R.C. v. Youthdale Treatment Centres, 2014 CFSRB 26

CHILD AND FAMILY SERVICES REVIEW BOARD

R.C.

v.

Youthdale Treatment Centres

REASONS FOR DECISION

Date: June 5, 2014

Citation: 2014 CFSRB 26

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

INTRODUCTION

1R.C. (the “Child”), asked the Child and Family Services Review Board (the “Board”) to review his May 21, 2014, emergency admission to the Secure Treatment Program at Youthdale Treatment Centre (“Youthdale”). The Child took the position that the 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 at the time of his admission. The Child’s mother sought his admission to the secure Youthdale program because of the Child’s severe depression and his suicidal ideation.

2The Board was satisfied that at the time of the Child’s admission he met all of the criteria for emergency admission and his request for release from Youthdale was therefore denied. The Board will only provide reasons for criteria (a), (b) and (e) in subsection 124 (2) of the Act because the Child conceded criteria (c) and (d).

BACKGROUND

3The Child is twelve years old and lives with his mother and half-sister. His parents have joint custody and he rarely sees his father. Visits became more sporadic during the last three months because the Child did not want to see his father who allegedly behaved inappropriately during visits and exposed the Child to adult sexual situations.

4The Child was diagnosed with major depression, epilepsy and a conversion disorder. He has been prescribed Epival, Lamictal and Abilify and he completed a six week Prozac trial but reported that it did not help his mood.

5The Child rarely attends school because he is bullied verbally and physically and as a result of a physical encounter, he suffered a concussion in June, 2012. The bullying began in 2010 and despite corrective measures taken by the school to rectify the situation, the bullying has continued.

6The Child allegedly engaged in cutting himself superficially and he became increasingly depressed and sad. He was hospitalized for three days in November 2013, for depression and outpatient services were recommended for follow-up. He wrapped a cord around his neck at school in March 2014, and talked about ending his life to his teacher. He was hospitalized overnight. The Child also told his teacher there were too many sharp things in the class and that he might hurt himself or others so the school called his Mother to remove him from the class room in April 2014.

7The Child was sad and not interested in activities like reading or going to school. He was referred to [Family Services] an organization that provides counselling and related support services to youth. He has had the services of a Child Psychiatrist, Intensive Child and Family Counselling provided by [a Children’s Centre], his School Social Worker and resources from the CAS but despite the therapies and interventions the Child’s moods worsened and he told his Mother that he was sad at least twenty times per day. The Mother reported that the Child began to avoid eating, he could not follow through with chores or instructions and he was stealing and lying about monetary issues. He also complained of pains, feeling dizzy, and chronic (sometimes daily) migraines.

ANALYSIS

8Section 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).

9Section 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 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;

10The Youthdale Psychiatrist on admittance of the Child made a provisional diagnosis of Major Depression Disorder and Parent-Child Relational Problem. The Psychiatrist testified that the Child expressed past and ongoing despair and thoughts of ending his life.

11The Admitting Psychiatrist believed that the Child was experiencing a mental disorder as defined in the Act because of the Child’s emotional dysregulation, mood instability and impaired emotions. He believed that the Child’s emotions are distorted, compounded by his inability to control his impulses. He noted that the Child has been unable to plan his life and that he struggled despite significant mental health interventions. The Psychiatrist testified that the Child has expressed suicidal ideation and he needed to be stabilized in a safe environment. The Admitting Psychiatrist assessed the Child as a high suicide risk due to his emotional labiality and his inability to make reasoned judgments in his emotionally disregulated state.

12The Admitting Psychiatrist testified that the Child has expressed past and ongoing despair, he had expressed thoughts of ending his life, his low self-esteem and despair did not feel good and this provided internal conflict for the Child. The Admitting Psychiatrist believed that the Child’s long standing dysthymic disorder affected his judgment because it reflects an overly distorted sense of self and consequently contributes to his emotional disorder. Although the Admitting Psychiatrist believed the Child’s emotional impairment impelled him to act in ways which were harmful to himself and others, he could not confirm that there was also cognitive impairment. The Admitting Psychiatrist believed there was serious risk of the Child harming himself because he could not make reasoned judgments due to his emotional impairment and pattern of mood fluctuation.

13The Mother testified that the Child’s depression has worsened and he is very sad and helpless and lonely. She tried to distract him by buying him things like an iPod and taking him on trips but that did not help. He had issues with lying and stealing and he ran away twice in May 2014. Once he ran from home and he was later found in his friend’s shed. He said that he was going to his grandparents. On another occasion he ran from school after which he was taken to the mental health unit at the hospital and admitted.

14The Mother reported that the Child began to self-harm by scratching and pricking his arm superficially with a protractor and a needle and told his mother that he did not know why he did it. The Child expressed that he felt unsafe and afraid of hurting himself and he refused to sleep in his own room. At first he slept on a mattress on the floor of the Mother’s room then in her bed because she was afraid that he would hurt himself.

