CHILD AND FAMILY SERVICES REVIEW BOARD
K.W.
v.
Youthdale Treatment Centres
REASONS FOR DECISION
Indexed as: K.W. v. Youthdale Treatment Centres (CFSA s.124)
INTRODUCTION
1K.W. (the “Child”), asked the Child and Family Services Review Board (the “Board”) to review her August 1, 2014, emergency admission to the Secure Treatment Program at Youthdale Treatment Centre (“Youthdale”). The Child took the position that the statutory criteria (a),(b), (c), (d) 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 her admission. The Child’s mother sought her daughter’s admission to the secure Youthdale program because of her aggression towards the mother and her behaviour in the community.
2The Board was not satisfied that at the time of the Child’s admission that criterion (a) was met as set out in subsection 124(2) and therefore granted the application for her release on August 6, 2014. The Board’s reasons address criterion (a) that the Child had a mental disorder but does not address criteria (b) through (e) as those criteria can only be met if there is a finding that criterion (a) was satisfied at the time of the Child’s emergency admission.
BACKGROUND
3The Child is fifteen years old and she resides with her mother and her seventeen year old brother. Her parents are divorced and she has sporadic contact with her father who has lived outside of the country for the last five years. The Child has frequently missed school since grade 7 and admits to smoking marijuana to help with her anxiety. She associates with older peers in the community.
4The mother reported that the Child was diagnosed with depression in 2013 and she was prescribed Prozac and Lorazepam during a visit to [the hospital]. However, the family doctor did not agree with the medication regime and took the Child off these medications after one week. Since the Child was openly smoking marijuana the family doctor did not prescribe any other medication. The mother reported that the Child was also diagnosed with Oppositional and Personality Disorders and she was admitted to [the hospital] in January 2014, because of superficial cutting. After one night she was transferred to [the second hospital] for three days. The mother also testified that Child told the police that she wanted to kill herself on July 22, 2014.
5The Child was assaulted twice while she was in the community by an 18 year old man. She suffered a concussion after the second attack. In July another older man assaulted her which resulted in injury to her knee. The Child’s boyfriend was eighteen years old and as reported by her mother he was a bad influence on the Child.
6The mother testified that the Child’s behaviour escalated this year. She ran away from home for five nights in March, 2014. After her mother reported her as a missing person she was found and taken to [the hospital] and released after one night. On July 9, 2014 the Child allegedly assaulted the mother with a cell phone and took up a vase to hurl across the room. The vase broke and the Child kicked it wounding herself for which she required seven stitches. She was taken to [the hospital] and held overnight.
7The mother testified that the Child had a onetime assessment with a psychiatrist at [Children’s Centre], they were involved with [the society] and the family had recently become involved with [Youth Services] and MST for intensive family services.
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
10The Board must decide whether each of the relevant criteria was met at the time of admission on the balance of probabilities.
Criterion (a): the child has a mental disorder;
11The Youthdale Psychiatrist on admittance of the Child did not make a provisional diagnosis. She testified that the Child was disregulated in her behaviour with her mother, she had difficulties in the community with peers and she was depressed as reported by her mother. The Psychiatrist cited the negative association of the Child with older individuals and their involvement with drugs and alcohol and the Child’s absence from home for five days in March 2014 as indicators of a mental illness. The Child had made a verbal comment regarding harming herself in July 2014 and she had been admitted to the hospital for this threat. She had also been admitted for superficial cutting in January 2014. The Psychiatrist testified that the Child had been defiant, she had abused substances, she lied and stole and she has not been attending school. Further the Child had been aggressive to her mother whom she hit with a cell phone.
12The Admitting Psychiatrist believed that the Child was suffering from a mental disorder as defined in the Act because of her risky behaviours in the community and the poor choices she made. She was unable to gage the Child’s cognitive status because the Child refused to talk to her. The Psychiatrist reported that all of the information regarding the Child was supplied by the mother. She also testified that she had not received any documents from the hospitals or the other doctors involved in the Child’s care and therefore there were no past medical records to take into consideration regarding past diagnosis or past care of the Child. The Admitting Psychiatrist believed that the psychiatrist who had treated the Child once supported inpatient intensive services to assess the Child; however, no proof of this was submitted to the Board and further the Board heard evidence that the family doctor had discontinued the prescribed medication for depression and anxiety after only one week.
13The Child and her mother received services from an organization that uses the Multi Systemic Therapy (MST) approach. The therapist from that organization testified that the organization worked short term to institute systems to support families. The therapist was assigned in March 2014 to provide in home family counselling for the Child’s family but the mother felt that individualized therapy for the Child was required because the counselling offered was primarily for the parent. The last program contact was on April 14, 2014 because the family was not engaged as the mother wanted a referral to an in-patient facility which the therapist was not in a position to make. This program was not a good fit and although a psychological assessment was discussed for the Child it was not completed. The therapist testified that there was a high level of conflict between the mother and her daughter and a safety plan was instituted to deal with “disengagement” if escalating behaviours were triggered. In March the Child had difficulties completing the MST Disclosure Statement and she had escalated with the mother and daughter triggering each other. The therapist reported that the Child was irritated that the services were not addressing her needs and this caused her to yell and scream and throw objects in the home. She noted that family sessions were often heated but sessions with the Child alone were quite calm. The therapist worked on a communication strategy for the mother and the Child to avoid triggering the Child.
