H.C. v. Youthdale Treatment Centres, 2014 CFSRB 12

CHILD AND FAMILY SERVICES REVIEW BOARD

H.C.

v.

Youthdale Treatment Centres

REASONS FOR DECISION

Date: March 13, 2014

Citation: 2014 CFSRB 12

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

INTRODUCTION

1H.C. (the “Child”), asked the Child and Family Services Review Board (the “Board”) to review her February 24, 2014, emergency admission to the Secure Treatment Program at Youthdale Treatment Centre (“Youthdale”). The Child took the position that the statutory criteria (a) through (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 Children’s Aid Society (the “Society”) sought the Child’s admission to the secure the Youthdale program because of her constant running away from her placements, hospitalizations for mental health issues and high risk behaviours in the community.

2The Board was not satisfied that, at the time of the Child’s admission, criterion (a) was met as set out in s. 124(2) and therefore granted the application for her release on February 28, 2014. The Board’s reasons address criterion (a) that the Child had a mental disorder but do 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 emergency admission.

PRELIMINARY ISSUES

3Counsel for the Child objected to a medical report dated April 17, 2013 being entered into evidence as the author was unavailable and the information could not be tested through cross examination as established by the Board’s case law. Counsel for Youthdale argued that past diagnoses were relied upon by the Youthdale admitting psychiatrists and the Board should admit this evidence. The Board reserved its decision on the admission of the report which is noted as an Addendum on the Admission Summary, pending its introduction by the Child’s admitting psychiatrist. The psychiatrist testified that the report was received by Youthdale after the Child’s emergency admission therefore the Board ruled that it could not be admitted into evidence.

BACKGROUND

4The Child is thirteen years old. She resided in a kin placement with her aunt and uncle for 11 years after which she has lived in two foster homes and two group homes. The Society has been involved with the Child since she was one month old and her worker reported that the Child has increasingly ran away from her placements since moving to her second foster home. She has missed more than half of the current school year because she has been out in the community, away from her home.

5The Child was placed at a mental health residence for high risk youth but she did not like it and refused to engage with the therapy. The Child reported to her worker that she slept at her friends’ homes when she ran away from her placements.

6The Child allegedly engaged in cutting, self-piercing and promiscuous behaviour in the community. She also allegedly admitted to her worker that she used marijuana, ecstasy, cocaine, heroin, Paxil, Seroquel, Loranzapam and mushrooms.

7The Child has long standing sleep issues and has difficulties falling asleep and staying asleep. She was involuntarily hospitalized (formed) on February 11, 2014 at [a hospital] having run away from her group home for twelve days and having allegedly ingested 10 or 12 unknown pills.

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 the child’s mental disorder is appropriate in the circumstances.

Criterion (a): the child has a mental disorder;

10The Youthdale admitting psychiatrist testified that she consulted with and supervised the Resident Psychiatrist with regards to the admission of the Child. The Admission Summary diagnosis listed the following mental disorders to be assessed:

PTSD, Oppositional Defiant Disorder, Conduct Disorder, Bipolar II Disorder, Adjustment Disorder, Eating Disorder.

11The admitting psychiatrist described the Child’s behaviours as high risk and she testified that Youthdale has not received a report from [the hospital] with regards to the Child’s recent hospitalization or from her previous group home. She cited the Child’s extensive pattern of running away, her alleged suicide attempt, her cutting, inappropriate sexual behaviours and substance abuse and made a provisional diagnosis for which she said that there was more questions than answers because the report had been completed by the Resident under her supervision. She stated that the Child’s mental health issues were unclear at the time of her admission and they needed to be “teased out”. She also testified that she believes the Child’s inappropriate sexual behaviours in the community showed poor judgment or a lack of self-care.

12The Board also heard testimony from the Child’s worker that the Child’s first foster placement, after her kin placement broke down, was successful and she did not run away during the year she spent in that home. She started running away during the next foster placement which resulted in the breakdown of that placement. Two group home placements also broke down which resulted in missing person reports and six media releases in six months.

