Board must apply in secure treatment reviews are 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.

Each of the above criteria must be met at the time of admission to confirm the Child’s placement at Youthdale.

Criterion (a) the Child has a mental disorder.

7The Board was satisfied that at the time of admission, 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.

8The mother testified to the behaviour of the Child that led to his admission at Youthdale. The mother has not been able to get the Child to attend school for the last 3 years. She has involved the school, the truant officer, and police in her efforts. Last year the school set up a program so that he can attend school part days. The Child started the reduced day program but then refused to go. He is currently doing home schooling and working on his own using the computer.

9The mother stated that the Child’s behavioural issues started about 4 years ago with violent episodes, anger, extreme mood swings with the Child yelling and screaming or being very sad. The Child was very close to his great-grandmother and when she passed away, his moods swings escalated. Now, the Child gets very angry, has “massive” temper tantrums, throws things, and says things such as, “I’m going to hurt you”, “I wish I was dead”, and “I don’t know why you had me”.

10The mother sought assistance from her family doctor who referred the Child to the [ ] program for families with mental health issues. About a year and a half ago, the Child started this program and attended once a week with a counsellor. The Child was asked not to come back until he was more stable when he got angry, threw something at a picture on the wall and broke it. The mother did not feel that the Child’s behaviour improved in this program.

11The family doctor referred the Child to see [ ], a psychiatrist in [city]. The psychiatrist diagnosed the Child with bipolar disorder and put him on Trileptal. The Child’s behaviour improved with less intense outbursts, however, after being on Trileptal for 10 months, his moods worsened again. The mother had difficulty making follow up appointments with [the psychiatrist] and the Child has not seen him since April of 2011.

12The Child threatens his younger sister if she does not do what he wants. She is afraid of him. He has episodes once or twice a week where he can be aggressive or sad and crying. The mother sleeps with the sister and makes sure that she is never alone. The mother has no knives in the house so that the Child cannot hurt himself. He is unpredictable and has threatened to harm the mother. The Child hears voices and recently the mother has heard him talking to the wall. Prior to his admission, his behaviour was escalating to violence. He has hit his mother with a broom, a baseball bat and a hockey stick and punched her in the face on numerous occasions. In March of 2012, the Child took a paring knife and threatened to kill his mother. He has broken windows and punched big holes in the living room walls. He has poured milk on the couch and ripped it. He has ripped out clumps of his mother’s hair and given her a black eye. When the grandfather got in his way, the Child has hit him. He has thrown rocks at the grandfather’s car. When the Child was away at a hockey tournament, he damaged the hotel room. The mother was unable to reason with him when he was in a rage. Sometimes the Child did not remember the episodes. Recently, [ ](the “Society”) was involved due to safety concerns for the sister and the mother.

13On April 27, 2011, the Child had a “melt down”. The mother was in bed with the little sister when the Child came upstairs yelling and screaming and hit the mother several times with a plastic tubing piece from a hockey net. He then proceeded to punch the mother who put up her arm in defence. The mother called police who escorted the Child to the local hospital where he was put on a Form 1 and kept overnight. He was given sedatives to calm him down. The Child was then transported to the [ ] (the “Health Centre”) by police where he remained for a week. The Child was assessed by a paediatrician and seen daily by a child psychiatrist. The Child Psychiatrist took the Child off Trileptal since he was not certain it was the proper medication. The Child Psychiatrist diagnosed him with oppositional defiant disorder with a high risk of developing bipolar disorder. The Child was released to the mother with the recommendation that she reconnect with [program], [the psychiatrist] and the Society to provide services for the Child and to develop a safety plan for the family.

14The mother reported that the Child has been hearing voices and that he was telling the voices to “shut up”. While at the hospital the Child thought someone was trying to kill him and he wrapped a pen in tape which the mother construed to be a weapon. On June [ ], 2012, the Child threatened to kill himself if he had to go to Youthdale.

15The Child denied that he heard voices. He claimed that when he was seen talking to the walls, he was playing video games and talking to people on line with a headset. He said that his sister has lied to his mom who then got mad at him. It seemed to him that his mother likes the sister more. He hit the mother to get her attention. He claimed that his mother got stressed out and they got into fights. The mother has recently split up with his stepfather and he was upset about that. He claimed that he did not threaten to kill himself, but said, “you might as well kill me”, when he was told about Youthdale. The Child admitted to having a temper and to having mood swings, but claims that he has valid reasons to feel the way he did. He admitted to having used drugs: marijuana about 3 to 5 times and cocaine once. The drugs helped him to calm down when he was very angry or sad. His mother does not know that he used drugs. He stated that he does not like school because the teachers did not help him.

