S.C. v. Youthdale Treatment Centres, 2011 CFSRB 1

S.C. v. Youthdale Treatment Centres

CHILD AND FAMILY SERVICES REVIEW BOARD

S.C.

v.

Youthdale Treatment Centres

REASONS FOR DECISION ON MERITS

Date: January 12, 2011

Citation: 2011 CFSRB 1

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

INTRODUCTION

1This is an application to the Child and Family Services Review Board (the “Board”) by S.C., (the “Child”) born February […], 1995 for a review of her emergency admission on December […], 2010 to the Secure Treatment Program at the Youthdale Treatment Centre (“Youthdale”), pursuant to section 124(9) of the Child and Family Services Act (the “Act”). The hearing was held on January 4, 2011.

2The Board must decide on a balance of probabilities, whether each of the criteria set out in subsection 124(2) of the Act were met at the time of admission, having regard to the best interests of the Child. The Respondent’s position was that all five criteria were met and that the application should therefore be denied. The Child’s position is that criteria (a), (b), and (e) were not met and consequently, she should be released. Counsel for the Child conceded that criteria (c) and (d) were met, therefore, the Board will not address these criteria in its reasons.

3For the reasons that follow, the Board found that the Child met all of the criteria listed in s.124(2) at the time of her admission, therefore, the Child was not released from Youthdale.

PROCEDURAL MATTERS

4Prior to the commencement of the hearing, the Child’s lawyer advised that she would be objecting to the admission of the Form 14 and the Youthdale Admission Summary into evidence, unless the admitting psychiatrist was available to give evidence and be subject to cross examination.

5Counsel for Youthdale advised that the admitting psychiatrist, Dr. S., was scheduled to work off-site, however arrangements had been made for him to give his evidence via teleconference.

6Both parties agreed to admit the psychiatrist’s testimony and testing of that evidence through cross-examination via tele-conference.

BACKGROUND

7[The Child] is a 15 year old girl who was placed in the temporary care of the [Children’s Aid Society] on October […], 2010 by her parents. She lived in a temporary foster home until she was placed at the [Foster Home] on November […], 2010 where she resided until her admittance to Youthdale.

8Prior to the temporary care agreement, [the Child] lived at home with her parents and older brother. She currently attends [School A], however her attendance and academic achievement has been very poor.

9[The Child] was prescribed Adderall 25mg in 2010 and the medication seemed to be beneficial with respect to her distractibility and concentration difficulties. Cipralex was prescribed in March/April, 2010 for the Child’s depressed moods and Risperidone was added in August, 2010 to control the Child’s misperception. Due to weight gain, the Risperidone was changed to Abilify in September/October, 2010. [The Child] reported hearing auditory hallucinations directing her to harm herself as well as to kill other family members. She was hospitalized in July and again in October, 2010 for attempting suicide by overdosing on medication. She also attended [Hospital A] on an outpatient basis on November […], 2010 after she attempted to strangle herself with a belt.

ANALYSIS

10The Board had to decide if all of the mandated criteria were met at the time of the admission.

11Section 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)

12The relevant criteria are set out in the following legislative provisions:

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.

Criterion (a) the child has a mental disorder.

13The Board was satisfied that at the time of admission the Child had a mental disorder within the meaning of the Act. A mental disorder is defined in the Act as a substantial disorder of emotional processes, thought or cognition which grossly impairs a person’s capacity to make reasoned judgments. The evidence demonstrated that, at the time of admission, the Child did have a substantial emotional processes disorder which grossly impaired her capacity to make reasoned judgments.

14The Child’s mother testified that [the Child’s] behaviour started deteriorating about two years ago. She became violent and aggressive; she destroyed property by overturning furniture, breaking walls, doors and pictures. She also started to cut her arms and neglected her personal care. The mother testified that the child had attempted suicide on several occasions and she frequently threatened family members with acts of violence.

15The Child admitted to hearing voices telling her to “put a belt around her neck” as reported in the [Foster Home] Incident Report dated November […], 2010 which resulted in paramedics taking her to [Hospital A]. Another Incident Report dated December […], 2010 reports that the Child had attempted “to light her right forearm on fire” and that she had reported to staff that she “sucked” nail polish remover (“huffing”) when she was upset.

16Dr. S., the admitting psychiatrist noted on the Form 14, Statement of Reasonable Grounds for Admission to Secure Treatment that he believes that the Child has a mental disorder, that is, a substantial disorder of the emotional process and thought as evidenced by her “history of aggression, self harm and perceptual abnormalities”.

17The Youthdale Admission Summary contains the following Provisional Diagnosis;

Axis 1 History of Attention Deficit Hyperactivity Disorder Conduct Problems Substance Abuse Rule out Developing Psychotic Illness Possible History of Learning Disabilities

Axis11 There may be some developing mixed cluster A or B personality traits

Axis 111 Not contributory There is a history of eczema, but no known allergies

Axis 1V Psychosocial stressors: These appear to be at least moderate and include problems with primary support group, peer relationships, education and recent placement in care.

