CHILD AND FAMILY SERVICES REVIEW BOARD
S.B.
v.
Youthdale Treatment Centres
REASON FOR DECISION
Indexed as: S.B. v. Youthdale Treatment Centres (CFSA s.124)
INTRODUCTION
1S.B. (the “Child”), made an application to the Child and Family Services Review Board (the “Board”) to review his January 7, 2015, 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 Children’s Aid Society (the “Society”) sought the Child’s admission to the secure Youthdale program because of his violent and aggressive behaviour in his parents’ home.
2The Board was not satisfied that, at the time of the Child’s admission, criterion (e) was met as required by s. 124(2). For that reason, the Board granted the application for his release on January 14, 2015. The Board’s reasons address criterion 124(2) (a) (b) and (e) because the Child conceded criterion (c) and (d) of the Act.
BACKGROUND
3The Child is fourteen years old. He resided with his parents and an older brother and attended school where he was on the Honour Roll. He refused to attend school beginning in June 2014 and he also stopped seeing his friends. The Child stayed in the home for more than seventy days during the summer of 2014 isolating himself from all social activities. He would not participate in any of the athletic activities suggested by his father, instead he played computer games all night for twelve to fifteen hours until he was tired, after which he slept and then he would awaken to play again. His father found him asleep in the bath with the water running and was afraid for his son’s safety. The Child was tired and sleepy as a result of his nocturnal activities.
4The Child also began to display sexualized inappropriate behaviours in the home and he developed significant concerns about his body image which led to his purging three times per day, in an effort to reshape his body. Further he would cover all the windows in the home so it would be dark, he neglected his personal grooming and he became angry and violent towards his parents.
5The father reported that the Child attended [ ] Hospital on three occasions where he was stabilized and sent home. Once he was kept overnight on a Certificate of Involuntary Admission (form 3). He also stated that the family doctor diagnosed the Child as suffering from severe depression and recommended that the parents take him to his paediatrician but the Child refused to attend.
ANALYSIS
6Section 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).
7Section 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;
8The Youthdale Psychiatrist on admittance of the Child, indicated on the Admission Summary that he seems to have met the criteria for depression over the summer. She also diagnosed a history of social anxiety on the Admission Summary. The Psychiatrist testified that the Child was anxious and he would not answer her questions. She was aware of the concerning behaviours, his need for darkened rooms, excessive video playing during the night which could lead to the disruption of the circadian rhythm (especially for children attending school), his withdrawal and his self-esteem issues and aggression in the home. The Psychiatrist believed that the Child had suffered from a depressive episode and she was concerned that some of his symptoms might be the prodromal symptoms for a psychotic episode based on his family history. The Psychiatrist referred to a [Mental Health Centre] dated December 16, 2014 which concluded that the Child would have likely met the criteria for a Major Depressive Episode during the summer and that his symptoms could also be the early stages of an illness preceding a full blown disorder.
9The Admitting Psychiatrist stated in the Admission Summary that the Child was suffering from a mental disorder as defined in the Act because of his,
a) Aggression (he had assaulted his parents and damaged property in the home including computers, TV and doors);
b) Mood Issues, (he was socially withdrawn, he lost interest in school, he had displayed sexualized behaviours, he had anger outbursts, there was deterioration in his hygiene grooming and he felt anxious with racing heart since April 2014;
c) Body Image Issues (he purged after meals since April 2014);
d) Addiction to video games
e) Other bizarre behaviours, covering windows to keep the home dark, he did not want to interact, participate or go out.
She testified that she was unable to gage the Child’s cognitive status because of his refusal to talk to her, answer her questions or make eye contact with her. She noted in the Admission Summary that the Child’s hands were sweating, his heart was racing and he had difficulty breathing because of his anxiety during their interview.
10The information supplied by the [Mental Health Centre] assessment, the father and other collaterals led the Psychiatrist to believe that the Child was suffering from a mental disorder as defined in the Act. The psychiatrist stated that the Child made suicidal comments to his father, behaved aggressively with his family and he became isolated and withdrawn during the summer. She believed his judgment was poor, based on his history, and his insight was limited.