16The Board found that the Child had a mental disorder within the meaning of the Act at the time of admission. The Act defines a mental disorder as a substantial disorder of emotional processes, thought or cognition which grossly impairs a person’s capacity to make reasoned judgements. The Child’s behaviours have demonstrated that at the time of admission, he had a substantial disorder which prevented him from making reasoned judgements. The Board heard extensively from the mother regarding the Child’s out of control behaviours and the Child’s mood swings from episodes of extreme anger and rage to periods of sadness, and crying. His judgement was so impaired that he resorted to hitting his mother with a broom, a baseball bat and hockey stick and punched her in the face. He threatened his mother with a paring knife and punched holes in the wall. The mother has reported that the Child heard voices and was talking to the wall. The Board accepts the mother’s evidence in this regard. The Child’s explanation about video games and headsets did not fit with the mother’s description of what she had observed. That is, there was no evidence of headsets or video games being present. The Child has refused to go to school despite attempts to engage him in a part time program. During one of his violent episodes, the Child was so out of control that the mother had to call police to escort him to the hospital where he had to be sedated. The mother could not control the Child during these rages and feared for her safety and the safety of the sister. The Child has admitted to taking drugs to calm himself down from these rages. From the Child’s behaviours, the Board concluded that the Child has a mental disorder within the meaning of the Act.

17The Board considered the clinical evidence before it that the Child had a mental disorder at the time of admission. The Board accepted the evidence of the mother that [the psychiatrist] diagnosed the Child with bipolar disorder. The Board accepted into evidence the Consultation Report of the Child Psychiatrist from the Health Centre with no objection from the Child’s counsel. The Child Psychiatrist from the Health Centre diagnosed the Child with oppositional defiant disorder (“ODD”) and considered the Child at high risk of developing bipolar disorder and conduct disorder. The Board also admitted into evidence the Admission Summary from Youthdale without objection from the Child’s counsel. The impression of the admitting psychiatrist from Youthdale was that the Child’s difficulty with authority was consistent with oppositional defiant behaviour and that the Child is at risk of developing bipolar behaviour. A diagnosis alone does not mean that the Child meets the criteria. However, the diagnoses given are consistent with the behaviours that demonstrate a substantial disorder of emotional processes, which grossly impaired the Child’s capacity to make reasoned judgments.

18Based on the clinical evidence before it and the behaviours of the Child, as described above, the Board finds that the Child has a mental disorder within the meaning of the Act.

19The Board was satisfied that criterion (a) was met at the time of the time of admission.

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.

20The Board was satisfied that the Child has, as a result of the mental disorder, attempted to cause or by words or conduct, made a substantial threat to cause serious bodily harm to himself and to his mother.

21The Child’s behaviour has recently decompensated and at the time of admission the frequency and severity of his violent episodes have increased to the point that the Child has made a substantial threat to cause serious bodily harm to himself and his mother. The Child has verbally threatened to harm his mother and has physically assaulted her with a broom, a hockey stick and punched her in the face. The use of these implements could have led to serious physical harm. The Child has threatened to kill his mother with a paring knife and pulled clumps of her hair out. A threat of death is one of serious bodily harm. These threats were not trifling or speculative but very real, in part because of the severity of the rages and the times that the Child did not remember what happened. Although not determinative, based on the Child’s threats and actions, the mother fears for her own safety and the safety of the sister whom she tries to keep safe by sleeping with her and making sure that the sister is never alone. The mother ensures that there are no knives in the house. She calls police for assistance when the Child is out of control. The Child’s violent behaviour has escalated recently and he was taken to the local hospital by police after he assaulted his mother with the plastic part of a hockey net. At the hospital, he had to be sedated. The letter from the Child Psychiatrist at the Health Centre in support of a referral to Youthdale gave the reason that the family is at risk of harm and that the Child is at risk of harming himself. Though the Child claims that he only said, “you might as well kill me”, the mother has testified that the Child threatened to kill himself when he was told of Youthdale. The Board accepts the mother’s testimony because the Child has periods of time when he does not remember what has happened.

22The Board finds that the Child’s behaviours have intensified and deteriorated rapidly in the last few months. As a result of his mental disorder, the Child has made substantial threats through his actions and verbalizations to cause serious bodily harm to himself and his mother. There were attempts to cause serious bodily harm and very real threats of serious bodily harm, given the Child’s volatility and the extent of his rages. His behaviours had progressed to the point that he required a police escort to the hospital and he required sedation at the hospital to keep him under control.

