M. v. Youthdale Treatment Centres, 2013 CFSRB 31

CHILD AND FAMILY SERVICES REVIEW BOARD

M.

v.

Youthdale Treatment Centres

REASONS FOR DECISION

Date: June 25, 2013 Citation: 2013 CFSRB 31 Indexed as: M. v. Youthdale Treatment Centres (CFSA s.124)

INTRODUCTION

1M, (the "Child"), asks the Child and Family Services Review Board (the "Board") to review her May 30, 2013 emergency admission to the Secure Treatment Program at Youthdale Treatment Centre ("Youthdale"). The Child took the position that statutory criteria (a) (b) and (e) for emergency admission contained in subsection 124(2) of the Child and Family Services Act, R.S.O. 1990, c.C.11, as amended (the "Act") were not met.

2The Board was satisfied that at the time of her admission, the Child met all five criteria for emergency admission for the following reasons and therefore denied her request for release. The Child conceded criteria (c) and (d), therefore the Board will only provide reasons for criteria (a) (b) and (e).

BACKGROUND

3The Child is fourteen years old and resides with her mother and her brother. Her relationship with her mother has become increasingly difficult and turbulent resulting in the involvement of the , at the mother's request. At first, service was provided to the family under a temporary care agreement then later under a voluntary care agreement when it became evident that the mother was unable to care for the Child.

4The Child is described as very bright, vocal and gifted artistically. She has recently enrolled in an alternative school which she believes is more appropriate for her personality and talents.

ANALYSIS

5Section 124(13) of the Act provides that;

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 clause 124(2) (a) to (e).

6Section 124(2) sets out the criteria all of which must be met at the time of admission.

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.

Criterion (a) the child has a mental disorder.

7The Child's Family Service Worker (the "Worker") testified that the Child's behaviour has been escalating since she attempted to commit suicide by overdosing on Tylenol in January 2013. She was admitted to the crisis unit at [the hospital] January 24 to 31, 2013 for medical intervention. She was again admitted to [the hospital] from March 4 to 7, 2013 and diagnosed with Major Depressive Disorder, Anxiety Disorder, Polysubstance Abuse Disorder, Cluster B Traits and Parent Child Relational Problem.

8The Worker testified the Child was admitted involuntarily ("formed") at both [the hospital] on March 4, 2013 and at [another hospital] on March 19, 2013. She was also admitted to [third hospital] on May 29, 2013 and transferred to Youthdale the next day.

9Leading up to the emergency admission, the Worker stated that the Child's behaviour became increasingly negative at school and she talked about overdosing and using drugs and despite the utilization of a safety plan the Child continued to have suicidal thoughts and to act on those thoughts. The Child was not at school on May 27th, 2013 and her mentor saw her on the street and reported that the Child seemed to be high. She had told her mentor that she was "done" with school and she was moving.

10The Child went home the next day, took her belongings, and told her mother that she was moving to live in [another province] with her boyfriend whom the mother did not know.

11The Child called her Worker on May 29, 2013 to pick her up at a library after she became aware of an Amber Alert pertaining to her disappearance. The Child was without her personal effects and she was unable to give the Worker a coherent account of what had happened to them. The Worker described the Child as volatile and emotional and testified that she took her to [the third hospital]. The Child ran out of the hospital waiting room, across the road and got on a streetcar while they were waiting for the doctor. The Worker was able to run after her and return her to the hospital. The Worker further described the Child's mood as "hopeless" and she stated that the Child did not know what to do as she was in and out of sleep.

12The mother testified that she previously had a "good" relationship with her daughter but the relationship changed last year after they moved to [city]. She reported that the Child lost interest in school and all of the extra-curricular activities she previously enjoyed. She became suicidal, started to take pills and abuse alcohol.

13The Youthdale Director of Psychiatric Services (the "Director") believed that the Child was suffering from a mental disorder as defined in the Act because of her out of control impulsive behaviours, despite significant mental health interventions at multiple hospitals. The Director testified that earlier hospitalizations had led to several diagnoses and he believed that the Child had become emotionally dysregulated. With her extensive history of running away, significant suicide ideation and multiple impulsive overdoses the Child needed to be stabilized in a safe environment as she was incapable of making reasoned judgments.

14The Act states:

s.112 "mental disorder" means a substantial disorder of emotional processes, thought or cognition which grossly impairs a person's capacity to make reasoned judgments.

15From the evidence presented the Board finds on the balance of probabilities, that there was sufficient evidence to demonstrate that the Child had a substantial disorder of the emotional processes and thought at the time of admission which grossly impaired her capacity to make reasoned judgments. The evidence of the Worker was that the Child's behaviour has been volatile and escalating and that she was unable to control her emotional state. This resulted in four mental health related admissions to hospitals during the last five months and a diagnosis of DSM disorders. Despite extensive psychiatric interventions (one hospital stay was three weeks), the Child continued to run away from home; escalate her unsafe and impulsive behaviours and her attempts to hurt herself by trying to commit suicide. The Director gave evidence that the Child's impulsive suicidal behaviours, mood dysregulation and deterioration indicate that the Child's emotional processes, thought or cognition were grossly impaired as was her capacity to make reasoned judgments.

