R.C. v. Youthdale Treatment Centres, 2013 CFSRB 37

CHILD AND FAMILY SERVICES REVIEW BOARD

R.C. v. Youthdale Treatment Centres

REASONS FOR DECISION

Date: August 2, 2013

Citation: 2013 CFSRB 37

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

INTRODUCTION

1R.C., (the “Child”), born October 17, 1997, asked the Child and Family Services Review Board (the “Board”) to review his July 9, 2013 emergency admission to the Secure Treatment Program at the Youthdale Treatment Centre (“Youthdale”). The Child took the position that criteria (a), (b), and (e) of the statutory criteria 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. Criteria (c) and (d) were conceded by the Child.

2The Child lived with his mother and his 11 year old brother prior to his current admission to Youthdale. The parents are separated, and the Child’s contacts with his father have become much less frequent in the last 4 months or so. The Child was at the Youthdale secure crisis unit earlier this year from May 6 until May 24. The clinical concerns at that time included a severe social anxiety disorder, parent-child relational problems, low self-esteem, perfectionism, difficulty in expressing and modulating intense feelings, and poor coping skills. He had been frequently truant from school. He spent most of the night playing video games in his bedroom. Upon discharge from Youthdale he went to his father’s home, but demanded a return to his mother’s home within the week.

3For the following reasons the Board is satisfied the Child met all the criteria for emergency admission at the time of his July 9, 2013 admission. His request for review is therefore dismissed.

ANALYSIS

4Section 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).

Section 124(2) sets out the criteria 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.

5Section 112 of Part VI Extraordinary Measures defines mental disorder:

“mental disorder” means a substantial disorder of emotional processes, thought or cognition which grossly impairs a person’s capacity to make reasoned judgements”.

6In the Form 14 “Statement of Reasonable Grounds For Admission to Secure Treatment” and in the Youthdale Admission Summary, completed at the time of the Child’s admission to Youthdale, the admitting psychiatrist states that the Child has a mental disorder, a substantial disorder of his emotional processes, as evidenced by his history of progressive social withdrawal and isolation. This opinion was also given in verbal testimony from the psychiatrist who dealt extensively with the Child during his previous admission to Youthdale in May of 2013. Neither psychiatrist sees a significant disorder of his thought processes, and the second psychiatrist recommends a psycho-educational assessment to determine if there is any disorder of the cognition process.

7The Child’s substantial disorder of the emotional processes manifests itself mostly in his almost total exclusion from any social interaction. Previously, the Child was doing well academically and especially in athletic activities, notably hockey and baseball. He finished grade 9 with marks in the 70’s and started grade 10 last September. Until the beginning of 2013, truancy was not an issue. Around the beginning of 2013, his academic performance started to deteriorate, and truancy was becoming a concern. In March he stopped going to school and has not been to any classes since then. Consequently, he has lost the bulk of his grade 10 credits. Overtures from teachers and from the school guidance counselor were not responded to at all, even though he told his mother that he was planning to go and meet with them. This decline in academic performance was paralleled by a substantial increase in the time he spent alone in his bedroom playing one particular video game [ ]. He started going to sleep later and later, and often played his game till 3 a.m. or later before going to bed. This resulted in his sleeping until early afternoon, when he would start playing the game again. His personal hygiene habits also deteriorated significantly.

8The Child has no friends, and spends all of his time alone. This is a significant change for a Child who has been involved very intensely in athletic activities. He displayed talent for both hockey and baseball. Late last year, he decided to drop hockey, and focus exclusively on baseball. He plays in one of the top teams in an elite competitive league. Around late April, he suddenly stopped going to his baseball games. He had effectively ceased to interact with team-mates, school class-mates, and anyone else in any social capacity. During the March school break, the Child travelled to [the United States] with his father to play and watch baseball practices. After the return home, he very quickly reverted back to his previous pattern of days spent sleeping, and evenings and nights spent playing his video game. A couple of days later, when he was to go to a baseball practice, he was lying down on his bed in his uniform, not moving (in a “catatonic state” as described by the father), and could not bring himself to return to baseball. His only stated reason was “I can’t face the kids”.

9The psychiatrist testified that the above behaviours were in line with a severe anxiety disorder and impairment in problem-solving abilities. The fear of criticism and others’ judgment has totally immobilized the Child. He avoids others, all the while more and more fearing their ridicule. Anti-anxiety medication has been prescribed, but the severity of his anxiety disorder makes it completely beyond being controlled or contained by medication alone.

