CHILD AND FAMILY SERVICES REVIEW BOARD
K.D.
v.
Youthdale Treatment Centres
REASONS FOR DECISION ON MERITS
Indexed as: K.D. v. Youthdale Treatment Centres (CFSA s.124)
1On July 10, 2009, the Child and Family Services Review Board (the “Board”) received the application of K.D., d.o.b. November […], 1993 (the “Child”), to be released from the Secure Treatment Program at the Youthdale Treatment Centre (“Youthdale”) pursuant to section 124(9) of the Child and Family Services Act R.S.O. 1990, c. C.11 (the “Act”). The Board heard the application on July 15, 2009.
2The Board must decide, on a balance of probabilities, whether each of the criteria set out in subsections 124(2) of the Act was met at the time of admission. The Respondent’s position is that all five criteria were met and the application should be denied. The Child’s position is that none of the criteria were met and she should be released.
3Pursuant to section 124 (13) of the Act, upon review,
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 clauses 124 (2) (a) to (e).
4The legal test for admission to the Secure Treatment Program is set out in the following legislative provision:
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.
5For the reasons that follow, the Board found that the Child met all of the five criteria for admission and denied the Child’s application. These reasons also address the Board’s decision relating to the validity of Form 14 at the time of the admission.
BACKGROUND
6The Child is a 15 year old youth who was admitted to Youthdale on July […], 2009. She has been living with her mother, K.D1., in Orillia for the past two years. Before that, she lived with her father. The Child left her father’s care because of physical abuse.
7The Child attended grade 9 at [X] Secondary School during the 2007/2008 school year. She was in a basic level program for students who had difficulty in the regular classroom. She obtained 6 credits. She went into grade 10 in September 2008 and started skipping school. In January 2009, the Child and her mother moved, and the Child was transferred to [Institute]. The Child had difficulty at [Institute] because it did not offer programming at the basic academic level. She was, however, offered help in the resource room. The Child testified that she did not like school because everyone “put her down”.
8The Child’s educational needs were not assessed in high school despite her obvious difficulties. There is information before the Board that the Child received some sort of assessment in grade 1 and it is believed that she has Attention Deficit Hyperactivity Disorder (ADHD).
9In February 2009, the Child stopped going to school. She was sexually assaulted around this time. She was involved in significant drug use. The Child admitted to smoking marijuana two to three times per day, four to five days per week. She tried crack cocaine once. The Child was sexually active and was infected with sexually transmitted diseases on two occasions.
10On June […], 2009, the Child was staying at her mother’s friend’s house. An incident occurred where a 29 year old male, P., tried to touch her inappropriately. The Child became very angry. She started screaming and threatened to hang herself. It was 1:30 in the morning and the police were called. The Child was taken to [Hospital] where she was transferred to [Health Centre] in [ ] and admitted on a Form 1 for 72 hours. At the end of the 72 hours, the Child and her mother were told that [Health Centre] could not help because the Child did not want help.
11On July […], 2009, the Child had another incident with P.. She became angry and started throwing CDs out of his car. The Child returned to her mother’s home and became angry again. She left her mother’s house, picked up a garden lantern and threw it into the house. The Child’s mother testified that the spike of the lantern missed her by an inch or two.
12The Child’s mother went to a justice of the peace the next day and completed a Form 2 for an order that the Child be picked up by the police and taken to a physician for an examination. The police apprehended the Child around 1:30 a.m. on July […], 2009. She had been drinking. The Child testified that she had consumed four to six beers. The police took her to [Hospital] and she was transferred to Youthdale later on that day.
13The Child’s mother sought help for her daughter over the last two years. Prior to going to [Hospital] and [Health Centre], she contacted the children’s aid society, a guidance counsellor, her family doctor and a paediatrician. The Child’s mother testified that there are no child psychiatrists in Orillia.
14The Child has not received a comprehensive assessment. There was no assessment conducted by [Hospital] or [Health Centre], presumably because of the short time the Child was admitted. The Child wants to be released from Youthdale because she believes she has the ability to deal with her problems on her own. She does not deny that she has problems.
