M.S. v. Youthdale Treatment Centres, 2014 CFSRB 21

CHILD AND FAMILY SERVICES REVIEW BOARD

M.S.

v.

Youthdale Treatment Centres

REASONS FOR DECISION

Date: May 26, 2014

Citation: 2014 CFSRB 21

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

INTRODUCTION

1M.S. (the “Child”), asked the Child and Family Services Review Board (the “Board”) to review her May 8, 2014, 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 her admission. The Children’s Aid Society (the “Society”), sought the Child’s admission to the secure Youthdale program because of her frequent mental health issues and her suicidal ideation.

2The Board was satisfied at the time of the Child’s admission that she met all of the criteria for emergency admission. Her request for release from Youthdale was therefore denied. The Child conceded criteria (c) and (d) in subsection 124 (2) of the Act, therefore the Board will only provide reasons for criteria (a), (b) and (e).

BACKGROUND

3The Child is fifteen years old and the Society has been involved with her since May, 2013. She became a Society Ward on March 18, 2014. The Child is in grade nine; however, she has not attended school regularly since January of this year. She is reported to be very bright and had a Child and Youth worker assigned to her to help with her social anxiety. When she became unproductive, aggressive and argumentative at her school it was recommended that she be placed in another school. In March 2014 the Child began attending a new school; however, her attendance was still sporadic.

4The Child has resided at [ ], a group home for youth with difficulties since June of 2013. She was placed in a residential treatment program for five days each week in March 2014. The Child attended school in a section 23 classroom with one to one support. She reportedly had conflict with her teacher and a peer which made her anxious and affected her sleep at nights. On Tuesday nights and on weekends she resided at the group home as the residential program did not operate on weekends the Child wanted to return to her group home to maintain her social contacts and use the internet on Tuesday nights.

5The Child allegedly engaged in cutting herself, including carving words into her arm and burning herself with salt and ice. She also refused to participate in her treatment program because she believed that the program was making things much worst and she refused to take her medication. In the past few months the Child has presented with rapid decompensation of mood fluctuation, impulsivity, suicidal threat and general emotional instability.

6The Child swallowed two razor blades taped together and she was hospitalized on April 9, 2014 until April 21, 2014 at [the hospital]. She was also involuntarily hospitalized (‘formed’) at [the second hospital] on May 7, 2014, immediately prior to her admission at Youthdale.

ANALYSIS

7Section 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).

8Section 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;

9The Youthdale Psychiatrist on admittance of the Child made a provisional diagnoses of Anxiety Disorder, Parent-Child Relational Problem, Emotional Dysregulation, Impulsive Self Harm, Suicidal Thoughts and Behaviours and Interpersonal Conflict. The Psychiatrist also wanted to rule out Post Traumatic Stress Disorder.

10The Admitting Psychiatrist testified that the Child was at “high risk” of harming herself because she had not only threatened to kill herself she had acted on the threats by ingesting two razor blades taped together on April 9, 2014. She was admitted to [the hospital] and discharged back to the group home on April 21, 2014 after she had passed the foreign objects. On May 6, 2014 she was absent without leave from her group home and threatened to swallow razor blades again. She returned to the home and was admitted to the [second hospital] on May 7, 2014, on a Form 1 (involuntary admittance).

11The Admitting Psychiatrist believed that the Child was suffering from a mental disorder as defined in the Act because of the Child’s emotional dysregulation, mood instability and impaired judgment despite significant mental health interventions. The Psychiatrist testified that the Child had significant suicide ideation and she needed to be stabilized in a safe environment because she was unable to make reasoned judgments when she became emotionally disregulated. She assessed her as high suicidal risk due to emotional labiality, and again, her rapid decompensation and the increase of her self-destructive threats combined with a history of a completed suicide in the family which places her in the high risk population.

12She noted that the Child had discontinued taking her medication and also that the Child had evolving personality traits but a diagnosis of personality disorder could not be made until the Child was at least eighteen years old.

13The Child‘s mother testified that her daughter had been receiving outpatient psychiatric treatment since she was six years old and had been diagnosed with social anxiety and depression prior to her admission to Youthdale. The Child had threatened to harm herself frequently and had told her mother that she had a plan to do so. The mother stated that there was an escalation in her daughter’s negative behaviours during the last couple of months which included cutting words like “ugly” into her arm, punching walls and swallowing two razor blades. Her temper had become increasingly volatile and her mood became very unstable. She also told her mother that she was hearing voices.

14The Society Worker testified that since February of this year the Child was admitted to [the hospital] for swallowing two razor blades, was absent without leave from her group home on May 6, 2014 after which she threatened to ingest razors again. The Child was admitted the next day [to the second hospital] due to suicide ideation. She had refused to participate in her mental health treatment program, she frequently requested to be taken to the hospital for mental health concerns, she had refused to take her medication, she was involved with peers with similar suicide ideation, and she was very anxious and had refused to eat on occasions. The worker testified that the Child had punched walls, burned herself with ice and salt and talked about her anxiety, acknowledging that she needed help.

