R.D. v. Youthdale Treatment Centres, 2014 CFSRB 42

CHILD AND FAMILY SERVICES REVIEW BOARD

R.D.

v.

Youthdale Treatment Centres

REASONS FOR DECISION

Date: August 7, 2014

Citation: 2014 CFSRB 42

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

INTRODUCTION

1R.D., the “Child”, asks the Child and Family Services Review Board (the “Board”) to review her July 29, 2014 emergency admission to the Secure Treatment Program at the Youthdale Treatment Centre (“Youthdale”). Her position is 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.

2The Board is satisfied that the Child met all the criteria for emergency admission at the time of admission. Her request for release from Youthdale is therefore dismissed. Since the Child conceded criteria (c) and (d) in subsection 124(2) of the Act, the Board will only give reasons for its findings concerning criteria (a), (b), and (e).

BACKGROUND

3The Child is a 15 year old girl who was apprehended at birth, placed in a foster home and adopted by her paternal grandparents. Her biological father lives in [province] and has not had much contact with her in the past several years. Her biological mother lives in [city] and has periodic phone contact with her. At the age of 5, the Child reported that she was sexually molested by a relative. She is currently in grade 9, has not attended school regularly and has only achieved 3 credits to date.

4[ ] (the “Society”) has been involved for the past several years due to conflict between the Child and the grandparents. During the past year the Child has refused to live with her grandparents. In September 2013 a Temporary Care Agreement was signed with the Society. In July 2014, the grandparents regained legal guardianship of the Child. The grandparents obtained a Form 2 from Court and the Child was apprehended by police and taken to the local hospital. From there, she was transported by ambulance to Youthdale on July 29, 2014.

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).

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

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.

Section 112 of the Act defines mental disorder as:

a substantial disorder of emotional processes, thought or cognition which grossly impairs a person’s capacity to make reasoned judgments.

Criterion (a) the child has a mental disorder.

6The psychiatrist (the “Psychiatrist”) who is the Director of the Secure Crisis Unit at Youthdale testified and spoke to the Admission Summary completed by the Admitting Psychiatrist. Based on a review of the documents, the Psychiatrist was of the opinion that the Child suffers from a mental illness within the meaning of the Act. Though he has not had direct contact with the Child, the Psychiatrist can form an impression from the documents. He was very concerned that the Child is suffering from mood instability resulting in impulsive self-harming behaviour. Based on her history, the Child engaged in behaviours of self- injury and threats of self- harm when upset. He noted that the Admitting Psychiatrist believed that her behaviours may be related to past trauma, attachment issues and breakdown in relationships. When stressed, the Child has difficulty regulating her behaviour and making reasoned judgements. Cognitively, the Psychiatrist did not think that the Child suffers from disorders of thought or cognition. There is no distortion of perception such as hallucination or paranoia. However, the Psychiatrist spoke to the Child’s difficulties relating to maintaining her emotional affect. The Child has an existing emotional process disorder, and there are concerns about an undiagnosed depression. Her emotional dis-regulation leads to impulse control issues. When stressed, the Child responds unsafely without using her intellectual skills. Her judgement is impacted leading to hospitalizations from threats of suicide and self- harm.

7The Family Service Worker was supportive of the Child’s admission to Youthdale. She believed that the Child’s behaviour has escalated over the past year and this has resulted in multiple living arrangements which broke down because the Child would not return home. The placement families did not feel that they could keep her safe. She has refused to live with her grandparents and was placed with an aunt and uncle last summer. Then, she moved to a kin family which the Child found on her own and she stayed there until May 2014. After that, she moved in with her principal’s family to finish the school year, but the same pattern of behaviour of not returning home recurred. Shortly after moving in with the principal, the Child’s behaviour escalated. She refused to go to school and went to the local coffee shop or with boyfriends she barely knew. The Family Services Worker stated that the Child had multiple boyfriends, one who was 28 years old and was an adult offender. She would put herself in unsafe situations by going over to his residence. The principal could not care for her any longer and the Child moved back with her grandparents in July 2014 and stayed there for a week before moving in with a boyfriend whom she had just met.

8The grandparents stated that living arrangements at the boyfriend’s family were very unstable with many people and infants living there. They could smell the odour of marijuana from the driveway and on the Child’s clothing. At times, she would appear to be “high”. The grandparents, on direction from the family doctor, refused to give the Child medication to take on her own when she was living with the boyfriend since they had to monitor the effects and the dosage and could not do so when the Child was not living in their home. The Child refused to go over to the grandparents to take the medication and, as a result, she had not taken her medications for several weeks prior to admission.

9In May 2014, the Child spoke of an actual plan for suicide while at school. She was taken to the local hospital and later transferred to a hospital with a psychiatric unit and involuntarily admitted for several days. On June 29, 2014, the grandparents were concerned about the Child’s mood and threat to kill herself and called police. Police escorted her to hospital where she was again involuntarily admitted for 3 days. When discharged, she went back to live with the boyfriend.