14The mother testified that her daughter became ill with the flu last September after which she found it difficult to get up and go to school. She testified that the daughter became involved with an eighteen year old boyfriend and other older peers whom she believes were influencing her negatively. The mother also testified that her daughter had been assaulted three times in the community, once resulting in concussion and once hurting her knee. Two of these incidents resulted in charges being laid against the perpetrators. The mother reported that she did not allow her daughter to be home alone because she did not want her friends in her home. She noted that the Child broke into the home on two occasions with her boyfriend because she did not have a house key.
15The mother testified that the Child hit her during an argument with a cell phone and grabbed her hair. She further stated that the Child went on to throw a vase and kicked it resulting in cuts to her foot requiring seven stitches. She testified that this was not the first time that the Child had assaulted her. The mother also testified that the [society] psychiatrist and the [second hospital] psychiatrist both saw her daughter once; however, there was no proper diagnosis and one psychiatrist suggested it could be “trauma”. The mother believes her daughter is incapable of making good decisions about people and that she has been unable to keep herself safe in the community because of her poor choices.
16The Child testified that life at home was good until her mother stopped listening to her. She confirmed that she has been missing school since grade seven and currently did not feel like she should go as she is concerned about what other people will think of her. The Child testified that the mother attempted to rip out her belly and nose rings, she would not let the Child use the home phone to make appointments for therapeutic services referred to her by the [Youth Services] worker and the mother would lock her out of the home having taken away her key. The Child stated that when she and her mother argued the mother would swear at her and say if you don’t go I will call the police because she had “things on her”.
17The Child testified that her comment about killing herself on July 22, 2014 was unplanned and it just came out of her mouth. She did not mean to harm herself at that time and was not planning to do so now. She testified that she did cut her arms superficially in January and was admitted to [the hospital] for one night after which she was admitted to [the second hospital] for three days but she has not done any more cutting since that episode. The Child stated that she had spent a lot of time talking with her Child Protection Worker about how to communicate effectively with her mother but when she tried to be honest with her mother, she did not listen nor did she reciprocate. The family had been involved with the [society] since March 2014; however, Youthdale did not communicate with the [society] prior to the secure admission of the Child.
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.
19The Admitting Psychiatrist gave evidence that the Child’s risky behaviours in the community, her poor choices, emotional dysregulation and impulse control indicated that her emotional processes, thought or cognition were grossly impaired as was her capacity to make reasoned judgments. She noted that the Child’s impaired judgment resulted in her history of defiance, hanging out with older male peers, sexualized behaviour, substance abuse and attachment issues; however, no provisional diagnosis of mental illness was recorded on the Admission Summary during the Child’s admittance to Youthdale.
20The evidence of the mother is that the Child’s behaviour had been escalating and that she was unable to control her emotional state and out of control behaviours. She believed that inpatient; intensive treatment was required for her daughter so she had sought the Youthdale placement for her Child. The Child testified that she did not want inpatient treatment and was open to community treatments and that she had tried to communicate with her mother but the mother did not listen to her.
21The Board finds that sufficient evidence was not presented to demonstrate that the Child had a substantial disorder of her thoughts and emotional processes at the time of her admission to Youthdale which grossly impaired her capacity to make reasoned judgments. The Board did not find that the Child’s dysregulation and aggression towards her mother or her behaviour in the community indicated gross impairment in her capacity to make reasoned judgments. The Board finds that there was insufficient evidence before it to conclude that the Child had a mental disorder within the meaning of the Act.
22Youthdale did not provide a provisional medical diagnosis that indicated that the Child has a mental disorder. The behavioural evidence before the Board did not establish the existence of a mental disorder. 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. While the Child showed poor judgement in her behaviour and relationships, the evidence did not indicate that her behaviour was so out of control as to indicate that her capacity to make reasoned judgements was grossly impaired.
23The Child ran away from home yet she kept her presence up to date on social media of which the mother was aware. The mother testified that the Child was engaged in risky behaviours such as drug and alcohol use, friendships with inappropriate older peers and sex with older men; however, the Child testified that her mother had locked her out of the home and would not allow her to be there alone therefore she had to spend time in the community. The Child also testified that the mother would not let her use the home telephone to confirm services which were being offered to her by her worker and the mother did not engage with her in relationship building to enhance their communication.
24The Board finds that the behaviours recounted by the mother may indicate that the Child displayed poor judgement in the community; however, it does not prove that she has a mental disorder which grossly impaired her judgement.
25The Child engaged in one incident of superficial cutting. She admitted that she did make a statement about killing herself but explained that she did not actively want to harm herself. She said the statement was unplanned and just came out of her mouth. She was placed on medication for anxiety and depression for one week which was discontinued by her family doctor who did not agree with this medication regimen. She had been seen by two psychiatrists on two separate occasions; however, no psychological assessments were completed and no medical reports from these doctors were placed before the Board.
26There was some evidence of emotional dysregulation that led to bad judgment but the evidence is unclear as to whether the family dynamics triggered some of the Child’s behaviours in the home and in the community. The Child testified that the relationship breakdown between her mother and herself makes frank and honest communication impossible between them and the therapist’s evidence suggested that the Child was calm when she was not in the company of her mother.
27The Board finds that criterion (a) was not met.
28Pursuant to section 124(13) of the Act, the Board, having satisfied itself that criterion (a) in subsection 124(2) has not been met, granted the application for release of the Child on August 6, 2014.
CONFIDENTIALITY ORDER
29Parties 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.
NATHALIE FORTIER
_____________________
Nathalie Fortier Presiding Member
LORNA KING
_____________________
Lorna King Panel Member
JOHN SPEKKENS
_____________________
John Spekkens Panel Member
Dated at Toronto, Ontario on the 15th day of August, 2014.