Axis V Best functioning in the past year: This appears to have been poor.

18Dr. S. testified that the Child has a history of depression and although her mood did respond initially to the medication, her function did not improve. He stated that a psychotic illness or a personality disorder could be developing as the Child was not responding well to her psychotropic medication. He further stated that the Child’s perceptual abnormalities, (hearing voices and seeing people who commanded her to harm herself or others) could also be a sign of a “developing” psychiatric illness such as manic depression or schizophrenia.

19The Board, after considering all of the evidence presented, accepted Dr. S.’s opinion that the Child’s history of aggression, self harm and perceptual abnormalities demonstrate a grossly impaired capacity to make reasoned judgments. In the Board’s opinion, the Child’s behavior indicated a substantial disorder of the emotional process as required by the Act.

20The Board finds that the Child did have a mental disorder, as defined in the Act, at the time of her admission to Youthdale. The Board was 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.

21The Board must decide whether 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. The mother testified that the Child not only threatened harm but she actively participated in activities which could result in serious bodily harm to herself and others.

22The Child’s mother testified that [the Child] threatened to commit suicide many times between January and October, 2010 while she lived at home with her. She was hospitalized at the [Hospital B]’s Children and Youth Mental Health Ward twice, one stay for four days and the other for six days, because she had overdosed on her prescription medication. These suicide attempts resulted in charcoal treatment and stomach pumping and the Child was “formed” on both occasions.

23[The Child] also took the contents of a bottle of Advil and locked herself in the bathroom with a knife in October, 2010 which resulted in another trip to the hospital for outpatient services. When [the Child] returned home, she was still volatile and she hit her father, spat in her mother‘s face and threw a knife at her brother. This incident precipitated the temporary care agreement with the CAS as the family could no longer manage the Child’s behaviours.

24On November […], 2010 [the Child] had an altercation with another peer in the foster home and staff found her burning herself with a lighter, using a digital clock frame to cut herself and later discovered her attempting to strangle herself with her belt. The police and paramedics responded to the home and took the Child to the [Hosptial A] Emergency Psychiatric Treatment Department.

25The Child’s worker testified that [the Child] was not meeting the targets which had been agreed upon during her plan of care. Her self harm behaviours had escalated with incident reports documenting that she was attempting to commit suicide, cutting, huffing (sucking nail polish) and burning herself. She was missing from her group home on the night of December […], 2010 and a missing person report was filed.

26These serious threats to harm herself as well as the threat of harm she posed to others by her actions and poor judgment were as a result of the Child’s mental disorder and in particular her inability to control her moods and actions. The Board finds that the threats were substantial because they involved more than the Child making statements. There were actions and circumstances; serious overdoses, auditory commands and self harm that increased the likelihood of the threat being carried out.

27The Board accepted Dr. S.’s opinion that as a result of the mental disorder, the Child caused, attempted to cause or by words or conduct made a substantial threat to cause serious bodily harm to herself or others. The Board was satisfied that criterion (b) was met at the time of admission.

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

28The Board must decide whether no less restrictive method of providing appropriate treatment was available. The evidence of the mother and the Child’s worker shows that no less intrusive treatment was available for the Child.

29[The Child’s] mother testified that the Child has been seeing a psychiatrist, Dr. D. since March 2010. She took Cipralex for depression, in July, 2010 the doctor added Adderall for her ADHD and in late September/October he replaced Risperadone with Abilify in an attempt to assess and control her misperception. [The Child] was concerned about her weight gain, hence the change in medication. She also saw Dr. C.V. for Cognitive Behavioral Therapy weekly; however, during the last month [the Child] began to miss her appointments. The family had sessions with the doctors as necessary.

30[The Child’s] worker reported that [the Child] resided in a treatment foster home and had an 11pm curfew which she ignored by staying out all night resulting in a missing person report being filed. She confirmed that the Child was missing appointments with her therapist and that her behaviours had created safety issues which could not be handled by the treatment home.

31The Child reported that she spent the night of December […], 2010 at her boyfriend’s home but his parents did not know that she was there until in the morning after which she left and returned to the group home. She testified that she liked living at the foster home and that she had not kept her appointments with her therapist because she did not have anything to say to her. She admitted that her psychiatrist and therapist had helped and that she feels better with medication.

32The Child has had services with various degrees of intrusiveness including a treatment foster placement, involvement with [Centre A], counselling, psychiatric support, hospital interventions and psychotropic medications and despite these measures the Child’s behaviors have escalated. The Board is satisfied that given the Child’s extreme behaviors and lack of engagement with her therapist, a locked setting was required for treatment at the time of admission.

33The Board finds that criterion (e) was met and that no less restrictive method of providing treatment appropriate for the Child’s mental disorder was appropriate in the circumstance.

CONCLUSION

34The Board, having satisfied itself that the criteria in subsections 124(2) (a) (b) & (e) have been met, pursuant to section 124(13) of the Act, denied the application for release of the Child on January 4, 2011.

Mary Wong Presiding Member

Lorna King Panel Member

Alina Lazor Panel Member