15The Act states:

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.

16The Admitting Psychiatrist gave evidence that the Child’s impulsive suicidal behaviours, emotional dysregulation and mood deterioration indicated that her emotional processes, thought or cognition were grossly impaired as was her capacity to make reasoned judgments. She cited the swallowing of the two razor blades as very concerning behaviour and noted that despite repeat psychiatric intervention, the Child‘s mood had not stabilized. She stated that the Child needed a comprehensive assessment of psychiatric and family dynamics.

17From the evidence presented, the Board finds 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 her capacity to make reasoned judgments. The evidence of the Mother was that the Child’s behaviour has been volatile and escalating and that she was unable to control her emotional state. Despite extensive psychiatric interventions the Child continued to escalate her unsafe and impulsive behaviours and attempted to commit suicide by swallowing two razor blades.

18The Board accepted the Admitting Psychiatrist’s evidence that the Child’s impulsive suicidal behaviours, emotional dysregulation and mood deterioration, indicated that her emotional processes, thought or cognition were grossly impaired as was her capacity to make reasoned judgments.

19The Board finds 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 himself, herself or others.

20The Society Worker testified that she sought a placement at Youthdale for the Child because of the escalation in her problematic behaviours since February 2014. The Child swallowed two razor blades that she had taped together and was admitted to [the hospital] from April 9, until April 21, 2014. On May 6, 2014 the child was absent without leave from her group home and she threatened to swallow razors again. She returned home and was formed the next day May 7, 2014 and admitted to Youthdale on May 8, 2014. The Society Worker stated that Child had become very anxious and was refusing to participate in treatment or to take her medication.

21The Admitting Psychiatrist testified that due to her severe anxiety the Child can be oppositional and defiant and she has been verbally aggressive and had punched walls. The Child and Family Worker testified that the Child told her that her hands were hurting from hitting the wall but she refused to go to the doctor.

22The Board finds that there was evidence that the Child made substantial threats and attempts to cause serious bodily harm to herself as a result of her mental disorder. The Child had attempted to commit suicide by swallowing two razor blades in April, 2014 which required hospitalization for 12 days. She was also hospitalized for mental health intervention when she threatened to ingest razors again in May 2014. Evidence of the Child’s past suicide attempt, her escalating behavioural difficulties, impulsivity and emotional dysregulation demonstrated that she was at serious risk of harming herself. The Child’s conduct was putting her at considerable risk of harm.

23The 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.

24The Child’s Mother testified that her daughter had experienced social anxiety since she was two years old. She had been involved with a psychiatrist, a psychologist and had an Art Therapy Counsellor. The Child had been diagnosed with Anxiety Disorder at six years old, subsequently she was diagnosed with a mood disorder, emerging personality disorder and oppositional defiant disorder. She has been prescribed psychotropic medications including fluoxetine, Adderall and Abilify. She had a history of not taking her medication consistently and had stopped taking Abilify on April 25, 2014.

25The Child’s mother stated that her daughter had been residing in a group home since June 23, 2013 and she had attended a regular high school; however, she had to withdraw from the school despite being assigned a Child and Youth Worker. The Child is reported to be very bright academically but her school attendance became sporadic because of her anxiety and behavioural issues. She was suspended in October 2013, and resumed classes in March 2014 in a section 23 classroom with support from a one to one worker. After a week at this school she refused to return to classes.

26The Society Worker testified that a residential mental health program was identified for the Child and she was admitted to the program on March 10, 2014. The Child attended the residential program from Monday to Friday and went to her group home on weekends as well as on Tuesday nights at her request, to keep up with media and social activities.

27The Child refused to attend family counselling and although art and music therapy were available she did not participate in these therapies. She wanted more behavioural therapy and told her worker that she felt like killing herself and that her mental health needs were not being met by the program.

28The Board finds that no less intrusive method of providing treatment would be appropriate for the Child based on the evidence presented. She had been placed in a group home and attended a weekly mental health program with psychiatric supports. She also had a Society Worker, one to one support at school, a psychiatrist and counsellors; however, despite these interventions and services the child’s problematic behaviours continued to escalate. She ran away from the group home, she refused counselling, she did not attend school and she discontinued taking her prescribed medication. The Child has been hospitalized twice for suicidal ideation since February 2014 and she had made a serious attempt to hurt herself by committing suicide. The Board concluded that no less restrictive method of providing treatment for the Child was appropriate due to her escalating impulsive suicidal behaviours and the necessity to contain her to keep her safe.

29The Board finds that criterion (e) was met.

CONCLUSION

30Pursuant to section 124(13) of the Act, the Board, having satisfied itself that criteria in subsections 124(2) (a) (b) and (e) have been met, denied the application for release of the Child on May 15, 2014.

CONFIDENTIALITY ORDER

31Pursuant 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.

NATHALIE FORTIER

_____________________

Nathalie Fortier

Presiding Member

LORNA KING

_____________________

Lorna King

Panel Member

ALINA LAZOR

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Alina Lazor

Panel Member