16The Board finds 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 others.

17The Child overdosed on Tylenol on two separate occasions. On one occasion Charcoal treatment was required. She was admitted to [the hospital] January 24-31, 2013. She self-presented at [the hospital] for containment and monitoring because she was contemplating jumping off a bridge March 4-7, 2013. She was admitted to [another hospital] on March 19, 2013 for three weeks because of attempted suicide by Tylenol overdose. Prior to this hospitalization the Child walked into a liquor store, took a bottle of rum and drank some of the contents. Her attending psychiatrist started her on Zoloft; however, the Child discontinued taking the medication. Prior to being admitted to Youthdale the Child was also admitted to [the third hospital] for one night. The Worker's testimony was that after the Child had recklessly run across the road to board a streetcar in an attempt to AWOL from her care while they were waiting at [the third hospital]; the Child told her "I am going to end up killing myself any way" in response to her concerns about the Child's safety.

18During the Child's testimony she did not deny that she had overdosed twice on Tylenol in suicidal attempts nor did she deny her emotional turmoil.

19The Board finds that in this case there was evidence that the Child made substantial threats and attempts to cause serious bodily harm to herself as a result of her mental disorder. The Child had attempted to commit suicide by Tylenol overdose on two occasions, one of which required charcoal treatment. There were four hospitalizations for mental health interventions since January of this year. Evidence of the Child's past suicide attempts, her escalating behavioural difficulties, impulsivity and emotional dysregulation clearly demonstrated that she was at serious risk of harming herself.

20The Board finds that criterion (b) was met.

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

21The Child was assigned a School Counselor, a Mentor and a [hospital] Social Worker for psychotherapy who offered to complete twelve sessions of cognitive behavioural therapy with her. The Worker reported that the Child attended three or four sessions with the Social Worker as she did not believe the therapy was useful. She met with the School Counselor two or three times for lunch or coffee and also discontinued the support. A Support Counsellor was also offered but the Child declined this service as she wanted to work on relationship building with her mother.

22The Child had been missing school and talking about overdosing which led to the utilization of a safety plan for her. This included a curfew, structure and calling home to check in. There was a safety plan instituted after the January suicide attempt but the Child testified that this plan was "who to contact for comfort" and the plan was "unhelpful" and she described it as a "quick fix". The Child had used the plan to self admit to the [hospital] for psychiatric treatment on March 4, 2013 after which she was discharged to the Society and placed at [a group home] on March 7, 2013. She was assigned a one to one worker while the Society investigated an appropriate placement for her through CARS (Centralized Access to Residential Services). The Child testified that a resident offered her drugs and threatened to harm her so she went AWOL after one day in this placement.

23On her return, the Child ran away again and after four days returned to her mother's home at which time she agreed to follow the safety plan, go to school and participate in cognitive behaviour therapy.

24The Child was able to follow the plan for a few weeks but on March 19, 2013 she was in crisis and overdosed on Tylenol. She also walked into a liquor store, took a bottle of rum, and drank some of the contents. She was admitted to [another hospital] where she was formed and admitted for three weeks. The Child's attending psychiatrist started her on Zoloft. She testified that the program was helpful and she found Art Therapy particularly beneficial along with the self-care program which included sleep schedule, morning running, going to school and rationalizing. However, she discontinued taking Zoloft after her release. Her testimony was that she did not feel that the meds were a necessity.

25The Worker testified that after this admission the Child was released to her mother on April 3, 2013 and the hospital recommended follow up by her family doctor.

26The Child testified that she returned to her old patterns a week after her return home and she did not find her counsellors helpful. After her mother found illegal substances in the home, the Child left and went to live with her friend. She became aware of an Amber Alert through the media and contacted her Worker who took her to [the third hospital].

27The Board finds that no less intrusive method of providing treatment would be appropriate for the Child based on the evidence presented. She had been placed on a safety plan, she was followed by a [hospital] Social Worker who had started a behavioural cognitive program, she had a Society Worker, a Mentor, a School Counsellor, she was removed from her difficult home environment to a group home and despite these interventions the child's behaviours continued to escalate. She ran away from the group home although she was assigned a one to one worker and she also ran away from her mother's home. The Child refused counselling, discontinued taking her prescribed medication and she continued her old behaviours which had resulted in four hospitalizations, including one that lasted three weeks. The Board concluded that no less restrictive method of providing treatment for the Child was appropriate due to her escalating impulsive suicidal behaviours and the necessity to contain her to keep her safe.

28The Board finds that criterion (e) was met.

CONCLUSION

29Pursuant to section 124(13) of the Act, the Board, having satisfied itself that criteria in subsections 124(2) (a) (b) and (e) have been met, and that criteria (c) and (d) were met, denied the application for release of the Child on June 7, 2013.

CONFIDENTIALITY ORDER

30Parties 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.