10In July 2014, the grandparents regained legal guardianship of the Child and sought a Form 2 in court because they were concerned about the Child’s decompensation, her unstable living arrangements and her safety.

11The Family Service Worker considered that the suicide issues, the hospitalizations, the Child’s deterioration in hygiene, the issue with the medication and the Child’s refusal to engage in any programs voluntarily were determinant factors for emergency admission.

12The Board accepted the evidence of the Psychiatrist that the Child at the time of admission had a mental disorder within the meaning of the Act. The Psychiatrist noted that the Child’s emotional processes are so dis-regulated that when under stress, she cannot make reasoned judgements. That the Child’s judgement is grossly impaired is reflected in the two involuntary admissions to hospital in order to stabilize and keep her safe. Of particular concern is the Child’s rapid decompensation within the last few months when she had to be hospitalized twice for threats to kill herself. The fact that the Child had a very graphic plan to kill herself demonstrated a substantial disorder of emotional processes, thought or cognition which grossly impaired her capacity to make reasoned judgements. The Board found that there was sufficient evidence to show that the Child had a mental disorder within the meaning of the Act.

13The Board is 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 herself or others.

14The Psychiatrist was concerned about the Child’s developing depression and her family history of completed suicides by her maternal grandmother, great grandmother and two paternal great uncles. Her family history was significant for increased risk for the Child. The Child has engaged in threats of suicide, had police involvement and hospitalizations to keep her safe and has been prescribed anti-psychotics to stabilize her moods and regulate her affect.

15The Board asked specific questions of the Psychiatrist with regards to the level of risk that the Child faces. He responded that her acute risk level is moderate, but that her chronic risk level is high. This is all the more significant in view of the family history of successful suicides.

16The Family Service Worker stated that in May the Child spoke of a suicide plan to hang herself on the deck of her placement home. She was taken to hospital by school staff, transferred and involuntarily admitted to another hospital with psychiatric services. She was again involuntarily admitted on June 29, 2014 at the local hospital following threats of self-harm.

17The Family Service Worker was also surprised that at the time the Child moved back with her grandparents her hygiene had decompensated very noticeably and that the Child was refusing to care for herself.

18The grandparents stated that the Child and the boyfriend’s brother have told them that the Child was cutting herself. However, due to the Child living away from them and usually wearing long sleeves, they have not observed any cuts.

19The Board was satisfied that the Child has made substantial threats to cause serious bodily harm to herself and that these are a result of the Child’s mental disorder. The Board considered that the Child did not just make a general threat to kill herself, but had thought about and devised a plan with a method and a location to commit suicide. She had planned to hang herself on the deck of her current residence. This method of suicide was used by her grandmother and great grandmother with success. The Board also considered the risk level of the Child as given by the Psychiatrist. All of this along with her recent decompensation in behaviour and emotional dis-regulation constituted a substantial threat, that is, a very real chance that the Child could have caused serious bodily harm to herself.

20The Board is satisfied that criterion (b) has been met.

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

21The Family Service Worker testified that the Child was receiving services in the community but she would sometimes attend but not engage. She was seeing a psychiatrist through the Telepsychiatry Program but did not attend the last session. When she did attend, she did not engage and would leave the session early. The Child had about 7 or 8 of these sessions. The Child also received counselling from a Society counsellor. She has also refused to see her. She was not taking her medications at her last residence because of issues with administering the drugs safely. The Family Service Worker has spoken to the Child about a voluntary placement at a residential mental health treatment centre multiple times within the last year. However, the Child was unwilling to even take a pre-placement visit at the residence. Since the placement is voluntary, the Child’s consent is required. The Family Service Worker does not feel that the Child is a good candidate for a voluntary placement. Every time that the Child had to move from a placement, she would say that she will run if placed in a foster home, or the grandparents’ home.

22The Psychiatrist stated that the Child has been hospitalized but it has not been demonstrated that she is able to be stabilized in the community. Though the service provided by Youthdale may be more intrusive in some ways, Youthdale is a secure setting and has a longer time frame to stabilize the Child and thus can provide more meaningful service. Youthdale has up to 4 weeks to stabilize the Child, review her medications, assess her and provide her with a long term plan. The Psychiatrist believes that this is the best program to provide the Child with that plan.

23The Board was satisfied that no less restrictive method of providing treatment for the Child’s mental disorder was appropriate. The Child was not benefitting from services offered in the community and she has rapidly decompensated within the last months. She has refused to go to a voluntary residential mental health treatment centre and has often threatened to run if she is not placed where she wants.

24The Board is satisfied that criterion (e) has been met.

CONCLUSION

25Pursuant to section 124(13) of the Act, the Board, having satisfied itself that each of the criteria in subsections 124(2)(a) through (e) have been met, dismissed the application for release of the Child on August 2, 2014.

CONFIDENTIALITY ORDER

26Pursuant 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.

JOHN SPEKKENS

_____________________

John Spekkens

Presiding Member

ALINA LAZOR

_____________________

Alina Lazor

Panel Member

MARY WONG

_____________________

Mary Wong

Panel Member