23The Board was satisfied that criterion (b) was 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.

24The 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 himself or others.

25The Psychiatric Crisis Worker testified to the resources that Youthdale has to prevent the Child from causing or attempting to cause serious bodily harm to himself or others. Youthdale offers a secure treatment program with a high ratio of staff to clients. The Child would be constantly monitored so that he would have no opportunity to harm anyone. It is also a locked unit so that the Child cannot leave the facility. There are no sharp objects in the unit and eating utensils are counted and collected.

26While at home, the Child had a tendency to harm the mother. At Youthdale, the Child will be away from the mother and not have the opportunity to harm her. The Child has threatened to harm himself. In a secure unit, the Child will be closely monitored and staff will intervene if the Child made any attempts to harm himself.

27The 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.

28The Board was satisfied that treatment appropriate for the Child’s mental disorder was available at Youthdale.

29The Admitting Psychiatrist at Youthdale indicated that the Child will require “wraparound intervention to change his trajectory”. The Psychiatric Crisis Worker testified that wraparound intervention is available at Youthdale to effectively integrate and co-ordinate psychiatric interventions and services. Youthdale has access to child psychiatrists and other medical professionals for the treatment of the Child’s mental disorder. Youthdale can also co-ordinate with other agencies to arrange for treatment of the Child. The Child and his family can take advantage of a family assessment and obtain therapy with [the doctor]. This therapy will be beneficial to the Child who reacts violently with his mother.

30The Board was satisfied that criterion (d) has been met.

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

31The Board was satisfied that no less restrictive method of providing treatment appropriate for the Child’s mental disorder is appropriate in the circumstances. After the Child’s release from the Health Centre, the Child was very angry, hyperactive and could not calm down. The mother contacted [program] and was waiting to complete the intake scheduled for May [ ], 2012. The mother also contacted the Society for services. The Society recommended Youthdale to the mother and wrote a letter to the Health Centre on her behalf asking for support for a referral to Youthdale. The Child Psychiatrist at the Health Centre responded with support citing the lack of mental health support for the family in the community and that the family and the Child are at risk of harm when the Child is challenged. The mother indicated that even though the Child had a diagnosis from the Health Centre, she wanted a comprehensive assessment from Youthdale since she had differing diagnoses from [the psychiatrist] and the Health Centre. After a 4 year process, Youthdale was the last resort.

32The mother has accessed resources available in her community of [city]. She has made use of her family doctor who referred her to the [ ] program. The Child attended for a while and was asked to leave due to his behaviour. The family doctor referred the Child to see a psychiatrist, [ ]. The Child attended for four sessions in March and April of 2011. [The psychiatrist] diagnosed the Child with bipolar disorder and prescribed Trileptal. After taking the medication for ten months, the mother found it not to be effective and the Child’s behaviour escalated again.

33The Board must determine whether a less restrictive option like outpatient therapy, brief hospitalization or unlocked residential treatment is appropriate. The Board finds that they are not because of the severity of the Child’s behaviours and the need for a locked environment to keep him and his family safe. The Child was taken to the local hospital where he was put on a Form 1. Following his release, the behaviours did not de-escalate. A short term contained environment did not prove effective. Due to the hospital’s inability to sufficiently treat the Child at the hospital, he was transported to the Health Centre which is in [city].

34The Society has been involved, though it is not clear what resources were offered to the mother, if any. After the Child’s discharge from the Health Centre, the mother contacted the Society. The Society’s recommendation was that the Child be referred to Youthdale. The Board was not aware of whether the Society explored residential treatment options for the Child. The question for the Board was whether such an option (which would not be locked) would be appropriate to treat the Child’s mental disorder. The Board determined that due to the unpredictability and instability of the Child’s moods and behaviour, a residential treatment placement would not be able to keep the Child and others at the residence safe.

35The Board was satisfied that in the circumstances of this Child, no less restrictive method of providing treatment appropriate for the Child’s mental disorder is appropriate.

36The Board was satisfied that criterion (e) has been met.

CONCLUSION

37Pursuant to section 124 (13) of the Act, the Board was satisfied that the criteria in subsections 124 (2) (a) through (e) have been met and therefore dismissed the application of the Child, under section 124(9) of the Act, on June 16, 2012.

CONFIDENTIALITY ORDER

38Parties and their representatives must not use, share or disclose any documents or information provided or used in this application with anyone including the media or on-line. Any documents or information shared by the parties must be used only for the purpose of the hearing of this application by the Board.