13The worker noted that the Child ran away on September 24, 2013 for a month and, on her return, she was placed in a new group home which she ran away from after one week. She was missing for two weeks from the placement. This pattern continued with the most recent absence occurring on January 31, 2014 for two weeks. The Child was picked up on February 11, 2014 and allegedly reported that she took 10 to 12 unknown pills. She was admitted to [the hospital] involuntarily (on a form1) and she was released the next day to her Society worker. The hospital did not keep her in the adolescent psychiatric unit but released her with the recommendation that she see a counselor. The worker testified that the Child has a counselor but because of her frequent running away, she has not been keeping her appointments and she has seen the counselor only three to five times during the last six months.

14The worker also testified that the Child had struggled with a depressed/hopeless mood in January 2014 and was prescribed Prozac by the group home pediatrician. The Child had refused to see a male psychiatrist while she was at the group home and the worker had difficulties finding a female doctor for her. The Child ran away two weeks later and discontinued taking the Prozac.

15The worker also stated that the Child had cut herself many times as well as performed body piercings on herself. No medical treatment had been necessary for the cuttings or the piercings. She believed that the Child’s lifestyle involved drugs, needles and unprotected sex with older men in the community during the periods when she ran away. The worker saw sexual pictures of the Child on Facebook although she never saw the Child taking drugs or under the influence of drugs. She testified that the Child had told her about the inappropriate behaviours which she found concerning.

16The Board is not satisfied that at the time of her 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.

17The Board heard evidence from the admitting psychiatrist who testified that the Child’s mental health issues were unclear at the time of her admission. The Child had been involuntarily admitted to [the hospital] two weeks prior to the emergency admission, she was released the following day and at that time the treating physician recommended counselling but did not recommend a locked setting.

18After the Child’s release from [the hospital] on February 12, 2014, she was placed in a group home with a one on one worker and her behaviour was stable. She was admitted to Youthdale on February 24, 2014, although there had been no further escalation in her behaviour or serious incident after her discharge from L.H. which necessitated an emergency admission to a secure treatment placement.

19The worker and the admitting psychiatrist testified that the hospitalization was as a result of an alleged suicide attempt which the Child later denied. No medical procedure or intervention resulted from the involuntary admission of the Child to [the hospital]. The Child allegedly took tablets without knowing what she took and the worker reported that she was informed about a suicide note in the Child’s backpack. The Board received no clear description of the content of the note or the Child’s intent. The psychiatrist further testified that the Child was not actively experiencing suicidal ideation at the time of her admission.

20Sufficient evidence was not presented to the Board to substantiate a substantial disorder of emotional processes, thought or cognition, which grossly impaired the Child’s capacity to make reasoned judgments. The Admitting Psychiatrist did not give any firm diagnoses of the Child’s mental disorder in the admission summary and only provided a list of mental disorders to be assessed. She stated that there was a strong suspicion of a mental disorder but that there are more questions than answers. This is not sufficient to meet the test of a substantial disorder of emotional processes, thought or cognition as required by the Act.

21The Child was frequently in the community and she allegedly admitted to her worker that she engaged in risky sexual behaviours for which she did seek medical attention and was prescribed medication. She discontinued the medication after the first week because of the side effects. She had been prescribed anti-depressant in the past which she also discontinued because she was absent from her placement. The Child did not require medical care for her cuttings or piercings which would suggest that they were superficial and not of a serious nature.

22The Board finds that the behavioural evidence did not establish the existence of a mental disorder which grossly impaired the Child’s capacity to make reasoned judgments. She frequently ran away from her placements and stayed with her friends because she disliked her foster/group homes and though the Child allegedly engaged in risky behaviours and drug abuse which would clearly reflect poor judgment; the Board found no evidence of gross impairment of her capacity to make reasoned judgments.

23The Board finds that criterion (a) was not met.

CONCLUSION

24Pursuant to section 124(13) of the Act, the Board satisfied itself that all five criteria in subsection 124(2) were not met, and the Board ordered the release of the Child.

CONFIDENTIALITY ORDER

25Pursuant 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.