REASONS FOR DECISION REGARDING MOTIONS FOR RELEASE
15Counsel for the Child argued that the admission to Youthdale was invalid because the Form 14, the form under which the Child was admitted, was signed by Dr. C., the admitting psychiatrist, and not by Dr. S., the person in charge of the program. Counsel submitted that Form 14 states clearly that it must be signed by the person in charge of the program. He argued that the failure of Dr. S. to sign the Form 14 invalidates the admission and the Child should be released on this basis.
16Counsel for Youthdale argued that the authority to sign the Form 14 is delegated from Dr. S. to the attending psychiatrist. He argued that it was standard practice at Youthdale for the admitting psychiatrist to sign the form.
17The Board is satisfied that the authority to admit a young person is delegated from the person in charge of the program, Dr. S., to the attending psychiatrist. It would not be possible for Dr. S. to sign the Form 14 for every young person that is admitted to Youthdale. Dr. C., who reports to Dr. S., had the delegated authority to admit the Child in the secure unit.
18The Board notes that Form 14 appears to be an internal document created by Youthdale. The Board recommends that Youthdale amend this form to make it clear that the authority to admit can be delegated from the person in charge of the program to the admitting psychiatrist. While this authority is implicit, it would be helpful for Youthdale to state it on the form itself.
REASONS FOR DECISION ON THE MERITS
ANALYSIS
Criterion (a): the child has a mental disorder
19The Board is satisfied that the Child has a mental disorder within the meaning of the Act. A mental disorder is defined as “a substantial disorder of emotional processes, thought or cognition, which grossly impairs a person’s capacity to make reasoned judgments”. The evidence demonstrates that, at the time of admission, the Child had a substantial disorder of emotional processes which grossly impaired her capacity to make reasoned judgments.
20Dr. C., the admitting psychiatrist at Youthdale, gave a provisional diagnosis of Substance Use Disorder, possible ADHD, severe psychosocial stressors, poor global functioning and a history of sexually transmitted infection. Dr. C. noted that Post Traumatic Stress Disorder, Mood Disorders, Fetal Alcohol Spectrum and Learning Disability should be ruled out. This diagnosis is set out in the Admissions Summary.
21The Child’s mother provided evidence that since February 2009, the Child’s behaviour steadily worsened. She abused marijuana, engaged in sexual activity with one man in his twenties, had medication for Chlamydia twice and was drinking the night before she was brought to Youthdale. The Child’s mother testified that morphine was found in the Child’s system in a drug test conducted before her admission to Youthdale. The Child’s mother testified further that her daughter does not know how to deal with her anger and frustration. The Child told her that she feels like there are two people – the good and the bad. When frustrated, the Child makes comments that she wants to hurt herself.
22The Child threatened to hang herself and attempted to hurt her mother by throwing the lantern. The Child’s mother is concerned that the Child is going to hurt herself or someone else. The Child’s mother stated that the Child does not like anyone to tell her how to run her life. The Child told her mother that she cannot wait until she is sixteen so she can live her life the way she wants.
23Counsel for the Child argued that the Board must differentiate between “bad choices” and grossly impaired judgment as required under the Act. Counsel submitted that the Child’s actions reflect bad choices as opposed to bad judgment.
24The Board is satisfied on the basis of the evidence, including the Admission Summary of Dr. C. and the testimony of the Child and the mother, that the Child has a mental disorder as defined under the Act. While any one of the Child’s actions may indeed reflect a “bad choice”, the cumulative effect of these choices is evidence of grossly impaired judgment. The Child was decompensating during the two weeks before her admission to Youthdale. She was not going to school, her daily functioning was below what was expected of an adolescent, she was abusing drugs, drinking and struggling to put limits around her relationship with a 29 year old male. She threatened to harm herself and tried to harm her mother. These events, when seen together, show grossly impaired judgment that if untreated, could result in serious harm to the Child and others.
25The Board is satisfied that criterion (a) was met at the time of the 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, herself or another person
26The Board is satisfied that the Child, as a result of her mental disorder, made a substantial threat to cause serious bodily harm to herself.
27The Child admitted that in late June 2009, she threatened to hang herself. The police were called and the Child was taken to the hospital. While the Child denied that she would carry out the threat, it was clear the threat was taken seriously. The threat resulted in the Child’s hospitalization at [Hospital] and her transfer to [Health Centre] for 72 hours.