10The Board has considered all the evidence and is satisfied, on a balance of probabilities that, at the time of admission, the Child had a substantial emotional processes disorder which grossly impaired his capacity to make reasoned judgments. The Child exhibits a severe anxiety disorder and an inability to think through the consequences of his actions.

11The Board finds criterion (a) was met at 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 or others.

12At this time, the Child’s threats and assaultive behaviour are directed at the parents, rather than at himself.

13The Board heard evidence that the serious bodily harm, directed at his mother, included throwing things at her, leading to police intervention on a number of occasions. At the suggestion of the police when they attended at the Child’s home on March 24, 2013, the Child left his mother’s home and went to his father’s home for a few days before returning to his mother’s home.

14One week later, another episode of verbal and physical aggression against his mother resulted in a further police intervention at his mother’s home. Then, the following week, on April 8th, the police removed the Child from the home, and took him to a local hospital, where he was detained for 72 hours on a Form 1. Upon discharge from the hospital, the Child was offered a spot in the ongoing alternative day school offered by the hospital. The Child indicated no interest in this schooling program and never attended. He was also given a suggested schedule to help him plan his activities and to become involved in issues other than his computer game. He never followed the hospital’s prescribed schedule.

15Further violence in the mother’s home led to yet another police intervention on April 17th. This resulted in the police calling in the Children’s Aid Society, out of their concern that the younger brother was at serious risk in the home.

16Another police intervention occurred on May 6th, again because of serious physical violence in the home, directed at the mother. As a result, an approach was made to Youthdale, and the Child was admitted on an involuntary basis on that same day. The Child was discharged on May 24, 2013. The Child believed that he had learned a lot from his placement at Youthdale, and staff agreed it was “worth a try” to release him. The plan that had been worked out between the Child and the Youthdale staff included a commitment from the Child that he would go back to school and back to baseball, and that he would go see the counselor at school. The day after his discharge, the Child emphatically told his mother that he was quitting baseball and quitting school. The Child did not implement any aspect of the plan that had been formulated with the staff.

17All attempts by the Child’s mother to get her son to go to school or to decrease the time spent at his video game were met with aggressive verbal rebuffs, and on a number of occasions with physically assaultive behaviour. A photo showing the mother’s arm on June 5, 2013 with 4 substantial bruises was submitted in evidence. Bruises on the legs were not photographed. An attempt to remove the video game was met with an aggressive response, both verbal and physical. The physical assaults usually consisted of a combination of throwing things at his mother, kicking her, and punching her.

18The Board is satisfied that there is ample evidence of serious threats and actual harm to others and that these are a result of the Child’s mental disorder and in particular his inability to control his moods and actions. The physically aggressive and assaultive behaviour towards his mother is escalating. The CAS has become involved out of concern for the safety of the younger brother in the home.

19The Board finds criterion (b) was met at the time of admission.

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.

20The Child conceded criterion (c).

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

21The Child conceded criterion (d) [without prejudice to his position on criterion (a)].

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

22Based on the evidence presented by the admitting psychiatrist and the crisis service youth worker, the Board was satisfied that no less restrictive method of providing treatment appropriate for the Child’s mental disorder was appropriate.

23A wide range of services were considered, but were not deemed appropriate in the circumstances. These services range from counselling at the school to much more intensive treatment at 3 children’s mental health centres, both on an out-patient counselling basis and a residential treatment basis. As well, services were offered by the psychiatrists at Youthdale, the Family Consultation Program at Youthdale, and the voluntary open residential unit at Youthdale. There was a referral to a co-ordinating organization for residential services which co-ordinates and sets priorities for referrals to various residential mental health settings.

24The serious long-term risks that the severe anxiety disorder presents for the Child, together with the likelihood that his condition will deteriorate if left untreated, and the reality that his condition is beyond the point where medication alone would be of significant help, are the factors that warrant placement in a secure setting. Compounding the issue as well is the Child’s refusal to attend any of the services that have been sought and offered.

25The Board is satisfied that given the Child’s serious condition, a locked setting was required. The admitting psychiatrist’s opinion was that the Child needed to be contained on a locked unit in order for any comprehensive assessment to be completed and a treatment program to be commenced.

26The Board finds that criterion (e) was met.

CONCLUSION

27Pursuant to section 124(13) of the Act, having satisfied itself that each of the criteria in subsections 124(2) (a) through (e) have been met, the Board dismissed the application for release of the Child on July 17, 2013.

CONFIDENTIALITY ORDER

28Parties and their representatives must not use, share, discuss or disclose any Board documents or decisions or any other documents or information provided or used in this application with anyone including through the media or on-line. The Board prohibits the use of any of this information for any purpose outside of the Board’s proceedings.