11The Child’s father testified that his son had friends in school and was enjoying a very successful year having been accepted into a gifted program in 2014, when he stopped attending school. He spent over seventy days at home playing video games for 12-15 hours each night. The father stated that he was afraid for the safety of the Child whom he found asleep in the bath with the water running. The Child also began to purge at least three times daily because he had developed significant concerns about his body image. He also started behaving in a sexually inappropriate manner towards his mother and father despite their attempts to explain appropriate behaviour and boundaries in the home. When the Child was angry he became aggressive towards his parents and spat at them, broke a fan, tried to choke his father, broke his father’s rib, hit him with a cane which required medical attention, hit his mother, broke an arm chair, and broke two computers and a TV monitor. The father also stated that the Child had threatened to kill himself on four occasions rather than live in a Society placement.
12The father testified that he had taken the Child to [ ] Hospital on three occasions during the last year and he would stabilize after which the hospital would discharge him. On one occasion he was kept overnight on a Certificate of Involuntary Admission (form 3). The child refused mental health intervention from a neighbourhood walk in clinic and also from his pediatrician when he resided with his parents.
13The Society’s Children’s Service Worker (Society Worker) testified that after the violent September incident the Child was taken into the Society’s care. He lived in an open custody facility for the majority of the time from September until his admission to Youthdale because of his refusal to be placed in a Society home. He had fears that a Society placement would not be in his best interest. During this time he saw the facilities’ psychiatrist on seven occasions and there were no reports of his purging. In this structured environment there were only minor complaints regarding the Child’s behaviour and there were no reports of any major outbursts during the months of October 2014 to January 2015 from staff.
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 his capacity to make reasoned judgments. The evidence of the Worker was that the Child’s behaviour while he lived at home was volatile and violent towards his parents and this resulted in his being apprehended into the care of the Society. The father gave evidence of the Child’s out of control behaviours and anger outbursts. He hit his mother and beat his father with a cane resulting in a broken rib and stitches as well he damaged property in the home.
16There were three mental health related attendances at [ ] Hospital in the summer of 2014. The admitting psychiatrist described the Child’s behaviours as high risk due to his anxiety which she testified could lead to self-harm. She also believed the symptoms could be the prodromal phase for a psychotic episode because of the family’s history of schizophrenia. She based this observation on the Child’s loss of interest, social withdrawal, poor self-care and unusual bizarre behaviours.
17Despite psychiatric interventions at the hospital the Child continued his violent behaviours in the home; he withdrew socially and behaved in an unsafe manner. The Board heard of the Child’s mood dysregulation, his self-esteem issues, his unusual behaviours, angry outbursts towards his parents and property damage in the home, an indication that the Child’s emotional processes, thought or cognition were grossly impaired as was his capacity to make reasoned judgments.
18The Board finds that criterion (a) was met.
19The Board is satisfied that at the time of his admission the Child had a mental disorder within the meaning of the Act. A mental disorder is defined under the Act as a substantial disorder of emotional processes, thought or cognition, which grossly impairs a person’s capacity to make reasoned judgments.
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 Board is satisfied that the Child, as a result of his mental disorder, has by his conduct made substantial threats to cause serious harm to himself and to his family. He has assaulted his parents and threatened to kill himself if he was placed in the care of the Society. The Admitting Psychiatrist linked the Child’s behaviours to the actions described to her by the father and the [Mental Health Centre] report at the time of admission and testified that in her opinion criterion (b) was satisfied.
21The father testified that the Child’s behaviours changed in June 2014 when he refused to attend school or go outside. When the father attempted to get him to resume school attendance in June and September 2014, the Child became angry and violent. The father stated that Law enforcement was called 19 times in the summer because the Child hit his mother, choked the father and hit the father with a cane breaking his rib and cutting him in the head for which he required stitches. As well he would lock them out of the home or in their bedroom during his outbursts. During some of the outbursts the Child would also damage property to the extent that the father describes the home as a “war zone”. This resulted in three mental health related visits to [ ] Hospital where the Child was stabilized.
22The Society Worker testified that the Child refused to live in a Society placement and the father testified that his son said he would rather kill himself than live in a placement. The father was concerned that the Child had engaged in risky activities like sleeping in the bath with the water running and purging three times daily after each meal because of his disaffection with his body image and the family had been unable to convince the Child to seek psychiatric help.