15The 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.

16The Admitting Psychiatrist gave evidence that the Child’s impulsive behaviours, emotional dysregulation, unstable mood and chronic depression indicated that his emotional processes, thought or cognition were grossly impaired as was his capacity to make reasoned judgments. He stated that the impaired and distorted emotional state of the Child had resulted in his acting in ways which were harmful to him. He was impulsive and he had been hospitalized for suicide ideation; he had started to cut himself and was increasingly hopeless and despairing. The Admitting Psychiatrist believed that the Child needed a safe space to address these concerns.

17The evidence of the Mother was that the Child’s behaviour has been escalating and that he has become increasingly sad and depressed and unable to control his emotional state. Despite extensive psychiatric interventions the Child has continued to escalate his impulsive behaviours and suicidal ideation.

18The Board finds that there was sufficient evidence presented to demonstrate that the Child had a substantial disorder of the emotional processes at the time of his admission which grossly impaired his capacity to make reasoned judgments. The Board accepted the Admitting Psychiatrist’s evidence that the Child’s impulsive suicidal behaviours, emotional dysregulation and mood deterioration, indicated that his emotional processes, thought or cognition were grossly impaired as was his capacity to make reasoned judgments.

19The 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.

20The Mother reported that the Child had wrapped a cord around his neck in March 2014 while at school and expressed to his teacher that he wanted to die, he ran away from school on May 9, 2014 and he was taken to [a hospital]. On May 11, 2014, the Child went to a birthday party, stole $100.00 dollars from his friend’s room and spent it. On May 13, 2014 the Child was found in an abandoned shed with a packed backpack. He said he was trying to get to his grandparents who lived in another town far away. He had been afraid of hurting himself with the sharp objects in his classroom at school which resulted in his teacher calling the Mother to take him out of school. At home he was afraid of sleeping in his room because he did not want to harm himself, subsequently he slept with his Mother.

21The Admitting Psychiatrist testified that the Child was at serious risk of hurting himself because of his emotional impairment and distorted thinking which leads to impaired judgment and self-regulation.

22The Board finds that there was evidence that the Child made substantial threats and attempts to cause serious bodily harm to himself as a result of his mental disorder. The Child had attempted to commit suicide by strangulation for which he was hospitalized, he had talked about running into the road and he was hopeless and despairing and unable to plan his life. He expressed that he might harm himself at school with the sharp objects in the classroom as well he was afraid to be alone in his bed and started to sleep with his Mother because of his fear that he would harm himself. He ran away from home and away from school in May 2014 and he started to superficially cut himself. His escalating behavioural difficulties, impulsivity and emotional dysregulation demonstrated that the Child was at serious risk of harming himself.

23The Board accepted the Admitting Psychiatrist’s testimony that the Child’s impaired judgement led to conduct which was putting him at considerable risk of harm.

The 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.

24The Child was diagnosed with depression and a conversion disorder approximately two years ago. He was treated by his family doctor and a Child Psychiatrist. He also received individual psychotherapy and counselling through [Family Services] and has participated in weekly intensive child and family therapy through [Children’s Centre]. The CAS provided a mental health nurse to expedite services for the family and the School Social Worker also provided support.

25In November 2013 the Child was hospitalized in the [Psychiatric unit for children and adolescent] for 3 days for mental health issues, in March 2014 he was taken to [a hospital] for suicidal ideation and admitted. The Child’s Mother testified that her son’s psychiatrist saw him every week for eight weeks beginning in early March of 2014 to monitor his condition. The psychiatrist prescribed Prozac for the depression but it was discontinued as the Child stated that it made him more depressed. He started to take Abilify on May 19, 2014. The Child also takes Epival and Lamictal for Epilepsy.

26The Board finds that no less intrusive method of providing treatment would be appropriate for the Child based on the evidence presented. He had a CAS Worker, a Child Psychiatrist, a Counsellor, a Family Doctor and a School Social Worker, he had been hospitalized twice since November 2013, he was taking prescribed medications and despite these interventions and services the Child’s problematic behaviours continued to escalate. He ran away from home and school, he refused to attend school regularly, and he expressed fears of hurting himself both at home and at his school. The Child had put a cord around his neck and told his teacher that he wanted to die and he had told his Mother he felt unsafe. The Admission Summary states that the Child’s psychosocial stressors since January has made the Child more sad and that he had the idea that life is not worth living and he said that he felt like running into the streets.

27The Board concluded that no less restrictive method of providing treatment for the Child was appropriate due to his escalating impulsive behaviours and the necessity to keep him safe. The Board accepted the Admitting Psychiatrist’s testimony that the Child’s unstable presentation compromises his safety and that he required the secure unit for stabilization and assessment.

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, denied the application for release of the Child on May 29, 2014.

CONFIDENTIALITY ORDER

30Pursuant to Rules 30.1 and 30.2 of the Board’s Rules of Procedure parties 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.