28Although no definitive diagnosis is available to the Board, the evidence shows that the Child has unstable mood control. Her poor impulse control increases her anxiety and affects her judgment. The Child’s substance abuse, in conjunction with her unstable mood, is putting her at risk for serious bodily harm.
29Based on this evidence, the Board was satisfied that criterion (b) was met at the time of the 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
30The Board is satisfied that the secure treatment program will be effective to prevent the Child from causing or attempting to cause serious bodily harm to herself.
31The Crisis Worker testified that Youthdale has a secure and very strict locked unit. There is a high level of supervision. Nurses, doctors and staff are available to monitor moods and behaviour. The high level of security and supervision ensure the safety of the Child and prevent her from engaging in self-harm. Youthdale physically separates the Child from the negative influences in her life, in this case, street drugs and unsafe sexual activity, preventing serious bodily harm or attempts at serious bodily harm.
32The Board is satisfied that criterion (c) was met at the time of the admission.
Criterion (d): treatment appropriate for the Child’s mental disorder is available at the place of secure treatment to which the application relates
33The Board is satisfied that treatment appropriate for the Child’s mental disorder is available at Youthdale.
34The Staff Psychiatrist testified that Youthdale offers a safe environment in which to observe and assess the child in order to determine future treatment. She stated that because the Child will soon turn sixteen, this is her last opportunity to get treatment as a child. The Staff Psychiatrist stated that because the Child does not live in Toronto, she can only access acute treatment.
35The Crisis Worker testified that in-depth assessments will be conducted on the Child including sleep studies, ADHD scales, mood swing scales, and neurological and psychological testing. The Child will be drug free and therefore, a more accurate assessment can be obtained. Most importantly, the Child cannot leave the facility thereby allowing a full assessment to occur.
36During the period of admission, Youthdale can provide many services to the Child such as regular sessions with her psychiatrist, peer therapy, individual programming and one-on-one assistance from front line staff.
37The treatment that this Child requires is stabilization and assessment in order to determine her future treatment needs. This is available at Youthdale. The Board is satisfied that criterion (d) was satisfied at the time of the admission.
Criterion (e): no less restrictive method of providing treatment appropriate for the child’s mental disorder is appropriate in the circumstances
38The Board is satisfied that no less restrictive method of providing treatment appropriate for the child’s mental disorder is appropriate in the circumstances.
39The Child has been in her mother’s care for the past two years. During this time, her mother tried to get help for the Child in the community. She took the Child to her family doctor. The family doctor referred the Child to a paediatrician. The Child waited one full year for this appointment. The Child’s mother obtained the assistance of the school guidance counsellor. The Child has a very positive relationship with this person. This relationship will continue in the fall. The Child’s mother sought the involvement of the children’s aid society. The children’s aid society offered foster care, summer camp and a daily program where someone would spend up to eight hours a day with the Child. The Child rejected all of these options. The Child’s mother sought to admit the child to the hospital on two occasions, hoping that the Child would be assessed. The assessment did not occur. Despite all of these steps, the Child continued to decompensate, engaging in progressively more dangerous behaviour.
40This Child has been terribly let down by the systems that are in place to help her. It is shocking that despite her obvious educational needs, she has not been assessed since grade 1. The Child went twice to her community hospital for an assessment and was discharged because she did not want help. It is not surprising that the Child does not want help at this point given the social factors that are and have been in play in her life for quite some time. It is unfortunate that the only recourse available to her in order to get the assessment that is so desperately required is to admit her into a secure treatment program. It is clear to the Board that this assessment will not be conducted in the community. The Board is satisfied that criterion (e) was met at the time of the admission.
CONCLUSION
41Pursuant to section 124 (13) of the Act, the Board, having satisfied itself that the criteria in subsections 124 (2) (a) through (e) were met at the time of the admission, denied the release of the Child, K.D., on July 15, 2009.
Ruth Ann Schedlich
Presiding Member
Alina Lazor
Panel Member
Jennifer Scott
Panel Member
Dated at Toronto, Ontario this 22nd day of July, 2009.