23The Board finds that in this case there was evidence that the Child made substantial threats and attempts to cause serious bodily harm to himself and his family as a result of his mental disorder. There were three hospitalizations for mental health interventions in the summer of 2014 and the evidence of the Child’s escalating behavioural difficulties and his emotional dysregulation in the home clearly demonstrated that he was at serious risk of harming himself or his family.
24The 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.
25The Board finds that a less intrusive method of providing treatment would be appropriate for the Child based on the evidence presented. After he was placed in a structured home away from his parents there were no reports of violent or aggressive incidents or unusual behaviours. He participated in educational and programming activities, he saw a psychiatrist on seven occasions and his presentation appears to have stabilized between October 2014 to and January 2015.
26The father testified that the Child previously refused services from a neighbourhood walk in clinic as well as his paediatrician. His behaviours escalated resulting in his removal from the home in September, 2014. The Child emphatically refused to be placed in a Society home because of his fear of negative outcomes and so he had spent most of the time since September in an open custody facility.
27The Society Worker testified that there were only minor complaints from staff at the Child’s residence since October 2014, as his behaviours had stabilized. There were no reports of purging or any serious behavioural concerns. During his stay in this open setting the Child saw the staff psychiatrist approximately seven times.
28The Youthdale Crisis Intervention Data noted on December 19, 2014 that a copy of the [Mental Health Centre] section 34 assessment was received and the treatment recommendation for the Child was “admission to an inpatient facility- YTC TPU (best option) or [Youth Inpatient Program]”. Neither of these placements are locked secure facilities.
29The Admitting Psychiatrist testified that the [Mental Health Centre] assessment on which she had relied, recommended the Youthdale Transitional Psychiatric Unit (TPU) which provides short-term clinical intervention in an open setting. The unit provides stabilization, assessment, and intensive treatment for children who present urgent emotional and behavioral difficulties, but no imminent risk of harm to themselves or others.
30The Psychiatrist stated that the Youthdale team prioritized and confirmed the Child’s admittance to the secure treatment unit at the facility rather than the TPU because the Child met the criteria for secure admittance due to his aggression and assault on his family. However, Youthdale relied on behaviours that were reported prior to the Child’s admission into the care of the Society, in September 2014. None of the notes in the Crisis Data or the testimony from the Society Worker indicate that the Child had any serious behavioural or aggressive incidents since October of 2014, when he was placed in a structured environment. Between December 19, 2014,when the Child indicated that he was” agreeable to service” and his admission to the Youthdale secure unit on January 7, 2015, there are no notations of escalation or changes in the Child’s stabilized behaviour which would necessitate a locked treatment setting.
31The Board did not hear any testimony regarding the efforts made to explore alternative treatment options for the Child in a non-secure setting as recommended by [Mental Health Centre], nor was the case made that there were no less restrictive methods of providing treatment appropriate for the Child’s mental disorder. The Board finds that appropriate services for the Child in a less intrusive setting were not investigated. Section 124 is under Part VI, Extraordinary Measures, of the Act. There must be extraordinary circumstances before a child is placed on an emergency basis in a secure treatment unit. The right to review the placement before the Board is a significant safeguard, which is in place to protect the child’s right to liberty. The admitting program, Youthdale, has a duty to present sufficient evidence to support a finding on the balance of probabilities that on admission, a child has met the criteria set out in section 124(2) of the Act.
31The Board concludes that a less restrictive method of providing treatment for the Child was appropriate due to the stabilization of his aggressive and violent behaviours and his willingness to engage with services.
32The Board finds that criterion (e) was not met.
CONCLUSION
33Pursuant to section 124(13) of the Act, the Board, having satisfied itself that criterion in subsections 124(2) (e) has not been met, granted the application for release of the Child on January 14, 2015.
CONFIDENTIALITY ORDER
34Pursuant 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, except with an order of the Court or the Board, as appropriate.
ANDREA HIMEL
________________
Andrea Himel
Presiding Member
LORNA KING
________________
Lorna King
Panel Member
ALINA LAZOR
________________
Alina Lazor
Panel Member
Dated at Toronto, Ontario on the 26^th^ day of, January 2015.